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Higher therapeutic doses i. Effects resulting from transdermal selegiline administration may also occur through its metabolites. However, transdermal dosing results in significantly higher exposure to selegiline with significantly lower exposure for all metabolites relative to oral administration. Oral selegiline: At doses used in Parkinson's disease, selegiline typically exhibits a greater affinity for MAO-B. At higher doses, MAO is blocked non-selectively, predisposing patients to the risks e.

Therefore, the dose limits established for specific oral selegiline products should not be exceeded. Oral selegiline tablets can ordinarily be used safely without dietary restrictions at doses where it presumably selectively inhibits MAO-B e.

Selegiline is available as an oral tablet, oral capsule, orally disintegrating tablet ODTand transdermal patch. Selegiline rapidly penetrates the blood-brain barrier. Although platelet MAO-B activity returns to the normal range within 5 to 7 days of discontinuation of oral selegiline, the link between platelet and brain MAO-B inhibition is not fully understood nor is the relationship of MAO-B inhibition to the clinical effect.

Selegiline is extensively metabolized to N-desmethylselegiline and L-methamphetamine. Selegiline ODT produces a smaller fraction of the administered dose recoverable as the metabolites than the conventional, swallowed formulation of selegiline.

Iopromide: Use of medications that lower the seizure threshold, such as monoamine oxidase inhibitors, should be carefully evaluated when considering intrathecal radiopaque contrast agents.

Ioversol: Use of medications that lower the seizure threshold, such as monoamine oxidase inhibitors, should be carefully evaluated when considering intrathecal radiopaque contrast agents. Irbesartan: Additive hypotensive effects may be seen when selegiline is combined with angiotensin II receptor antagonists.

Isavuconazonium: Concomitant use of isavuconazonium with selegiline may result in increased serum concentrations of selegiline. Caution and close monitoring are advised if these drugs are used together. Isoflurane: Patients taking MAOIs should not undergo elective surgery, including dental procedures, that require the use of general anesthetics due to the potential for CNS and cardiovascular reactions.

Isoniazid, INH: Concurrent use of selegiline and isoniazid may increase the risk of a hypertensive crisis. Isoniazid has monoamine oxidase inhibiting activity and selegiline is a monoamine oxidase inhibitor MAOI type B. Monoamine oxidase type A is the primary enzyme in the gastrointestinal tract, and is responsible for the breakdown of dietary amines such as tyramine. When monoamine oxidase is inhibited by an MAOI, tyramine is absorbed systemically and may result in a hypertensive crisis.

Although selegiline is a selective monoamine oxidase inhibitor type B, there is a risk of hypertension during ingestion of substances high in tyramine or during concurrent use of other drugs with MAOI activity such as isoniazid, since the MAOI-B selectivity of selegiline decreases with increasing dosages.

Isosulfan Blue: Use of medications that lower the seizure threshold, such as monoamine oxidase inhibitors, should be carefully evaluated when considering intrathecal radiopaque contrast agents. Isradipine: Additive hypotensive effects may be seen when monoamine oxidase inhibitors MAOIs are combined with antihypertensives. Kava Kava, Piper methysticum: Avoid the concomitant use of psycho-active herbs, such as kava kava, with MAOIs whenever possible.

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Selegiline should not be used in combination with selective serotonin reuptake inhibitors SSRIserotonin noradrenaline reuptake inhibitor SNRI venlafaxinetricyclic antidepressants, sympathomimetics, monoamine oxidase inhibitors e. Selegiline should not be used in patients with active duodenal or gastric ulcer.

When selegiline is prescribed in combination with levodopa, the contraindications which apply to levodopa must be taken into account. These patients should be monitored. These undesirable effects disappear after levodopa doses reduction. If selegiline is administered in higher doses than recommended 10 mgselegiline may lose its MAO-B selectivity and therefore the risk of hypertension rises.

Special care should be taken administering selegiline to patients with peptic or duodenal ulceration, labile hypertension, cardiac arrhythmias, severe angina pectoris, severe liver or kidney dysfunction or psychosis as aggravation of these conditions may occur during treatment.

Selegiline should be used with caution in severe liver or kidney dysfunction.

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Phenobarbital: MAOIs may prolong the effect of phenobarbital and cause additive CNS depression. Phenoxybenzamine: Additive hypotensive effects may be seen when monoamine oxidase inhibitors MAOIs are combined with antihypertensives. Phentolamine: Additive hypotensive effects may be seen when monoamine oxidase inhibitors MAOIs are combined with antihypertensives.

Pindolol: Additive hypotensive effects may be seen when monoamine oxidase inhibitors MAOIs are combined with antihypertensives. Posaconazole: Posaconazole and selegiline should be coadministered with caution due to an increased potential for selegiline-related adverse events.

Posaconazole is a potent inhibitor of CYP3A4, an isoenzyme partially responsible for the metabolism of selegiline. These drugs used in combination may result in elevated selegiline plasma concentrations, causing an increased risk for selegiline-related adverse events.

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Concomitant use of hypertensive agents, antihypertensives, psychostimulants, central suppressant drugs sedatives, hypnotics and alcohol should be avoided. The available safety data concerning the use during pregnancy and lactation is insufficient to justify the use of selegiline in these patient groups. PregnancyStudies in animals have shown reproductive toxicity only at high multiple of human doses.

This medicine can impair cognitive function and can affect a patient's ability to drive safely. This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988. They are listed below as MedDRA preferred term by system organ class and frequency.

As selegiline potentiates the effect of levodopa levodopa should be usually given in association with a peripheral decarboxylase inhibitorthe side-effects of levodopa may be emphasised unless the dosage of levodopa is reduced. Once the optimum levodopa dose level has been established, the side-effects produced by the combination will usually be less than those caused by the levodopa therapy on its own.

Common Buy Elocon ide effects may include:

  • Significant inhibition of intestinal MAO-A activity can impose a cardiovascular safety risk.

  • Typically, this equal applies to stu- dents of nursing, but Benner has suggested that nurses at higher levels of experience in individual area of mode could be classified at the freshman true if placed in an area or post completely foreign to them such as moving from general medical-surgical matured vigilance to neonatal thorough-going be keen on units Benner, 1984a.

  • Drug Mechanism: Jumex provides selective protection against the age-related degeneration of the dopaminergic nervous system.

  • Codeine: Codeine use is contraindicated in patients who are receiving or who have received monoamine oxidase inhibitors MAOIs within the previous 14 days.

The maximal concentrations are reached in 0. Selegiline is a lipophilic, slightly basic compound, which quickly penetrates into tissues, also into brain. DistributionSelegiline is rapidly distributed throughout the body, the apparent volume of distribution being 500 l after an intravenous 10 mg dose.

Selegiline inhibits enzyme MAO-B irreversibly and enzyme activity only increases again after new enzyme is synthesized. The strong inhibitory effect of platelet enzyme MAO-B activity after single 10 mg dose lasts over 24 h, and the platelet enzyme MAO-B activity returns to normal level approximately after 2 weeks.

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  • Another patient receiving protriptyline and ELDEPRYL developed tremors, agitation, and restlessness followed by unresponsiveness and death two weeks after ELDEPRYL was added.

  • Ethanol: Ethanol may cause additive CNS depression and some ethanol-containing products may also contain tyramine.