Selegiline (Oral)

Selegiline is used together with levodopa or a combination of levodopa and carbidopa to treat Parkinson's disease (also known as "shaking palsy" or "paralysis agitans"). This medicine helps increase and prolong the effects of levodopa and may help slow down the progression of Parkinson's disease.

You can get this medicine only with your doctor's prescription.

It is very important for your doctor to monitor your progress during regular visits so that your dose can be adjusted if needed. Blood tests may be required to check for any side effects.

Do not take selegiline if you have used narcotic pain medications (including meperidine, methadone, tramadol, Demerol®, Dolophine®, Ultram®) or an MAO inhibitor (MAOI) (e.g., isocarboxazid, linezolid, phenelzine, tranylcypromine, Marplan®, Nardil®, Parnate®, Zyvox®) in the last 14 days. Doing so may lead to agitation, confusion, restlessness, stomach or intestinal issues, sudden high body temperature, extremely high blood pressure, or severe seizures.

Do not take cyclobenzaprine, dextromethorphan (Robitussin®, Pediacare®), propoxyphene (Darvon®), or St. John's wort while using this medicine. Combining these medications can cause unwanted effects.

Selegiline may cause a condition called serotonin syndrome if taken with certain MAO inhibitors (e.g., phenelzine, rasagiline, tranylcypromine) and medications for depression (e.g., amitriptyline, doxepin, fluoxetine, fluvoxamine, nortriptyline, paroxetine, sertraline, Elavil®, Luvox®, Pamelor®, Paxil®, Prozac®, or Zoloft®). Contact your doctor immediately if you experience anxiety, restlessness, fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or hallucinations.

When selegiline is taken at doses of 10 mg or less per day for Parkinson's disease, there are no restrictions on what you can eat or drink. However, taking higher doses for other conditions may lead to dangerous reactions, including sudden high blood pressure, when combined with certain foods, drinks, or medications. These include:

• Foods high in tyramine (often found in aged or fermented foods), such as cheeses, fava or broad bean pods, yeast or meat extracts, smoked or pickled meats, poultry, or fish, fermented sausage (bologna, pepperoni, salami, summer sausage), sauerkraut, or overripe fruit. If you do not receive a list of these foods and drinks, ask your doctor for one.
• Alcoholic beverages or alcohol-free or reduced-alcohol beer and wine.
• Large amounts of caffeine from coffee, tea, cola, or chocolate.
• Any other medicine unless approved or prescribed by your doctor, especially nonprescription (over-the-counter [OTC]) medicines, such as those for colds (including nose drops or sprays), cough, asthma, hay fever, appetite control, “keep awake” products, or sleep aids.

Additionally, for at least 2 weeks after stopping this medicine, these foods, drinks, and other medications may still interact with selegiline if it was taken at doses higher than those typically used for Parkinson's disease.

Contact your doctor or go to the emergency room immediately if you experience severe headache, stiff neck, chest pain, fast heartbeat, or nausea and vomiting while taking this medicine. These could be signs of a serious side effect that needs medical attention.

This medicine may cause drowsiness. It can even lead you to suddenly fall asleep while driving, talking, or eating. Avoid driving or doing anything potentially dangerous until you know how this medicine affects you.

Dizziness, lightheadedness, or fainting can occur, especially when standing up from a lying or sitting position. Getting up slowly may help. If the issue continues or worsens, consult your doctor.

Contact your doctor right away if you have pain when swallowing, mouth pain, redness, swelling, or sores in your mouth while taking this medicine.

Selegiline may cause dry mouth. For temporary relief, you can use sugar-free candy or gum, suck on ice chips, or use a saliva substitute. However, if dry mouth persists for more than 2 weeks, consult your doctor or dentist. Ongoing dry mouth may increase the risk of dental issues, including tooth decay, gum disease, and fungal infections.

Some people using this medicine have experienced unusual behavioral changes. Talk to your doctor if you start having unusual urges, such as a desire to gamble, binge eat, shop compulsively, or have increased sexual urges.

Do not stop taking this medicine without first consulting your doctor. Your doctor may want you to gradually reduce your dose before stopping completely.

Do not take other medications unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medications and herbal or vitamin supplements.

In deciding to use a medicine, you and your doctor must consider the risks of taking it versus the benefits it may provide. Here are some important points to think about for this medicine:

Allergies

Inform your doctor if you have ever had any unusual or allergic reactions to this medicine or any other medicines. Also, let your healthcare professional know if you have any other allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Studies on the effects of selegiline in children have not been conducted. Its safety and effectiveness have not been established for this age group.

Geriatric

So far, studies have not shown any specific problems in older adults that would limit the use of selegiline. However, older patients are more likely to experience unwanted effects (such as high or low blood pressure, orthostatic hypotension, and unusual drowsiness), which may require caution in elderly patients taking selegiline.

