Selegiline (Transdermal Route)

Selegiline is a monoamine oxidase inhibitor that is used to treat symptoms of depression.

Overview

Selegiline is a monoamine oxidase inhibitor that is used in the treatment of patients who suffer from symptoms of depression.

This antidepressant drug works by rebalancing the proportions of certain naturally occurring substances called neurotransmitters that are produced in the brain. When the chemical balance within the brain is restored, the patient’s mood is improved and their feelings of depression are replaced by a sense of well-being.

Selegiline is available in transdermal patch form and on prescription from your GP. Transdermal patches are designed to gradually release a balanced amount of selegiline through the skin, ensuring that a constant effect is maintained.

Conditions Treated

  • Depression

Type of Medicine

  • Monoamine oxidase inhibitor
  • Transdermal patch

Side Effects

In addition to the benefits it brings, selegiline can cause a few unpleasant side effects. You may not experience all of the effects listed below, however, if you do notice any of them, you should consult your treating physician.

Common side effects in people being treated with selegiline include cold sweats, chills, dizzy spells, faintness, confusion, and feeling lightheaded when rising from a seated or lying position.

There are some effects that patients taking selegiline sometimes experience that do not require medical attention. These effects usually appear when you first start taking the medication and will vanish readily by themselves as your body adjusts to the new drug. Your doctor may be able to suggest ways of avoiding or managing these effects but do ask for more advice if you have any concerns or if the effects prove to be especially annoying. These effects can include:

  • Sensations of itching, burning, reddening of the skin, skin rash, soreness or swelling under the patch
  • Diarrhea
  • Dry mouth
  • Headache
  • Trouble sleeping
  • Acid stomach
  • Belching
  • Body aches or pains
  • Nasal congestion
  • Cough, dryness or soreness of the throat
  • Fever
  • Heartburn
  • Hoarseness
  • Indigestion
  • Tenderness around cheekbones and eyes
  • Rashes
  • Runny nose
  • Breathing difficulties
  • Stomach upset
  • Swollen neck glands
  • Tightness of the chest
  • Wheezing
  • Trouble swallowing
  • Vocal changes
  • Weight loss or gain
  • Decreased interest in sexual intercourse
  • Loss in sexual ability
  • Inability to orgasm

There may be a few other effects that are not mentioned here that may also appear in some people. If you experience any other effects, mention them to your GP.

Dosage

You must apply selegiline transdermal patches exactly as instructed by your GP. Do not apply more patches or use them more frequently than you have been told to.

You will be given a medication guide when you receive your prescription of selegiline transdermal patches. Make sure that you read the guide completely and follow the instructions therein. If you do not understand anything in the guide or have any questions, ask your GP or pharmacist for guidance.

Correct use of selegiline transdermal patches

  • Wash your hands with soap and water before and after applying each new patch. Wash the application site and ensure that it is thoroughly dry before sticking on a patch.
  • Always apply the transdermal patch immediately after removing it from its packet. Try not to touch the sticky side of the patch; this will prevent it from adhering to your skin properly. Do not apply more than one patch at any one time, and do not cut the patch into smaller sections.
  • Ensure that your skin is clean, dry and intact before applying a patch. Apply the patch to your back, upper chest area, upper thigh, or outside of your upper arm; the site should be above your waist and below your neck.
  • Avoid areas that are hairy, scarred, or very greasy. The patch will not adhere properly to these areas and will thus not be properly effective. Do not put the patch where close-fitting clothing could rub it off.
  • Press the patch down firmly with your fingers, ensuring that edges adhere completely.
  • If the patch falls off and cannot be successfully reapplied, replace it with a fresh one.
  • Patches should be replaced after 24 hours, ideally at the same time each day. When siting the new patch, try to put it in a different place each time so as to avoid skin irritation.
  • Fold used patches in half with sticky sides facing. Be sure to dispose of used patches where children and pets cannot access them.
  • Where possible, keep exposing the patch to sources of direct heat, including heat lamps, hot tubs, direct sunlight, and electric blanket to a minimum.
  • Transdermal patches are designed to provide a slow release of selegiline across a 24 hour period. For this reason, it is important that you always wear your prescribed patch. Check your patch each morning when you get up to make sure that it has not come off during the night. Patches can sometimes come off when the wearer becomes hot and sweaty, such as when playing sport or venturing out in very hot weather. Be aware of this and check to see that your patch is still in place after undertaking sporting activities or going out on hot days.

Do not abruptly stop using your patches unless your doctor tells you to. If you have not used selegiline for a few days concurrently, do not begin using it again without first consulting your GP.

Do not use any patches that appear damaged, where the packet has been opened, or where the plastic guard has become detached from the sticky side.

The dose of selegiline that you will be prescribed will not necessarily be the same for all patients. You should take the dose as prescribed to you by your GP or follow the instructions on the product packet. The following doses are based on the average. If you have been given a different dose, do not change it unless expressly instructed to do so by your treating specialist.

