Selegiline transdermal

EMSAM

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FDA label

BOXED WARNING Suicidal thoughts and behaviors: increased risk in pediatric and young adult patients; monitor closely. Contraindicated in patients less than 12 years of age due to increased risk of hypertensive crisis.

FDA dosing	Population	Start	Target	Max
Major depressive disorder	Adults	6 mg/24 h once daily	6 mg/24 h	12 mg/24 h
Major depressive disorder	Elderly (≥65 y)	6 mg/24 h once daily	6 mg/24 h	6 mg/24 h

Titration Increase in 3 mg/24 h increments at intervals of no less than 2 weeks

Renal No adjustment needed (mild, moderate, or severe); not studied in ESRD/dialysis

Hepatic No adjustment needed (mild or moderate Child-Pugh); not studied in severe

Observe washout intervals when switching to/from contraindicated drugs (≥2 weeks after stopping EMSAM; ~1 week (or 5 weeks for fluoxetine) before starting EMSAM)

Instructions

Apply to dry, intact skin on upper torso, upper thigh, or outer upper arm once every 24 hours; rotate sites
Avoid tyramine-rich foods/beverages at doses of 9 mg/24 h and 12 mg/24 h (and 2 weeks after reducing/stopping those doses)
Avoid external heat (heating pads, saunas, hot tubs, prolonged sunlight) at application site
Screen for bipolar disorder before starting

Contraindications

Serotonergic drugs: SSRIs, SNRIs, clomipramine and imipramine, meperidine, tramadol, methadone, pentazocine, and propoxyphene; and the antitussive agent dextromethorphan — because of a risk of serotonin syndrome
Carbamazepine (possible increased risk of hypertensive crisis)
Patients less than 12 years of age (potential for hypertensive crisis)
Pheochromocytoma