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Selegiline-Venlafaxine – Serotonin Syndrome Risk — SCE Neurology MCQ

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ModerateMovement DisordersSelegiline-Venlafaxine – Serotonin Syndrome RiskSCE Neurology

A 65-year-old man with PD and co-existing depression is started on venlafaxine. His neurologist warns about a specific interaction with selegiline (his MAO-B inhibitor). What is the concern?

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Correct answer: D — Serotonin syndrome risk — at higher doses, selegiline loses MAO-B selectivity and inhibits MAO-A, which combined with venlafaxine (SNRI) can precipitate serotonin syndrome

Selegiline at standard PD doses is a selective MAO-B inhibitor, but at higher doses it loses selectivity and also inhibits MAO-A. Combined with serotonergic agents (SSRIs, SNRIs, TCAs, tramadol), this creates a risk of serotonin syndrome. BNF and MHRA advise caution with this combination. Rasagiline has the same risk. A: Clinically significant interaction. C: Venlafaxine can be used cautiously but the interaction exists. D: Not an absorption issue. E: Both MAO-B inhibitors carry this risk.

Reference: BNF Drug Interactions; MHRA