Drug reference

Selegiline

MAO Inhibitor · Antiparkinsonian

Also known as selegiline hydrochloride

MAO InhibitorAntiparkinsonian

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

—

not curated

Top interactionssee all 12 →

SympathomimeticsContraindicatedTextbookG&G 14e
Tyramine Containing FoodsContraindicatedTextbookG&G 14e
TramadolContraindicatedDatabaseDDInter
5ht Reuptake Inhibiting AntidepressantsSevereTextbookG&G 14e

Mechanism

As a monoamine-oxidase-B inhibitor, selegiline selectively inhibits the enzyme monoamine oxidase B, which is responsible for the breakdown of dopamine in the brain. This action leads to increased dopamine levels in the brain, thereby improving motor symptoms in Parkinson's disease.

Indications

Early Parkinson's disease (when motor symptoms do not affect quality of life)Adjunct to levodopa for dyskinesia or motor fluctuations in Parkinson's diseaseParkinson's diseasedepressionSymptomatic treatment of early or mild PDAdjunctive therapy in patients with deteriorating response to levodopaParkinson's disease (mild antiparkinsonian action in early cases, adjuvant to levodopa to prolong action and attenuate motor fluctuations)

Dosing

Adult: weight of the child to enable the dose prescribed to be checked. Consideration should also be given to including the dose per unit mass e.g. mg/kg or the dose per m2 bodysurface area e.g. mg /m2 where this would reduce error. The following should be noted: . The strength or quantity to be contained in capsules, lozenges, tablets etc. should be stated by the prescriber.…

Pharmacokinetics

Bioavailability

Negligible

Protein binding

94%

Metabolism

Metabolised

Excretion

Negligible

Contraindications

convulsive disorders

Side effects

Common

anxietyinsomniaaccentuate adverse motor and cognitive effects of levodopa therapypostural hypotensionnauseaconfusionagitation

Serious

Acute akinesia (upon abrupt withdrawal)
Neuroleptic malignant syndrome (upon abrupt withdrawal)
hypertensive crisis (reduced risk with transdermal patch, or at low doses where MAOA is spared)
serotonin syndrome (with 5HT reuptake inhibitors, tryptophan, substituted amphetamines)
hypertensive interactions (with higher doses or indirectly acting sympathomimetic amines)
accentuation of levodopa induced involuntary movements
psychosis

Drug interactions

Sympathomimetics

Contraindicated

Textbook

Potentially life-threatening elevation of blood pressure (hypertensive crisis).

Avoid concurrent use of MAOIs and medications containing sympathomimetic compounds.

Source: G&G 14e

Tyramine Containing Foods

Contraindicated

Textbook

Marked increases in blood pressure (hypertensive crisis).

Patients on MAOIs must avoid foods containing high levels of tyramine, such as soy products, dried meats and sausages, dried fruits, home-brewed and tap beers, red wine, pickled or fermented foods, and aged cheeses.

Source: G&G 14e

Tramadol

Contraindicated

Database

Serious drug interaction.

Avoid coadministration.

Source: DDInter

5ht Reuptake Inhibiting Antidepressants

Severe

Textbook

Serotonin syndrome, characterized by hyperthermia, muscle rigidity, myoclonus, tremors, autonomic instability, confusion, irritability, and agitation, which can progress to coma and death.

SSRIs should not be started until at least 14 days following discontinuation of treatment with an irreversible MAOI. For all SSRIs except fluoxetine, at least 14 days should pass prior to beginning treatment with an MAOI following the end of SSRI treatment. For fluoxetine, at least 5 weeks should pass. For venlafaxine, a 7-day interval is considered safe between ending MAOI therapy and starting venlafaxine. For duloxetine, a 5-day waiting period is needed before beginning MAOI treatment after ending duloxetine.

Source: G&G 14e

Albuterol

Severe

Textbook

Increased risk of adverse cardiovascular effects.

At least 2 weeks should elapse between the use of MAO inhibitors and administration of β2 agonists or other sympathomimetics.

Source: G&G 14e · p264

Altretamine

Severe

Textbook

Severe, life-threatening orthostatic hypotension.

Not specified, but implies avoidance due to severe, life-threatening effect.