Select therapeutic use:
Indications for EMSAM:
Major depressive disorder.
Initial: apply one 6mg/24hrs patch daily to dry, intact skin on upper torso, upper thigh, or outer surface of upper arm. May titrate at intervals of ≥2 weeks in increments of 3mg/24hrs; max 12mg/24hrs. Rotate application sites. Reevaluate periodically. Do not cut patches.
To avoid potentially severe or fatal interactions (hypertensive crisis and/or serotonin syndrome), allow sufficient drug-free interval (see literature) between selegiline and: fluoxetine, buspirone, SSRIs, serotonin/norepinephrine reuptake inhibitors, tricyclics, bupropion, meperidine, tramadol, methadone, propoxyphene, dextromethorphan, St. John's wort, mirtazapine, cyclobenzaprine, other MAOIs, carbamazepine, oxcarbazepine, amphetamines, other sympathomimetic amines (eg, pseudoephedrine), general anesthesia [esp for elective surgery], cocaine, local anesthetics containing sympathomimetic vasoconstrictors; others (see literature). Pheochromocytoma.
Doses above 6mg/24hrs: see literature for tyramine dietary modifications. Avoid exposing patch to external heat sources. Mania/hypomania. Monitor for clinical worsening or suicidality. Recent MI. Unstable heart disease. Conditions that affect metabolism or hemodynamic response. Elderly (monitor BP). Pregnancy (Cat.C). Nursing mothers.
See Contraindications. Avoid alcohol, dietary supplements with tyramine.
Application site reaction, headache, insomnia, GI upset, dry mouth, rash, pharyngitis, sinusitis, orthostatic hypotension; others.