Selegiline

FDA label

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Titration Maintain 1.25 mg once daily for at least 6 weeks before increasing to 2.5 mg once daily

Renal No adjustment for mild–moderate (CLcr 30–89); not recommended if CLcr <30 or ESRD

Hepatic Reduce to 1.25 mg in mild–moderate (Child-Pugh 5–9); not recommended in severe (Child-Pugh >9)

Doses >2.5 mg/day provide no added benefit and should be avoided

Instructions

• Take in the morning before breakfast without liquid
• Place tablet on top of tongue to disintegrate in seconds
• Avoid food and liquid 5 minutes before and after each dose
• Do not push the tablet through the foil backing

Contraindications

• Concomitant opioids (e.g., meperidine, tramadol, methadone) — serotonin syndrome; allow ≥14 days between
• Concomitant other MAOIs or potent MAO inhibitors, including linezolid — hypertensive crisis; allow ≥14 days between
• Concomitant St. John's wort or cyclobenzaprine
• Concomitant dextromethorphan — reported psychosis/bizarre behavior

Cautions

• Hypertension at doses above 2.5 mg/day (loss of MAO-B selectivity; tyramine reactions)
• Serotonin syndrome when used with antidepressants
• Falling asleep during activities of daily living / somnolence
• Hypotension / orthostatic hypotension
• Dyskinesia (new or worsened)
• Hallucinations and psychotic-like behavior
• Impulse control / compulsive behaviors
• Withdrawal-emergent hyperpyrexia and confusion on abrupt discontinuation
• Irritation of the buccal mucosa
• Contains phenylalanine — risk in phenylketonuria

Adverse reactions

• Constipation
• Skin disorders
• Vomiting
• Dizziness
• Dyskinesia
• Insomnia
• Dyspnea
• Myalgia
• Rash

Pregnancy No adequate human data; animal developmental toxicity (decreased embryofetal/postnatal growth and survival)

Lactation No data; breastfeeding not recommended during treatment and for 7 days after final dose (risk of hypertensive reactions)