Breast Feeding

There are no adequate studies in women to determine the risk to infants when using this medication while breastfeeding. Weigh the possible benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Certain medicines should not be used together. In other cases, two different medicines may be used together, even if an interaction might happen. In such situations, your doctor may need to adjust the dose or take other precautions. When taking this medicine, it is very important that your healthcare professional knows if you are taking any of the medicines listed below. The following interactions are significant and may not be all-inclusive.

Using this medicine with any of the following is not recommended. Your doctor may decide not to treat you with this medication or change your other medicines.

• Amitriptyline
• Amoxapine
• Amphetamine
• Apraclonidine
• Atomoxetine
• Benzphetamine
• Brimonidine
• Bupropion
• Carbamazepine
• Carbinoxamine
• Citalopram
• Clomipramine
• Codeine
• Cyclobenzaprine
• Cyproheptadine
• Desipramine
• Desvenlafaxine
• Deutetrabenazine
• Dexfenfluramine
• Dexmethylphenidate
• Dextroamphetamine
• Dextromethorphan
• Diethylpropion
• Doxylamine
• Duloxetine
• Ephedrine
• Escitalopram
• Fenfluramine
• Fluoxetine
• Fluvoxamine
• Furazolidone
• Gepirone
• Guanadrel
• Guanethidine
• Hydroxytryptophan
• Imipramine
• Iproniazid
• Isocarboxazid
• Isometheptene
• Levomethadyl
• Levomilnacipran
• Linezolid
• Lisdexamfetamine
• Maprotiline
• Mazindol
• Meperidine
• Methamphetamine
• Methotrimeprazine
• Methyldopa
• Methylene Blue
• Methylphenidate
• Milnacipran
• Mirtazapine
• Moclobemide
• Nefopam
• Nialamide
• Nortriptyline
• Opipramol
• Ozanimod
• Paroxetine
• Phendimetrazine
• Phenelzine
• Phenmetrazine
• Phentermine
• Phenylalanine
• Phenylephrine
• Phenylpropanolamine
• Procarbazine
• Propoxyphene
• Protriptyline
• Pseudoephedrine
• Rasagiline
• Reserpine
• Safinamide
• Serdexmethylphenidate
• Sertraline
• Sibutramine
• Solriamfetol
• St John's Wort
• Sumatriptan
• Tapentadol
• Tetrabenazine
• Tramadol
• Tranylcypromine
• Trazodone
• Trimipramine
• Tryptophan
• Venlafaxine
• Vilazodone
• Viloxazine
• Vortioxetine

Using this medicine with any of the following is usually not recommended, but may be necessary in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you take one or both medicines.

• Albuterol
• Alfentanil
• Alizapride
• Amineptine
• Amitriptylinoxide
• Atropine
• Benzhydrocodone
• Bromperidol
• Buprenorphine
• Buspirone
• Butalbital
• Butorphanol
• Clovoxamine
• Dibenzepin
• Difenoxin
• Dihydrocodeine
• Diphenoxylate
• Dolasetron
• Domperidone
• Dothiepin
• Doxepin
• Droperidol
• Epinephrine
• Ethchlorvynol
• Femoxetine
• Fentanyl
• Fluspirilene
• Formoterol
• Frovatriptan
• Granisetron
• Guarana
• Haloperidol
• Hydrocodone
• Hydromorphone
• Iobenguane I 123
• Iobenguane I 131
• Kava
• Lasmiditan
• Levorphanol
• Licorice
• Lithium
• Lofepramine
• Lorcaserin
• Ma Huang
• Mate
• Melitracen
• Mephentermine
• Metaraminol
• Metaxalone
• Methadone
• Metoclopramide
• Metopimazine
• Midodrine
• Morphine
• Morphine Sulfate Liposome
• Nalbuphine
• Naratriptan
• Nefazodone
• Norepinephrine
• Ondansetron
• Oxycodone
• Oxymetazoline
• Oxymorphone
• Palonosetron
• Penfluridol
• Pentazocine
• Pimozide
• Reboxetine
• Remifentanil
• Sufentanil
• Sulpiride
• Sultopride
• Tianeptine
• Tiapride
• Tocilizumab
• Tyrosine
• Valbenazine
• Veralipride
• Vilanterol
• Ziprasidone

Using this medicine with any of the following may lead to an increased risk of certain side effects, but it may still be the best treatment for you. If both medicines are prescribed together, your doctor may adjust the dose or how often you take one or both medicines.

• Acarbose
• Chlorpropamide
• Desogestrel
• Dienogest
• Dopamine
• Drospirenone
• Estradiol
• Ethinyl Estradiol
• Ethynodiol
• Gestodene
• Ginseng
• Glimepiride
• Glipizide
• Glyburide
• Insulin
• Insulin Aspart, Recombinant
• Insulin Bovine
• Insulin Degludec
• Insulin Detemir
• Insulin Glargine, Recombinant
• Insulin Glulisine
• Insulin Lispro, Recombinant
• Levonorgestrel
• Mestranol
• Metformin
• Nateglinide
• Nomegestrol
• Norethindrone
• Norgestimate
• Norgestrel
• Repaglinide
• Tolazamide
• Tolbutamide

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be taken around the time of eating food or certain types of food due to possible interactions. Drinking alcohol or using tobacco with certain medicines may also cause interactions. The following interactions are significant and may not cover all possibilities.

