- Side Effects
- Drug Interactions
- What Else to Know
- Pregnancy & Breastfeeding
Generic Name: selegiline
Brand Names: Eldepryl (discontinued), Zelapar
Drug Class: Antiparkinson Agents, MAO Type B Inhibitors
What is selegiline, and what is it used for?
Selegiline is a medication used in the treatment of Parkinson’s disease, a movement disorder caused by the degeneration of nerve cells (neurons) in certain regions of the brain.
Selegiline is used as an adjunct in patients treated with levodopa/carbidopa, whose response to these medications has deteriorated. Selegiline is an antiparkinson agent that belongs to a class of medications known as monoamine oxidase type B ((MAO-B) inhibitors.
Dopamine is a chemical (neurotransmitter) in the brain that has multiple functions including the regulation of movement, learning, memory, cognition and emotion. Parkinson’s disease symptoms are primarily from damage to the neurons in the dopamine-producing region of the brain, which causes dopamine levels to drop. Selegiline prevents the breakdown of dopamine, increasing its concentration in the brain.
Selegiline works by inhibiting monoamine oxidase, an enzyme that is involved in the degradation (reuptake) of the neurotransmitters dopamine, serotonin, and norepinephrine in the central nervous system and peripheral tissues. At the doses recommended for Parkinson’s disease, selegiline selectively inhibits MAO-B, the type found in the brain which primarily breaks down dopamine. At higher doses, selegiline inhibits MAO-A also, which increases the levels of serotonin and norepinephrine as well.
- Do not use in patients with known hypersensitivity to selegiline or any of its components.
- Do not use selegiline concomitantly with the following medications:
- Opioid drugs such as meperidine, tramadol, or methadone. It can lead to serotonin syndrome, a life-threatening reaction. At least 14 days should elapse between discontinuation of MAO inhibitors and initiation of opioids.
- Other MAO inhibitors including linezolid, because of an increased risk for hypertensive crisis. At least 14 days should elapse between discontinuation of selegiline and any other MAO inhibitor.
- St. John’s wort or cyclobenzaprine, a tricyclic muscle relaxant.
- Dextromethorphan, because of reported episodes of psychosis or bizarre behavior.
- Antidepressants including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, tetracyclic antidepressants, triazolopyridine antidepressants, because of the risk for serotonin syndrome.
- Daily doses should not exceed the recommended doses, because selegiline loses its selectivity for MAO-B at higher doses.
- Hypertensive reactions to foods containing tyramine, an amino acid, have been reported with even recommended doses and the risk increases with higher doses, with the loss of MAO-B selectivity.
- The precise dose at which selegiline loses its selectivity is not known and may vary with individuals.
- There have been reports of uncontrolled hypertension with the recommended dose of selegiline taken concurrently with ephedrine, a sympathomimetic medication.
- Monitor patients for new onset or exacerbation of hypertension.
- Selegiline can cause drowsiness and patients have reported falling asleep during activities of daily living. Caution patients and caregivers appropriately to avoid hazardous activities.
- Selegiline can cause a drop in blood pressure with postural change (orthostatic hypotension), more frequently during dose increase. The risk is higher in patients above 65 years of age.
- Selegiline may potentiate the dopaminergic effects of levodopa and lead to new onset of uncontrolled movements (dyskinesia) or exacerbate pre-existing dyskinesia. Reducing levodopa dose may lessen dyskinesia.
- Selegiline can affect the mental status and cause hallucinations, and abnormal thinking and behavior, including paranoid ideation, delusions, agitation, aggressive behavior, confusion, disorientation and psychotic-like behavior.
- Avoid using selegiline to treat patients with pre-existing psychotic disorder, it can exacerbate psychosis. In addition, certain antipsychotic drugs may decrease selegiline effects and exacerbate Parkinson’s symptoms.
- Patients on selegiline therapy may experience intense urges to gamble, increased sexual urges, intense urges to spend money, binge eating, and/or other intense urges, and an inability to control these urges. Specifically ask patients and caregivers about such urges, because patients may not recognize these urges as abnormal. Consider reducing the dose or stopping selegiline if such urges develop or worsen.
