Selegiline Meperidine

Drugs that may interact with selegiline include fluoxetine and meperidine. 

Fenfluramine Dextromethorphan Meperidine Methylene dioxymethamphetamine Meta-chlorophenylpiperazine (mCPP) Trazodone (mCPP) Selegiline Nefazodone Trazodone Pethidine Tramadol Mirtazapine TCA medications Venlafaxine SSRI agents... 

Neither selegiline nor rasagiline should be taken by patients receiving meperidine. They should be used with care in patients receiving tricyclic antidepressants or serotonin reuptake inhibitors because of the theoretical risk of acute toxic interactions of the serotonin syndrome type (see Chapter 16), but this is rarely encountered in practice. The adverse effects of levodopa may be increased by these drugs. 

Phenelzine Blockade of MAO-A and MAO-B (phenelzine, nonselective) MAO-B irreversible selective MAO-B inhibition (low dose selegiline) Transdermal absorption of selegiline achieves levels that inhibit MAO-A Major depression unresponsive to other drugs Very slow elimination Toxicity Hypotension, insomnia Interactions Hypertensive crisis with tyramine, other indirect sympathomimetics serotonin syndrome with serotonergic agents, meperidine... 

Tramadol, pethidine, oxycodone, morphine, meperidine Buspirone, chlorpheniramine, dextromethorphan, linezolid, lithium, selegiline, tryptophan, St. John s wort... 

Clinically important, potentially hazardous interactions with alprazolam, amphetamines, astemizole, clarithromycin, clozapine, desipramine, dexibuprofen, dextroamphetamine, diethylpropion, droperidol, duloxetine, erythromycin, haloperidol, imipramine, isocarboxazid, linezolid, lithium, MAO inhibitors, mazindol, meperidine, methamphetamine, midazolam, moclobemide, nortriptyline, phendimetrazine, phenelzine, phentermine, phenylpropanolamine, phenytoin, pimozide, pseudoephedrine, selegiline, serotonin agonists, sibutramine, St John s wort, sumatriptan, sympathomimetics, tramadol, tranylcypromine, trazodone, tricyclic antidepressants, troleandomycin, tryptophan, zolmitriptan... 

Figure 12.3. Phenylpiperidine analgesics and metabolic activation of MPTP. In efforts to synthesize the meperidine-like analgesic agent MPPP ("designer heroin,") (4), MPTP (3)can be formed. It is converted selectively by monoamine oxidase type B (MAO-B, inhibited by agents including deprenyl (selegiline)and pargylineto MPDP (7), and thence to MPP" (8)the proposed toxic species that accumulated in dopamine neurons to result in disruption of their cellular respiration and death.

CYP2B6 <5 1-2 Bupropion Carbamazepi ne Cyclophosphamide Selegiline Flunitrazepam Meperidine Bupropion Selegiline Ethinylestradiol Phencyclidine Tamoxifen Ticlopidine Clotrimazole Carbamazepine Phenobarbital Phenytoin Pioglitazone Rifampin Troglitazone Valproic acid Ritonavir... 

Toxicity Adverse effects include insomnia, mood changes, dyskinesias, gastrointestinal distress, and hypotension. Meperidine in combination with selegiline has caused agitation, delirium, and death. Selegiline has been implicated in the serotonin syndrome when used in patients taking selective serotonin reuptake inhibitors (see Chapter 30). 

X V 1 1 PO. Rapidly absorbed. Crosses blood brain barrier. Metabolized in liver. Amphetamine is a minor metabolite. Fatal reactions between meperidine and MAO inhibitors have been documented. Selegiline slows progression of Parkinson s when used in conjunction with levodopa/carbidopa. 

Meperidine has a strong adverse reaction when given to patients receiving a monoamine oxidase inhibitor. This drug interaction has been seen recently in patients with Parkinson s disease taking the monoamine oxidase-selective inhibitor selegiline (Eldepryl). 

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