Adult Dosing
Adjunctive treatment of patients with Parkinson's disease receiving levodopa/carbidopa
TABS or CAPS
- 5 mg PO bid at breakfast and lunch
- After 2-3 days of selegiline treatment, may decrease the dose of levodopa/carbidopa
- Max: 10 mg/day
ODT
- 1.25 mg PO qam X 6 wks before breakfast and without liquid
- If a desired effect is not achieved after 6 wks, increase the dose to 2.5 mg qam before breakfast and without liquid if the patient tolerates
- Max: 2.5 mg/day
Note: Avoid ingesting food or liquids for 5 minutes before and after taking the drug
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established for selegiline (TABS AND CAPS)
- Safety and effectiveness have not been established in pediatric patients <16 yrs for selegiline (ODT)
[Outline]
See Supplemental Patient Information
- Do not exceed recommended daily dosage of 10 mg/day (2.5 mg/day for ODT) because of the risks associated with non-selective inhibition of MAO (potentially serious food or drug interactions may occur at higher doses)
- Rare cases of hypertensive reactions have occurred in patients, consuming tyramine-containing foods, taking the recommended daily dose of selegiline
- Concomitant administration of non-selective MAOIs and TCA may cause severe CNS toxicity associated with hyperpyrexia and death
- Serious, life-threatening reactions with signs and symptoms including hyperthermia, rigidity, myoclonus, autonomic instability with rapid fluctuations of the vital signs, and mental status changes such as extreme agitation progressing to delirium and coma have been reported in patients receiving a combination of SSRI and non-selective MAOIs
- There should be at least 14 days gap between discontinuation of selegiline and initiation of treatment with TCA/SSRI
- Because of the long half-lives of fluoxetine and its active metabolite, at least 5 wks should elapse between discontinuation of fluoxetine and initiation of treatment with selegiline
- Patients taking selegiline (ODT) may be at an increased risk of developing orthostatic hypotension, especially at the time of dose increase. The incidence of adverse orthostatic hypotension and dizziness was higher in geriatric patients
- Patients with Parkinson’s disease are more prone to develop melanoma. Patients and providers are advised to monitor for melonama frequently at periodic intervals during therapy
- May potentiate the dopaminergic side effects of levodopa due to increased amounts of dopamine reaction with super sensitive, post-synaptic receptors and may exacerbate preexisting dyskinesia. Reducing the dose of levodopa may ameliorate this side effect
- Patients may experience intense urges to gamble, increased sexual urges, and other intense urges, and the inability to control these urges while taking selegiline
- Selegiline (ODT) contains phenyalanine; caution should be exercised in phenylketonuric patients
- Increased frequency of mild oropharyngeal abnormality (e.g., mouth pain, swallowing pain, multiple foci of reddening, and/or ulceration) was associated in patients treated with selegiline (ODT) compared to patients who received placebo
- Increase in BUN and creatinine have been reported in patients treated with selegiline (ODT)
- Rapid dose reduction, withdrawal of, or changes in antiparkinsonian therapy may be associated with a symptom complex resembling the neuroleptic malignant syndrome (NMS) manifested by elevated temperature, muscular rigidity, altered consciousness, and autonomic instability
- Hallucinations have been reported during therapy with selegiline (ODT). Patients are advised to promptly report to their healthcare provider if they experience any signs of hallucinations
Caution: Use cautiously in
Supplemental Patient Information
- Advise patients not to exceed the daily recommended dosage
- Inform patients to promptly report their physicians if they experience new or increased gambling urges, increased sexual urges or other intense urges
- Advise patients to immediately report any severe headache or any unusual or atypical symptoms that were previously not experienced
Pregnancy Category:C
Breastfeeding: Less information is available on the use of selegiline during breastfeeding; an alternate drug may be preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 8 April 2011). As per manufacturer's data, because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, analyzing the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- Zelapar 1.25 MG TBDP [Box] (VALEANT)
10 mg = $99.99
30 mg = $295.98 - Selegiline HCl 5 MG TABS [Bottle] (MYLAN)
30 mg = $60.99
90 mg = $165.98 - Eldepryl 5 MG CAPS [Bottle] (SOMERSET PHARM)
60 mg = $158
180 mg = $452.98
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
