Formulary
Selegiline hydrochloride: Indications, Dosing, Side Effects and Interactions
Selegiline is a monoamine-oxidase B inhibitor.
MedNext Academy | 3 min read
Selegiline hydrochloride: Indications, Dosing, Side Effects and Interactions
Selegiline is a monoamine-oxidase B inhibitor.
Drug action
Selegiline is a monoamine-oxidase B inhibitor.
Indications and dose
**Parkinson's disease, used alone or as adjunct to co-beneldopa or co-careldopa to reduce 'end of dose' deterioration,Symptomatic parkinsonism**
- **Adult** (By Mouth Using Immediate-Release Medicines): Initially 5 mg once daily for 2-4 weeks, then increased if tolerated to 10 mg daily, dose to be taken in the morning.
- **Adult** (By Mouth Using Oral Lyophilisate): 1.25 mg once daily, dose to be taken before breakfast.
Cautions
Angina; arrhythmias; duodenal ulceration; gastric ulceration; history of hepatic dysfunction; patients predisposed to confusion and psychosis; psychosis; uncontrolled hypertension
Contraindications
Active duodenal ulceration; active gastric ulceration; avoid or use with great caution in postural hypotension (when used in combination with levodopa)
Side effects
Common or very common Arrhythmias; arthralgia; back pain; confusion; constipation; depression; diarrhoea; dizziness; dry mouth; fall; fatigue; hallucination; headache; hyperhidrosis; hypertension; hypotension; movement disorders; muscle cramps; nasal congestion; nausea; oral disorders; sleep disorders; throat pain; tremor; vertigo Uncommon Alopecia; angina pectoris; anxiety; appetite decreased; chest pain; dyspnoea; leucopenia; mood altered; myopathy; palpitations; peripheral oedema; pharyngitis; psychosis; skin eruption; thrombocytopenia; urinary disorders; vision blurred Frequency not known Hypersexuality Side-effects, further information Side-effects of levodopa may be increased-concurrent levodopa dosage can be reduced by 10-30% in steps of 10% every 3-4 days.
Interactions
**Severe interactions:**
- Eldepryl should be used cautiously when co-administered with buprenorphine/opioids as the risk of serotonin syndrome, a potentially life-threatening condition, is increased (see section 4.4).
- Serious reactions with signs and symptoms that may include diaphoresis, flushing, ataxia, hyperthermia, hyper/hypotension, seizures, palpitation, dizziness and mental changes that include agitation,...
- Tricyclic antidepressants Severe CNS toxicity (serotonin syndrome) has been reported in patients with the combination of tricyclic antidepressants and selegiline.
**Other interactions (13):**
- Tramadol and buprenorphine are also potential interacting medicaments.
- Selegiline should not be administered with any type of antidepressant.
- The combined use of the SSRI, fluoxetine and Eldepryl, should only be used under clinical supervision.
- Similar experience has been reported in patients receiving selegiline and two other serotonin reuptake inhibitors, sertraline and paroxetine.
- There is a potential risk of interaction with fluvoxamine and venlafaxine.
- Death has been reported to occur following the initiation of therapy with non-selective MAO inhibitors shortly after discontinuation of fluoxetine.
Pregnancy
Avoid-no information available.
Breast feeding
Avoid-no information available.
Hepatic impairment
Manufacturer advises caution in severe impairment.
Renal impairment
Use with caution in severe impairment. M
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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