selegiline hydrochloride: clinical use

Prescribing considerations

• Complete an interaction review, including antidepressants, opioids, migraine treatments, decongestants, linezolid and planned anaesthesia.
• With levodopa, assess for dyskinesia, agitation, hallucinations and hypotension.
• Counsel patients and carers to report compulsive or repetitive behaviours.
• Advise avoidance of alcohol and caution with driving until individual effects are known.
• Use caution with severe hepatic or renal dysfunction and in people with cardiovascular risk or previous hepatic dysfunction.

Contraindications and cautions

• Hypersensitivity to selegiline or product excipients.
• Concomitant antidepressants, other MAO inhibitors, sympathomimetics, serotonin agonists used for migraine, or pethidine and other contraindicated opioids.
• Active gastric or duodenal ulcer.
• Extrapyramidal disorders not related to dopamine deficiency.
• When combined with levodopa: severe cardiovascular disease, hypertension, tachyarrhythmia, severe angina, hyperthyroidism or thyrotoxicosis, phaeochromocytoma, narrow-angle glaucoma, prostatic adenoma with residual urine, psychosis or advanced dementia.

Monitoring

• Clinical response and motor fluctuations.
• Dyskinesia, agitation and other potentiated levodopa effects.
• Supine and standing blood pressure where hypotension is suspected.
• Hallucinations, confusion, mood or psychotic symptoms.
• Impulse-control and compulsive behaviours, with carer input where appropriate.
• Liver enzymes when clinically indicated, particularly with previous hepatic dysfunction.

Clinical pharmacology

Selegiline is a lipophilic, irreversible selective MAO-B inhibitor that enters the brain and reduces dopamine breakdown. Its pharmacodynamic effect outlasts plasma exposure because recovery depends on synthesis of new enzyme.

Formulation and product differences

• The selected product is a conventional oral tablet.
• Dispersing or crushing conventional tablets for swallowing difficulty is off-label and should be assessed individually.

Tablet

Route: Oral

Strengths: 5 mg, 10 mg