- There have been reports of neuroleptic malignant syndrome-like symptoms such as elevated temperature, muscular rigidity, altered consciousness, and autonomic instability with rapid dose reduction, withdrawal or changes in antiparkinsonian therapy.
- Selegiline can irritate the mucous membrane of the mouth and tongue and cause mouth pain, swallowing pain, swelling, redness and/or ulceration in the mouth. Treat patients appropriately.
- Selegiline contains phenylalanine, an amino acid. Use with caution in patients with phenylketonuria, an inherited disorder with inability to metabolize phenylalanine, which can lead to brain and nerve damage. The combined daily amount of phenylalanine obtained from all sources, including food and other medications, should be considered before prescribing selegiline.
What are the side effects of selegiline?
Common side effects of selegiline include:
- Oral inflammation (stomatitis)
- Swallowing difficulties (dysphagia)
- Tooth disorder
- Indigestion (dyspepsia)
- Abdominal pain
- Gas (flatulence)
- Dry mouth (xerostomia)
- Involuntary uncontrolled movements (dyskinesia)
- Drug-associated movement disorder (extrapyramidal symptoms)
- Impairment of coordination, balance and speech (ataxia)
- Drowsiness (somnolence)
- Psychotic-like behavior
- Mood changes
- Aggressive behavior
- Activation of mania/hypomania
- Compulsive behaviors such as uncontrolled binge eating, gambling and sexual urges
- Suicidal thoughts and behavior
- Drop in blood pressure when standing from sitting or lying down (orthostatic hypotension), particularly in geriatric patients
- Fainting (syncope)
- Leg cramps
- Muscle pain (myalgia)
- Generalized pain
- Chest pain
- High blood pressure (hypertension)
- Irregular heart rate (cardiac arrhythmia)
- Nasal inflammation (rhinitis)
- Throat inflammation (pharyngitis)
- Shortness of breath (dyspnea)
- Low blood potassium (hypokalemia)
- Urinary retention
- Skin disorders including:
- Serotonin syndrome, a serious drug reaction
Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:
- Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
- Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
- Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
- Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.
This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.
What are the dosages of selegiline?
- 5 mg
- 5 mg
- 1.25 mg
- 5 mg orally at breakfast and 5 mg at lunch (10 mg/day)
- After 2-3 days of selegiline therapy, can begin to taper levodopa dose by 10-30% as tolerated; continue to taper based upon patient response
- Not to exceed 10 mg/day
Orally-disintegrating (with levodopa/carbidopa)
- Initial 1.25 mg orally every day, may increase after 6 weeks if inadequate response, no more than 2.5 mg/day
- Do not swallow
- Take in the morning before breakfast and without liquid; patient should avoid ingesting food or liquids for 5 minutes before and after taking medication
- Use caution; dosage adjustment not provided in manufacturer’s labeling; not studied
- Mild to moderate impairment (creatinine clearance [CrCl] 30-89 mL/minute): Dose adjustment not necessary; maintenance dose determined by individual response
- Severe impairment (CrCl less than 30 ml/minute): Not recommended
- End-stage renal disease: Not recommended
- Use caution; dosage adjustment not provided in manufacturer’s labeling; not studied
- Mild to moderate hepatic disease (Child-Pugh class A and B): Daily dose should be reduced (from 2.5 to 1.25 mg daily), depending on clinical response and tolerability
- Severe hepatic impairment (Child-Pugh class C): Not recommended
5 mg PO at breakfast and 5 mg at lunch (10 mg/day)
Less than 5 mg/day when combined with levodopa
After 2-3 days of selegiline therapy, can begin to taper levodopa dose by 10-30% as tolerated; continue to taper based upon patient response
Not to exceed 10 mg/day
Orally-disintegrating (with levodopa/carbidopa)
Initial 1.25 mg orally every day, may increase after 6 weeks if inadequate response, no more than 2.5 mg/day
Do not take food or liquid for 5 minutes after dose
Safety and efficacy not established
- Overdose of selegiline may cause restlessness (psychomotor agitation) and severe low blood pressure (hypotension).