Using this medicine with any of the following is usually not recommended, but may be necessary in some cases. If used together, your doctor may adjust the dose or provide specific instructions regarding food, alcohol, or tobacco use.

• Avocado
• Bitter Orange
• Tyramine Containing Food

Other Medical Problems

Having other medical issues may influence how you can use this medicine. Be sure to tell your doctor about any other medical problems, especially:

• Dyskinesia (abnormal muscle movements) or
• Hypertension (high blood pressure) or
• Hypotension (low blood pressure) or
• Mental illness (for example, psychosis) or
• Postural hypotension (dizziness, lightheadedness, or fainting when getting up from a lying or sitting position)—Use with caution. This may worsen these conditions.

• Kidney disease (such as end-stage kidney disease)—This medicine is not recommended for patients with this condition.

• Liver disease—Use with caution, as higher blood levels of selegiline may occur and cause more side effects.

• Phenylketonuria (PKU)—The disintegrating tablet contains phenylalanine, which can worsen this condition.

Along with its necessary effects, a medicine may cause some unwanted effects. Although not all of these side effects may happen, if they do, they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

• Twitching, twisting, uncontrolled repetitive movements of the tongue, lips, face, arms, or legs

Less common

• Blurred vision
• bruising
• chest pain or tightness
• decreased urine
• difficult or labored breathing
• difficulty with swallowing
• discouragement
• dizziness
• dry mouth
• feeling sad or empty
• headache
• increased thirst
• irregular heartbeat
• irritability
• large, flat, blue or purplish patches in the skin
• loss of appetite
• loss of interest or pleasure
• mood changes
• muscle pain or cramps
• nausea or vomiting
• nervousness
• numbness or tingling in the hands, feet, or lips
• pounding in the ears
• seeing, hearing, or feeling things that are not there
• seizures
• shakiness and unsteady walk
• shakiness in the legs, arms, hands, or feet
• sleepiness or unusual drowsiness
• slow or fast heartbeat
• swelling or inflammation of the mouth
• tiredness
• trouble concentrating
• trouble sleeping
• unsteadiness, trembling, or other problems with muscle control or coordination
• unusual tiredness or weakness

Incidence not known

• Agitation
• diarrhea
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• fever
• overactive reflexes
• poor coordination
• restlessness
• shivering
• sweating
• talking or acting with excitement you cannot control

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

• Agitation
• chest pain
• difficulty opening the mouth or lockjaw
• dizziness (severe) or fainting
• fast or irregular pulse (continuing)
• high fever
• high or low blood pressure
• severe spasm where the head and heels are bent backward and the body arched forward
• trouble breathing

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Dry skin
• hives, itching, or skin rash
• itching, scaling, severe redness, soreness, or swelling of the skin
• runny or stuffy nose
• sneezing

Less common

• Acid or sour stomach
• back pain
• belching
• bloated or full feeling
• body aches or pain
• congestion
• cough
• difficulty having a bowel movement (stool)
• difficulty with moving
• dryness or soreness of the throat
• excess air or gas in the stomach or intestines
• heartburn
• hoarseness
• indigestion
• joint pain
• leg cramps
• muscle aches, cramps, pains, or stiffness
• passing gas
• stomach discomfort, upset, or pain
• swollen joints
• tender, swollen glands in the neck
• tooth problems
• voice changes

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

In the U.S.

• Eldepryl
• Zelapar

Available Dosage Forms:

• Tablet, Disintegrating
• Capsule
• Tablet

Therapeutic Class: Antiparkinsonian

Pharmacologic Class: Monoamine Oxidase Inhibitor, Type B

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

It is best to take the capsules or tablets in the morning during breakfast and lunch. You should not use it with dinner because you may have trouble sleeping.

If you are using the disintegrating tablet, make sure your hands are dry before you handle the tablet. Do not open the blister pack that contains the tablet until you are ready to take it. Remove the tablet from the blister pack by peeling back the foil, then taking the tablet out. Do not push the tablet through the foil. Do not break or split the tablet. Place the tablet on the top of your tongue, where it will melt quickly. Do not eat food or drink liquids for 5 minutes before or after taking this medicine. It is best to take this medicine before breakfast.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For Parkinson's disease: For oral dosage forms (capsules or tablets): Adults—5 milligrams (mg) two times a day, taken at breakfast and lunch. Your doctor may adjust your dose as needed. Children—Use and dose must be determined by your doctor. For oral dosage form (oral disintegrating tablets): Adults—At first, 1.25 milligrams (mg) once a day before breakfast, for at least 6 weeks. After 6 weeks, your doctor may increase your dose to 2.5 mg once a day. Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.