Selegiline, Oral

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KEY POINTS

• This medicine is taken by mouth to help treat Parkinson’s disease. Take it exactly as directed.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may cause you to suddenly fall asleep without warning, have unusual urges, or cause other unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: anti-Parkinson's; MAO-B inhibitor

Generic and brand names: selegiline, oral; Eldepryl; Zelapar

What is this medicine used for?

This medicine is taken by mouth to increase the effectiveness of levodopa/carbidopa in the treatment of Parkinson's disease.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• Heart problems
• Kidney or liver disease
• Low blood pressure
• Mental health problems such as schizophrenia or hallucinations
• Phenylketonuria (PKU). The tablet that melts on the tongue contains phenylalanine.

Tell your healthcare provider about all other medicines you are taking, especially pain medicines, antidepressants, cough medicine, and other nonprescription medicines, supplements, or natural remedies. You may need to wait at least 14 days between using an MAO inhibitor and any other medicine.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without discussing with your healthcare provider.

How do I take it?

Important: Check the label on the medicine for directions about your specific dose. Take this medicine exactly as your healthcare provider prescribes. Do not take more or less or take it longer than prescribed. Taking too much can cause serious side effects. Do not stop taking this medicine without your healthcare provider's approval. You may have to reduce your dosage gradually to keep Parkinson's symptoms from returning.

Check with your healthcare provider before using this medicine in children under age 18. Do not use this medicine in children under age 12.

This medicine comes in the form of tablets or capsules that you can swallow or as tablets that melt on your tongue.

If you have the tablets or capsules that you swallow whole, you may take this medicine with or without food. Taking it with meals may lessen the chance the drug will upset your stomach.

If you have the tablets that melt on your tongue, do not open the blister pack until you are ready to take the tablet. With dry hands, peel open the blister pack and place the tablet on your tongue. Do not swallow the tablet whole. Do not eat or drink for 5 minutes before and after taking this medicine.

Your healthcare provider may reduce the amount of levodopa/carbidopa you are taking when you start taking this medicine. Check with your healthcare provider.

What if I miss a dose?

If you miss a dose, take it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: muscle twitching, fast or irregular heartbeat, severe headache, confusion, seizures, coma.

What should I watch out for?

Get medical care right away if you have heavy sweating, severe chest pain, severe headache, faster or slower heartbeat, large pupils, stiff neck, nausea, vomiting, or any other serious side effects.

When taken with certain foods or drinks, this medicine can rarely cause an increase in blood pressure. The risk increases if you take higher doses of this medicine. Talk with your healthcare provider about this.

Using this medicine for a long time may cause muscle spasms, twitching in the face and body, and uncontrolled tongue or jaw movements. Talk to your healthcare provider about this.

This medicine may cause strong urges, such as to gamble, binge eat, or have sex. Talk with your healthcare provider if you have unusual urges while taking this medicine.

People taking this medicine may have a higher risk for skin cancer. You will need to have checkups regularly to see how this medicine affects you. Your healthcare provider will want to see you regularly to check on your progress and dosage. Keep all appointments.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

This medicine may cause you to fall asleep without warning during daily activities including driving a car. This medicine may cause drowsiness and confusion. Do not drive or operate machinery unless you are fully alert.

You may feel dizzy or faint when you get up quickly after sitting or lying down. Getting up slowly may help.

Do not drink alcohol while taking this medicine. Do not take other medicines without your healthcare provider's approval.

Adults over the age of 65 may be at greater risk for side effects from this medicine. Talk with your healthcare provider about this.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; chest pain or tightness in your chest; swelling of your lips, tongue, and throat).

Serious (Report these to your healthcare provider right away.): Chest pain, hallucinations, bloody or tarry bowel movements, trouble urinating, enlarged pupils, fast or slow heartbeat, irregular heartbeat, severe headache, increased sensitivity to light, increased sweating (possibly with fever or cold, clammy skin), severe nausea and vomiting, stiff or sore neck, stiff muscles, severe agitation, unusual urges or behavior, new or worsening depression, unusual mood changes, thoughts of suicide, confusion, severe dizziness or fainting, loss of balance, increase in unusual movements, problems walking or talking.