- Selegiline overdose can inhibit both MAO-A and MAO-B, resulting in symptoms that include drowsiness, dizziness, faintness, irritability, hyperactivity, agitation, severe headache, hallucinations, lockjaw (trismus), backward arching of head, neck and spine (opisthotonos), convulsions, coma, rapid and irregular pulse, high blood pressure (hypertension), hypotension and vascular collapse, respiratory depression and failure, high body temperature, excessive sweating, and cool, clammy skin.
- Selegiline overdose is treated with symptomatic and supportive care. Treatments may include:
- Induced vomiting, gastric lavage and charcoal administration to eliminate any undigested drug
- Airway maintenance and respiratory support, if required
- Intravenous fluids and medications based on symptoms
What drugs interact with selegiline?
Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.
- Selegiline has severe interactions with at least 60 different drugs.
- Selegiline has serious interactions with at least 43 different drugs.
- Selegiline has moderate interactions with at least 109 different drugs.
- Mild interactions of selegiline include:
- ruxolitinib topical
The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.
It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.
Subscribe to MedicineNet's General Health Newsletter
What else should I know about selegiline?
- Take selegiline exactly as prescribed.
- Report to your physician immediately if you:
- Experience symptoms of hypertension. You may need to avoid foods containing tyramine, an amino acid.
- Develop symptoms of drug reactions such as high fever, muscle rigidity, and/or altered consciousness.
- Experience new onset or exacerbation of Parkinson’s symptoms.
- Notice any changes in your usual behavior and mental status.
- Develop new or increased urges for intense gambling, sexual or other impulsive behaviors that you are unable to control.
- Selegiline can make you drowsy and fall asleep during activities of daily living. Avoid hazardous activities such as driving and operating heavy machinery.
- Store selegiline safely out of reach of children and others.
- Seek immediate medical help or contact Poison control, in case of overdose or suspected overdose. Signs and symptoms of overdose may not appear immediately and may set in even up to 12 hours after ingestion.
Pregnancy and breastfeeding
- There are no adequate and well-controlled studies on the safety of selegiline use in pregnant women. Animal reproductive studies show selegiline use during pregnancy is associated with reduced fetal and newborn growth and survival.
- When treating a pregnant woman, the potential risks of taking an MAOI, particularly the risk of hypertensive crisis during pregnancy, along with the established benefits of treatment should be considered. An agent other than selegiline may be preferred in the treatment of pregnant women.
- There are no data on the presence of selegiline or its metabolites in breast milk, the effects on milk production or the breastfed infant. Nursing mothers should avoid breastfeeding while on selegiline therapy and for 7 days following the final dose, because of the potential for serious adverse reactions in the infant, including hypertension.
Selegiline is a medication used in the treatment of Parkinson’s disease, a movement disorder caused by the degeneration of nerve cells (neurons) in certain regions of the brain. Common side effects of selegiline include nausea, vomiting, swallowing difficulties (dysphagia), indigestion (dyspepsia), abdominal pain, gas (flatulence), constipation, diarrhea, dry mouth (xerostomia), dizziness, headache, involuntary uncontrolled movements (dyskinesia), tremor, impairment of coordination/balance/speech (ataxia), suicidal thoughts and behavior, insomnia, hallucination, psychotic-like behavior, and others.
Multimedia: Slideshows, Images & Quizzes
Parkinson's Disease: Symptoms, Causes, Stages, Treatment
Discover the symptoms, causes, stages, and treatment options for Parkinson's disease. Learn more about the stages of Parkinson's...
The Stages of Dementia: Alzheimer's Disease and Aging Brains
What are the symptoms of dementia? What causes dementia? Dementia includes many disorders, such as Lewy Body dementia,...
Brain Health: Foods that May Lower Dementia Risk
What foods are associated with Alzheimer's disease and other forms of dementia? Cognitive function is predicated on good...
