Selegiline side effects

Selegiline (Eldepryl ) Blocks MAOB metabolism and presynaptic reuptake of DA in the brain Start with 5 mg in the morning if symptoms continue, add 5 mg at noon 5 mg daily may be as clinically effective as 10 mg daily with fewer side effects... 

Selegiline COCs decrease metabolism of selegiline Increase side effects of selegiline may adjust dose of selegiline if needed... 

We do not recommend the routine use of selegiline, nonsteroidal anti-inflammatory drugs like ibuprofen, or herbs such as ginkgo biloba for patients with dementia. These all have the potential for problematic side effects that may outweigh their benefit. If they are used, please be sure that a physician closely monitors your patient. 

Levodopa side effects Some patients given selegiline may experience an exacerbation of levodopa-associated side effects, presumably caused by the increased amounts of dopamine reacting with supersensitive postsynaptic receptors. 

Children with Tourette s syndrome and ADHD refractory to other ADHD medication (n = 29) were treated openly with an average deprenyl dose of 8 mg/ day (Jankovic, 1993). The vast majority of patients (26/29) reported clinical improvement with no serious adverse outcomes. Mild side effects that did not require discontinuation of the drug were noted in six patients. Two patients had exacerbations of their tics. A later controlled trial of low-dose selegiline (10 mg/day) did not demonstrate statistically significant improvement of ADHD symptoms in children with Tourette s syndrome (Feigin et ah, 1996). 

Selegiline is relatively safe in terms of short-term adverse side effects. With some MAO inhibitors, there is frequently a sudden, large increase in blood pressure if the patient ingests foods containing tyramine (see Chapter 7). However, selegiline does not appear to cause a hypertensive crisis even when such tyramine-containing foods are eaten.48 Other side effects include dizziness, sedation, gastrointestinal distress, and headache. 

Because of undesirable side effects associated with monoamine oxidase inhibitor therapy (see section 2.3.2), pharmaceutical companies nearly abandoned research on new analogs in the 1960s. The early MAO inhibitors were nonselective and irreversible. Today, efforts toward the development of monoamine oxidase inhibitors are focused on selective MAQA or MAOB inhibitors. Selective MAOB inhibitors are being examined in the treatment of, for example, schizophrenia, Alzheimer s disease, and Parkinson s disease. MAO-B inhibitors might be effective in the treatment of depression, but relatively little woik has been done in this area. Selegiline... 

Because antipsychotic therapy has shown only modest efficacy and poses a substantial risk of undesirable side effects, medications traditionally used to treat disruptive behaviors and aggression in other psychiatric and neurologic disorders have been suggested as potential alternatives. These alternatives include benzodiazepines, buspirone, carbamazepine, selegiline, and SSRls. 

MAOIs can be classified into two groups the irreversible (older) MAOIs such as Parnate (tranylcypromine) and Nardil (phenelzine), and the reversible (newer) drugs such as Manerix (moclobemide) and Deprenyl (selegiline). Older MAOIs have more side effects associated with them since their action is less specific than newer MAOIs. 

Waters CH. Side effects of selegiline (Eldepryl). J Geriatr Psychiatry Neurol (1992) 5, 31-34. 

This method was described previously in Section 9.7 and is effective because it replenishes the supply of dopamine in the brain. Another method for increasing dopamine levels is to slow the rate at which dopamine is removed from the brain. Dopamine is primarily metabolized under the influence of an enzyme (a biological catalyst), called monoamine oxidase B (MAO B). Any drug that inactivates this enzyme will effectively slow the rate at which dopamine is metabolized, thereby slowing the rate at which dopamine levels decrease in the brain. Unfortunately, a closely related enzyme, called MAO A, is used for the metabolism of other compounds, and any drug that inactivates MAO A leads to significant cardiovascular side effects. Therefore, the selective inactivation of MAO B (but not MAO A) is required. The first selective MAO B inactivator, called selegiline, was approved by the FDA in 1989 for the treatment of Parkinson s disease ... 

Selegiline was approved by the FDA first, but one of the compounds to which it is metabolized has a structure similar to that of methamphetamine (the street drug known as speed page 179). So, some patients taking the drug experience psychiatric and cardiac effects. These side effects have not been found in patients taking rasagiline. 

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