emsam

Has any one used Emsam (selegiline) patch for major depression. My pdoc suggests giving this a try. I don't know much about it. It is a relatively new FDA approved patch, i know it is a MAOI. From what i have read, the smaller doses don't require dietary monitoring, but how well does the small doses work, what are the chances that the dose will have to be increased creating the need? I would appreciate any insight or info about this medication.

Wow, it is interesting that they are coming more & more to using patches for medications. I don't know anything about emsam. I do know that using patches for medication are a great way of taking a med. I am on a narcotic (fentynal) that is in patch form that has to be changed every 3 days. I hate swollowing pills, so the use of a med entering my body through the skin makes it much easier to use the med. I hate trying to remember taking pills & I end up choking on them when I do.

I guess it wouldn't be a bad thing to try, but I would request only filling a small amount of the prescription before filling the whole thing. That way you can know if causes you any bad side effects before sinking in money for the whole amount of the med.

Good luck on the use of this med....I am sure that many of us will be interested in how it works for you.
Debbie

The active ingredient in Emsam, selegiline, has been in use for decades. What is new about this particular product is the delivery system, i.e. the transdermal patch. Here is a link to the monograph for the drug, if you want to read up on it: http://www.rxlist.com/cgi/generic4/emsam.htm You'll find explicit descriptions of the clinical trial data with respect to the tyramine/blood pressure reactions on the Side Effects and Drug Interactions page.

What sets selegiline apart from the other irreversible MAO inhibitors is that selegiline preferentially binds to MAO-B, the enzyme form more localized to neurons. MAO-A, the isoform which is bound with lower affinity, is the predominant form in the gut. Selegiline is also extensively metabolized by other liver and gut enzymes. In order for sufficient selegiline to make it to the brain and have the desired mood elevating effect, the oral dose must be so high as to also inactivate the gut MAO-A. As a result, oral selegiline never offered any real benefits over Parnate or Nardil, the "standard" irreversible MAOI medications.

Selegiline did find a niche market in the realm of nootropics, drugs used to sharpen the mind and improve cognitive performance. Users of low-dose selegiline for cognitive improvement found that dissolving the tablet under the tongue (or employing a selegiline solution) vastly improved the drug effect. That's because selegiline dissolves into the skin, and the skin under the tongue is very thin. When the drug enters the blood transdermally, it bypasses all those enzymes in the gut and liver, which are collectively called the first pass metabolism. Therefore, transdermal delivery of selegiline eliminated its greatest drawback, the requirement to use a high enough oral dose to incapacitate gut MAO-A. That meant that dietary tyramine would no longer cause the hypertensive crisis (the "cheese effect") which was the greatest drawback to the MAOI class of drugs collectively.

Well, the statistics say that, pretty much.

But statistics don't apply to individuals. No one can assume that they will not need to concern themselves with tyramine intake, if using the Emsam patch. The number of people actually observed in the tyramine challenge part of the clinical trials is relatively small, and there was considerable variation between individuals in those trials. It's probably very safe to use the 6 mg/day Emsam patch, and it may be nearly as safe to use the 9 mg/day and 12 mg/day doses, but.....

Anybody who uses an MAOI (even reversible ones like moclobemide (Mannerix/Aurorix)) should be aware of foods which contain tyramine, and the symptoms of hypertensive crisis. The safety margin at 6 mg/day is statistically quite substantial (about 10 times the likely intake from a typical diet), and is still about 3-fold at 9 mg/day, but those are average values. There are too many individual variables, beginning with 4-fold variation in uptake from the patch, and including genetic differences in enzyme concentrations in the gut and liver, to make firm predictions.

I have never used the patch form of selegiline, but I had good effects from oral tablets dissolved under my tongue. Selegiline is relatively benign drug, with respect to side effects, with insomnia being one of the more troublesome reactions. Because transdermal delivery systems maintain stable blood concentrations of the drug, if insomnia is a problem, you actually lose the opportunity to time your drug dose (i.e. once a day, morning dosing) to have your sleep cycle coincide with a daily low in blood concentration.

It all comes down to individual differences. People tend to love this drug, or hate it, based on comments I've heard. I would certainly be willing to try it, myself.

Good luck,
Lar

I was up to the max dose of 12mg of the patches and it absolutely drove me crazy. I am bipolar, so it made me manic and I was staying up for weeks at a time and doing crazy things. So he had to take me off it. I was on it for about 3 months.

You're right, lower doses dont require dietary monitoring (the 6 and 9mg) but the high one does. You cant eat aged cheese, fava beans, soy, draft beer and quite a few other things because there is a risk of heart problems. The drug definitely raises your BP. The lowest dose helped me a little, but it all depends on your body chemistry and how sensitive you are to MAOIs, because it is a potent drug from what I understand. After taking this though, my doc wont even put me on an AD for a while even though I get SEVERELY, suicidally depressed still.

But, my advice to you would be, try it. If you're taking it for major depression and not bipolar like I was (though I was taking lamictal and abilify, mood stabalizers with it). It didnt work for me, well, I felt actually GREAT, but not in a good way. Give it a try, I've heard great things about it for unipolar depression.

If you have any other questions PLEASE feel free to PM me about it. I have plenty else to say about it and can offer you advice about dealing with the sideeffects.

Good luck darling!

<3 Kelly <3

i've been on emsam 6mg now for two months (unipolar MDD) and it is working well for me, no side effects.