Other: mild dizziness, trouble sleeping, back pain, dry mouth, stomach cramps or indigestion, mild nausea, diarrhea, constipation, mouth sores or irritation, runny nose.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Allergy, cold, or cough medicines such as dextromethorphan, naphazoline, oxymetazoline (Afrin, Dristan), phenylephrine (Neo-Synephrine, Sudafed PE), pseudoephedrine (Sudafed), and tetrahydrozoline (Tyzine, Visine)
• Alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), and terazosin
• Antibiotics such as linezolid (Zyvox), nafcillin, and rifampin (Rifadin)
• Antidepressants such as amitriptyline, amoxapine, citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), imipramine (Tofranil), maprotiline, mirtazapine (Remeron), nefazodone, nortriptyline (Pamelor), protriptyline (Vivactil), sertraline (Zoloft), trazodone, trimipramine (Surmontil), venlafaxine (Effexor), vilazodone (Viibryd), and vortioxetine (Trintellix) (Do not take this medicine and these antidepressants within at least 14 days of each other; or within 5 weeks of fluoxetine.)
• Antipsychotic medicines such as aripiprazole (Abilify), asenapine (Saphris), chlorpromazine, clozapine (Clozaril, FazaClo), fluphenazine, haloperidol (Haldol), iloperidone (Fanapt), lurasidone (Latuda), olanzapine (Zyprexa), paliperidone (Invega), perphenazine, pimozide (Orap), quetiapine (Seroquel), risperidone (Risperdal), thioridazine, trifluoperazine, and ziprasidone (Geodon)
• Antiseizure medicines such as carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), oxcarbazepine (Trileptal), phenobarbital, phenytoin (Dilantin, Phenytek), and primidone (Mysoline)
• Atomoxetine (Strattera)
• Beta blockers such as acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), carvedilol (Coreg), labetalol (Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), nebivolol (Bystolic), pindolol, and sotalol (Betapace, Sorine)
• Blood pressure medicines such as hydralazine, methyldopa, minoxidil, and reserpine
• Bupropion (Aplenzin, Forfivo, Wellbutrin, Buproban, Zyban)
• Buspirone
• Cabergoline
• Calcium channel blockers such as amlodipine (Norvasc), amlodipine/atorvastatin (Caduet), diltiazem (Cardizem, Cartia, Tiazac), felodipine, isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat CC, Procardia), nisoldipine (Sular), and verapamil (Calan, Covera, Verelan)
• Doxepin (Silenor)
• Ephedrine
• Epinephrine (Adrenalin, Asthmanefrin, Auvi-Q, EpiPen)
• Lithium (Lithobid)
• MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• Medicines to treat breathing or lung problems such as albuterol (ProAir, Proventil, Ventolin), arformoterol (Brovana), formoterol (Perforomist), levalbuterol (Xopenex), pirbuterol (Maxair), salmeterol (Serevent), and theophylline
• Medicines to treat high pressure in the eye such as apraclonidine (Iopidine) and brimonidine (Alphagan P)
• Methyldopa
• Metoclopramide (Metozolv, Reglan)
• Midodrine
• Migraine medicines such as almotriptan (Axert), dihydroergotamine (D.H.E. 45, Migranal), eletriptan (Relpax), ergotamine (Ergomar), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Alsuma, Imitrex, Sumavel), and zolmitriptan (Zomig)
• Milnacipran (Savella)
• Muscle relaxants such as baclofen (Gablofen, Lioresal), carisoprodol (Soma), cyclobenzaprine (Amrix), dantrolene (Dantrium), methocarbamol (Robaxin), and tizanidine (Zanaflex)
• Natural remedies such as green tea, kava, ma huang, SAMe, St. John's wort, tryptophan, and tyrosine
• Nevirapine (Viramune)
• Other selegiline products (Emsam)
• Pain medicines such as buprenorphine (Buprenex, Butrans), codeine, fentanyl (Abstral, Actiq, Duragesic, Fentora, Sublimaze), hydrocodone (Hysingla, Zohydro), hydrocodone/acetaminophen (Norco, Vicodin), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin), oxycodone (OxyContin, Roxicodone), oxycodone/acetaminophen (Percocet, Roxicet), oxymorphone (Opana), pentazocine (Talwin), tapentadol (Nucynta), and tramadol (ConZip, Ultram)
• Parkinson’s disease medicines such as bromocriptine (Cycloset, Parlodel), entacapone (Comtan), levodopa/carbidopa (Duopa, Rytary, Sinemet), levodopa/carbidopa/entacapone (Stalevo), rasagiline (Azilect), and tolcapone (Tasmar)
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Procarbazine (Matulane)
• Products that contain methylene blue (Hyophen, Prosed DS, Urophen, Uta)
• Stimulants and diet pills such as armodafinil (Nuvigil), benzphetamine (Regimex), dexmethylphenidate (Focalin), dextroamphetamine (Dexedrine), diethylpropion (Tenuate), lisdexamfetamine (Vyvanse), methamphetamine (Desoxyn), methylphenidate (Concerta, Daytrana, Metadate, Ritalin), modafinil (Provigil), phendimetrazine, and phentermine (Adipex-P, Suprenza)
• Thiotepa

When taken with certain foods or drinks, this medicine can cause an increase in blood pressure. To avoid this, do not eat large amounts of foods or drink beverages that have a high tyramine content. This includes foods that are aged, fermented, pickled, or smoked, such as aged cheeses; yogurt, sour cream, bananas, avocados, dried fruits, smoked fish, meat, or poultry; sauerkraut; soy sauce; red wine; or beer. Avoid caffeine and chocolate. Talk with your healthcare provider about this.

Do not drink alcohol unless your healthcare provider approves.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

If you have the tablets that melt in your mouth, use them within 3 months of opening the pouch.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.