Healthy Aging: Reasons for Memory Loss and Dementia Risk
Forget your keys? That might be absentmindedness. Forget what you did this morning? That might be a more serious memory problem....
Parkinson's Disease Quiz: Test Your Medical IQ
Parkinson's disease is common among neurodegenerative disorders. Do you know how it works? The causes? The symptoms? Take the...
Picture of Vascular (Multi-Infarct) Dementia 2
There are several types of vascular dementia, which vary slightly in their causes and symptoms. See a picture of Vascular...
Picture of Lewy Body Dementia
Lewy body dementia (LBD) is one of the most common types of progressive dementia. See a picture of Lewy Body Dementia (LBD) and...
Picture of Frontotemporal Dementia (FTD)
Frontotemporal dementia, sometimes called frontal lobe dementia, describes a group of diseases characterized by degeneration of...
Picture of HIV-associated Dementia (HAD)
A 40-year-old woman diagnosed with HIV presented with confusion and decline in memory. See a picture of HIV-associated Dementia...
Picture of Vascular (Multi-Infarct) Dementia 1
Vascular dementia is the second most common cause of dementia, after Alzheimer's disease. See a picture of Vascular...
Dementia and Alzheimer's: 13 Bad Brain Health Habits
Good brain health depends on exercising regularly, eating well, and getting enough sleep. Learn how to develop good health habits...
Dementia and Alzheimer's: Is It Aging or Alzheimer's?
Learn the difference between memory problems that can happen to all of us as we get older and real warning signs of dementia.
Related Disease Conditions
Dementia is defined as a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. There are several different types of dementia, including cortical, subcortical, progressive, primary, and secondary dementias. Other conditions and medication reactions can also cause dementia. Dementia is diagnosed based on a certain set of criteria. Treatment for dementia is generally focused on the symptoms of the disease.
What Are the Seven Stages of Lewy Body Dementia?
Lewy body dementia (LBD) or dementia with Lewy bodies (DLB) is associated with protein deposits in the brain that cause disruptions in the normal functioning of the brain. Diagnosing the disease is extremely tough because its symptoms may resemble other brain diseases. There are seven stages of Lewy body dementia.
How Do You Know When a Dementia Patient Is Dying?
When a dementia patient is close to dying, you may notice signs such as agitation, restlessness, moaning, and changes in breathing.
How Long Does the Final Stage of Dementia Last?
While it is difficult to predict how long the final stage of dementia will last, most patients survive for one to three years.
What Are the Seven Stages of Dementia?
The progression of dementia (in Alzheimer’s disease) has been divided into seven stages. Learn about treatment, prevention, and foods that can help fight dementia.
What Are the 5 Stages of Parkinson’s Disease?
Parkinson's disease (PD) is a progressive neurological disease that affects movement. Learn about symptoms in each of the 5 stages.
What Are the 7 Stages of Dementia?
What are the 7 stages of dementia and how do you recognize them? Learn the signs of dementia and what to do if you or your loved one is showing symptoms of dementia.
Can Parkinson’s Be Reversed With Diet?
Parkinson's disease cannot be reversed with diet, but dietary changes, exercise, and medications can help ease symptoms and slow the progression of the disease.
What Is the Difference Between Dementia and Alzheimer's?
Dementia is a group of symptoms (syndrome) characterized by a decline in memory, thinking and reasoning. Although dementia is a cluster of symptoms, Alzheimer’s is a slowly progressive disorder of the brain that destroys memory and thinking skills.
Early Warning Signs and Stages of Dementia
Dementia is a decline and or loss of behavior of mental abilities, loss of judgment, language, and reasoning. Early warning signs of dementia include misplacing items, difficulty planning or problem solving, poor work performance, difficulty doing familiar tasks, and withdrawal from social activities. There are seven stages of dementia that range from stage 1, with no cognitive decline to stage 7, which is severe dementia.
Can You Be Bipolar With Dementia?
Because bipolar disorders can alter brain structure and chemistry over time, gradual damage to brain cells can lead to symptoms of dementia such as memory loss.
