Jeffrey Panko NP Psychiatry · Patient education
Selegiline
Emsam antidepressant patch / Separate oral Parkinson formulations
A guide for adults taking selegiline.
Follow the directions on your prescription and your provider's recommendations.
Formulations: Emsam patches deliver 6, 9, or 12 mg over 24 hours. Oral tablets, capsules, or dissolving formulations have separate instructions.
What it is used for
The Emsam patch treats major depression in adults. Oral selegiline formulations are used for Parkinson disease under different labeling; their dose and food rules must not be substituted for patch instructions.
How it works
It inhibits monoamine oxidase, affecting breakdown of serotonin, norepinephrine, and dopamine. The route and dose determine how much gut tyramine metabolism is affected.
What to expect over time
Sleep, energy, or appetite may change before mood improves. Benefit usually builds over several weeks; some conditions need a longer trial at a useful dose.
Track the symptoms you are treating and how you manage daily activities. Keep follow-up appointments. Schedule an earlier appointment if your mood gets worse.
Taking your medication
- Apply one patch daily to clean, dry, intact skin at an approved site. Remove the old patch first, rotate sites, and do not cut patches.
- Avoid heating pads, hot tubs, or other direct heat over the patch.
- If a patch is missed or falls off, follow the leaflet; never apply extra patches to make up a dose.
- Follow the food rules for your strength and have every new medication checked.
When to get help
Emergency symptoms. Get emergency care for a sudden severe headache, chest pain, a pounding heartbeat, neck stiffness, vomiting, or visual changes. These can signal a dangerous blood-pressure reaction. Fever with agitation and muscle rigidity may be serotonin syndrome.
Prompt medical advice. Contact your provider for marked dizziness, faintness, worsening depression, or unusually high energy with little need for sleep. Do not treat a suspected blood-pressure crisis with extra medication on your own.
If you feel unsafe or have thoughts of self-harm, call 911 or go to an emergency department.
Possible side effects
- Skin irritation at the application site
- Insomnia, headache, or dry mouth
- Dizziness or low blood pressure when standing
Keeping track of treatment
Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.
Antidepressants can increase suicidal thoughts in people under 25. Watch for changes in mood or behavior at any age, especially when starting treatment or changing a dose.
Have blood pressure checked. Review dizziness, sleep, and medication or food exposures. Keep the written interaction and diet instructions available.
If you take too much
For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.
Before you start
Discuss heart or blood-vessel disease, uncontrolled high blood pressure, liver disease, seizures, bipolar symptoms, and planned surgery.
Discuss pregnancy, pregnancy plans, and breastfeeding with your provider. Treatment decisions should consider both the medication and the condition being treated.
Medicines and interactions
Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.
Many antidepressants, stimulants, decongestants, tramadol, meperidine, dextromethorphan, and other medicines must not be combined. A pharmacist should check every prescription, OTC medicine, and supplement.
Switching intervals depend on the other medicine. Many require at least 14 days; fluoxetine generally requires at least five weeks before an MAOI. Never manage a switch yourself.
Everyday tips
Keep written diet and drug-interaction instructions with your medication list.
Fold used patches adhesive sides together and keep them away from children and pets.
Tell emergency, dental, and anesthesia teams that you take an MAOI.
Your questions answered
Which patch strengths require food restrictions?
The 9- and 12-mg patches require a low-tyramine diet. Continue it for two weeks after stopping those strengths or reducing to 6 mg. Starting and remaining at 6 mg does not ordinarily require that diet under U.S. labeling.
Do medication restrictions still apply at 6 mg?
Yes. The lower patch strength does not remove dangerous drug interactions or required switching intervals.
Storage and safety
Keep medication in its labeled container, away from excess heat and moisture and out of reach of children and pets. Do not share it. Ask a pharmacy about disposal of unused medication.
Sources
About this information
Educational handout; does not replace your prescription or provider's recommendations.
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.