The dose of selegiline that you are given will depend on the strength of the patches. In addition, the length of your course of treatment will depend on the medical condition for which you are being treated.

Selegiline transdermal patches – for depression

  • Adults: initially, use one 6 mg patch per day. Your GP might increase the strength of the patches if necessary.
  • Children aged over 12 years: Your doctor will advise you on the dose to be used.

It is not recommended that this drug is used to treat children under 12 years of age.

In the event that you forget to put on one of your patches or forget to change one, try to do so as soon as possible. Do not apply extra patches to make up for your omission.

If you inadvertently apply too many patches and you do not realize that you have done so, there may be a danger that you have overdosed. In such circumstances, you should remove the oldest patches immediately and contact your treating physician straight away.

Some patients are very sensitive to selegiline. In order to make the risk of side effects less likely, your GP might start you off on a low dose and gradually increase it. Once your conditions show signs of improvement and you have been feeling better for a few months, your doctor may suggest reducing your dose.

Interactions

There are some drugs that must never be used together. However, there are some occasions when your doctor may consider it appropriate to use two or more medications at the same time, even though there is a chance that an interaction could occur. If this applies in your case, your GP might opt to vary the dose of one or both of the drugs, and will give you advice on how to manage any side effects that the interaction between the medications may cause.

Before you begin using selegiline transdermal patches to treat your depression, tell your doctor if you are already taking any of the drugs in the following bulleted list. It is not recommended to use selegiline with the following medicines, so your GP may choose a different medication for you or may change some of the other drugs that you are already taking:

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

The use of selegiline with any of the following drugs is not generally recommended, although in some cases it may be deemed necessary. Your doctor may make adjustments to the dose or frequency of use of one or both of the medicines. Tell your GP if you are currently taking any of the following:

  • Ziprasidone
  • Veralipride
  • Tyrosine
  • Tiapride
  • Tianeptine
  • Sultopride
  • Sulpiride
  • Reboxetine
  • Pimozide
  • Pentazocine
  • Penfluridol
  • Palonosetron
  • Oxymetazoline
  • Oxycodone
  • Nefazodone
  • Naratriptan
  • Morphine Sulfate Liposome
  • Morphine
  • Metopimazine
  • Metoclopramide
  • Metaraminol
  • Mephentermine
  • Melitracen
  • Mate
  • Ma Huang
  • Lorcaserin
  • Lofepramine
  • Licorice
  • Kava
  • Iobenguane I 123
  • Hydromorphone
  • Hydrocodone
  • Haloperidol
  • Guarana
  • Granisetron
  • Frovatriptan
  • Fluspirilene
  • Fentanyl
  • Femoxetine
  • Ethchlorvynol
  • Droperidol
  • Doxepin
  • Dothiepin
  • Domperidone
  • Dolasetron
  • Diphenoxylate
  • Difenoxin
  • Dibenzepin
  • Clovoxamine
  • Buspirone
  • Buprenorphine
  • Bromperidol
  • Atropine
  • Amitriptylinoxide
  • Amisulpride
  • Amineptine
  • Altretamine
  • Alizapride

The use of selegiline with any of the following drugs may present an increased likelihood of you experiencing some side effects, although using both medications together might be the best option in your case. If your GP does prescribe both medicines together, your dose of one or more of them may be adjusted.

  • Tolbutamide
  • Tolazamide
  • Repaglinide
  • Nateglinide
  • Metformin
  • Insulin Lispro, Recombinant
  • Insulin Glulisine
  • Insulin Glargine, Recombinant
  • Insulin Detemir
  • Insulin Degludec
  • Insulin Bovine
  • Insulin Aspart, Recombinant
  • Insulin
  • Glyburide
  • Glipizide
  • Glimepiride
  • Ginseng
  • Dopamine
  • Chlorpropamide
  • Acarbose

Some drugs should not be used around the time of eating certain foodstuffs, at meal times, when using tobacco, or drinking alcohol. To do so may cause interactions to occur that could be detrimental to your well-being. Before you begin using selegiline transdermal patches, you should discuss the potential ramifications of this with your doctor.

It is not generally recommended to eat products containing avocado, bitter orange, or foods that contain tyramine when you are using selegiline.

You should avoid eating the following foods, which are known to be high in tyramine, especially if you are using the higher strength selegiline patches (over 9 mg):

  • Caffeine (coffee, cola, tea)
  • chocolate

You must also not eat these foodstuffs for at least two weeks after you have completed your course of treatment with selegiline transdermal patches.

Warnings

Some existing and historical medical conditions may have an adverse effect when used with selegiline. Be sure to discuss your medical history candidly and fully with your doctor before you begin using selegiline. Note that the following conditions may be made worse by the use of selegiline transdermal patches and caution should be taken when using them:

  • Manic-depressive disorder
  • Bipolar disorder
  • Heart problems
  • Low blood pressure (hypotension)
  • History of hypomania or mania
  • History of mental illness

Selegiline must not be used in patients who suffer from the adrenal gland condition, pheochromocytoma.