Parkinson's Disease: Eating Right
Eating a well-balanced and nutritional diet is very beneficial to people with Parkinson's disease. With a proper diet, our bodies work more efficiently and it is especially helpful because Parkinson's disease medications will work properly.
What Are the Newest Drugs for Parkinson’s?
Parkinson's disease is a brain disorder that causes movement problems like a slow, shuffling walk, loss of balance and coordination, and tremors. The newest drugs for Parkinson's are adenosine A2a antagonists and other therapies.
Periodic Limb Movement Disorder
Periodic limb movement disorder (PLMD) is a sleep disorder characterized by rhythmic movements of the limbs during sleep. The movements typically involve the legs, but upper extremity movements may also occur. Movements occur periodically throughout the night and can fluctuate in severity from one night to the next. They tend to cluster in episodes that last anywhere from a few minutes to several hours. These movements are very different from the normal spasms, called hypnic myoclonia, that we often experience initially while trying to fall asleep.
What Mental Illness Is Similar to Dementia? Can It Be Bipolar?
Despite not being classified as a mental illness, here are four mental health disorders often mistaken for dementia due to their similar symptoms.
Is Dystonia a Form of Parkinson's?
Dystonia can be one of the symptoms of Parkinson’s disease (PD). PD is a long-term neurological movement disorder with various symptoms ranging from slowness of movement (bradykinesia), rigidity of muscles, tremor, loss of balance, memory impairment, personality changes and others.
What Are 10 Possible Causes of Parkinson's Disease?
Parkinson's disease is a neurological condition that mainly affects your body's movement. The 10 possible causes of Parkinson's disease include genetics, chemical exposure, where you live, and other factors.
What Is the Best Treatment for Parkinson’s Disease?
Parkinson's disease is the deterioration of brain nerves that control movement. Learn what medical treatments can help ease your Parkinson's disease symptoms and speed up your recovery.
What Foods Should People With Parkinson’s Disease Avoid?
Diet and nutrition play a significant role in boosting the overall health of people with Parkinson’s disease. Here are 7 foods people with Parkinson’s should avoid.
How Do You Get Parkinson's Disease?
Parkinson's disease results from a lack of dopamine production in the brain, affecting a person's physical and mental abilities. Learn what the causes and symptoms are of Parkinson's and how to best treat it.
16 Early Signs of Dementia
Dementia is a general term for a group of conditions characterized by a decline in memory, thinking and reasoning. The early signs of dementia may vary depending on the cause of dementia. Some of the early signs include a decline in memory, inability to focus, forgetfulness and other symptoms.
What Is the Most Effective Treatment for Parkinson's?
Parkinson’s disease is a brain disorder that causes movement problems like shaking, slow movements, muscle stiffness, and loss of balance and coordination. The most effective treatment for Parkinson's is levodopa, but there are other medications and treatments available.
How Do People Get Parkinson’s?
Parkinson's disease is a chronic age-related brain condition of the nervous system, causing parts of your brain to degenerate. People get Parkinson's due to genetic and environmental factors, age, gender, and other things.
What Causes Motor Fluctuations in Parkinson’s Disease?
Motor fluctuations in Parkinson’s disease are caused by drops in dopamine brain levels since your nerve cells can no longer make enough of the chemical.
What Are the Signs of Early Onset Dementia?
Early onset dementia is rare and difficult to diagnose. Learn about early signs of dementia that may indicate that something is wrong.
What Causes Periodic Limb Movement Disorder?
Periodic limb movement disorder or PLMD is a medical condition in which a person’s limbs, legs, and sometimes arms move repetitively and uncontrollably during sleep. Most of the people who suffer from this condition are unaware of these abnormal movements occurring during sleep.
What Are the 5 Signs of Parkinson's Disease?
Parkinson's disease is an age-related neurodegenerative disorder that leads to a gradual decline of your motor functions. The 5 signs of Parkinson's include tremors, stiffness, balance problems, trouble speaking, and small handwriting.
Treatment & Diagnosis
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.