You must inform your GP if you have ever noted any allergic or bad reactions to this or any other form of medication. This also applies to over-the-counter drugs, vitamin pills, or herbal preparations. It is also important to tell your doctor if you are allergic to any animal derivatives, food preservatives, food colorings, or certain food groups such as dairy.

Although selegiline patches are sometimes used to treat depression in children, studies to date have not shown any notable benefit in doing so. In addition, research has produced evidence to show that some children, young adults, and teenagers have experienced suicidal thoughts or exhibited suicidal tendencies when treated with this drug. Owing to this inherent toxicity, it is not recommended that children be treated with this medication.

Selegiline transdermal patches must never be used in children under the age of 12 years.

There is currently no evidence to show that using selegiline during pregnancy can present a risk to the fetus. Similarly, there is no evidence to show that there is a risk to nursing infants. However, you should weigh the prospective risks against the potential benefits of using selegiline before trying to get pregnant or breastfeeding. If you have any concerns in either regard, you should discuss the matter more fully with your midwife or doctor.

In order to monitor your condition and to make sure that your drug treatment therapy is working effectively, your doctor or treating specialist will want to see you for regular progress checks. Be sure to attend all these check-up appointments. It may be necessary to adjust the dose of your medication, depending on how your body responds to the drug. You will also have the chance to talk about other aspects of your condition, including any unwanted side effects that you may have noticed while taking selegiline. Regular reviews are also important to enable your doctor or specialist to work with you to uncover the root cause of your depression. It may then be possible to work out a holistic treatment regime, in addition to your drug therapy.

In rare circumstances, selegiline may cause the patient to develop catastrophically high blood pressure, which could potentially prove fatal. If you experience any of the following side effects, stop using selegiline immediately and contact your treating physician immediately:

  • Stiff or sore neck
  • Severe vomiting or nausea
  • Severe headaches
  • Irregular, slow, fast, or irregular heartbeat
  • Increased or very sudden light sensitivity
  • Fever
  • Excess sweating
  • Clammy skin
  • Chest pains

In some patients, treatment with selegiline can interact with some other drugs to cause a dangerous increase in serotonin levels within the body, potentially causing the extremely serious condition, serotonin syndrome. If you begin to notice any of the following effects and symptoms, you should stop taking selegiline and seek urgent medical attention:

  • Hallucinations
  • Uncharacteristic feelings of restlessness
  • Lack of or loss of coordination
  • Rapid heartbeat
  • Extreme dizziness
  • Fever
  • Very severe diarrhea, vomiting, or nausea
  • Muscular tremors or twitching

Some people suffer from a potentially very serious condition called anaphylaxis. Anaphylaxis occurs when the patient experiences a violent allergic reaction to the drug itself or to something that has been used in its manufacture. The symptoms of anaphylaxis include the following:

  • A rash
  • Swelling of the face
  • Itching or tingling of the inside of the mouth, tongue, or throat
  • Swelling of the throat or tongue
  • Feeling dizzy
  • Breathing difficulties
  • Shortness of breath
  • Wheezing

If someone goes into anaphylactic shock, urgent emergency medical attention should be summoned immediately by calling 911.

Storage

In order for your selegiline transdermal patches to work correctly and to avoid damaging them, you must store them properly.

Keep the patches in their packet and away from direct sunlight. Place the packet in a location that is away from sources of direct heat and from moisture. If the patches become too hot, the adhesive backing will melt and become damaged, meaning that the patches will not adhere to your skin properly.

Keep the patches in a place where children and pets cannot reach them.

If a pet eats any of your patches, including used ones, contact your vet for advice immediately.

Do not retain any patches that you no longer need. Do not pass on your patches to anyone else. Before use, check that your supply of patches is still within date. In the event that your prescription has passed the use-by date displayed on the packaging, ask your doctor for a fresh prescription and throw the old patches away.

Dispose of unwanted patches responsibly. Do not flush them down the toilet or drain. Fold used patches in half with the sticky sides facing, place them into the empty packet, and place them in a sealed bag before putting them in your trash. New patches that have not been used should be returned to your pharmacist in their original packaging for safe disposal.

Summary

Selegiline transdermal patches are used in the treatment of the symptoms of depression, primarily in adults. The drug works by re-adjusting the balance of neurotransmitters within the patient’s brain, helping to promote feelings of well-being and improving mood.

There are a number of minor side effects that may be experienced by patients using transdermal patches, which primarily affect the site of patch application. These effects are easily managed and most people experience no long-term issues. However, there is a long list of drugs that should not be used with selegiline as side effects can occur. For this reason, it is important that you discuss your medical history fully with your doctor before taking this drug.

Resources
Last Reviewed:
January 29, 2018
Last Updated:
February 10, 2018