Selegiline, Transdermal

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KEY POINTS

• This medicine is a patch put on the skin to treat certain types of depression. Take it exactly as directed.
• This medicine may increase suicidal thoughts or actions, or cause other behavior changes in some people.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may cause unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Certain foods, drinks, and medicines can cause dangerously high blood pressure if you consume them while taking this medicine. 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: MAO inhibitor; antidepressant

Generic and brand names: selegiline, transdermal; Emsam

What is this medicine used for?

This medicine is a patch put on the skin to treat depression.

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
• Bipolar disorder
• Heart problems or a heart attack
• High or low blood pressure or fainting problems
• Pheochromocytoma (a tumor on the adrenal gland)
• Seizures

Tell your healthcare provider if you are currently taking any other medicines, including nonprescription medicines, supplements, or natural remedies. Many other medicines should not be taken within 2 weeks or longer of taking this medicine. Taking certain other medicines can cause serious or life-threatening side effects.

Females of childbearing age: Talk with 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 your healthcare provider's approval.

How do I take it?

Read the Medication Guide that comes in the medicine package when you start taking this medicine and each time you get a refill.

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

Important: Check the label on the medicine for directions about your specific dose. Use this medicine exactly as your healthcare provider prescribes. Use only 1 patch at a time. Do not cut the patch into smaller pieces. Change the patch once every 24 hours. Do not stop using this medicine without your healthcare provider's approval, even if you feel better.

Do not use a patch if the seal is broken, or if it is cut or damaged in any way. Just before you apply the patch, remove it from the sealed pouch. Do not store the patch outside of the sealed pouch.

Put a patch on dry, smooth skin on your upper chest or back (below the neck and above the waist), upper thigh or to the outside of the upper arm. Do not place the patch where tight clothing could cause the patch to rub off. Do not put the patch on skin that is broken or irritated. Do not use a heating pad, electric blanket, hot tub, sauna, or other direct heat where you apply the patch. These may increase the amount of medicine released from the patch and could result in an overdose.

Choose a new site each time you change your patch. Do not use the same site 2 days in a row. Apply the patch at about the same time each day. If patch falls off and cannot be pressed back on, put a new patch on a new site.

Wash the area gently and thoroughly with soap and warm water. Rinse until all the soap is removed. Dry the area with a clean dry towel. After you have applied the patch, wash your hands well with soap and water to remove any medicine that may have gotten on them. Do not touch your eyes until after you have washed your hands.

To dispose of a used patch, fold it so that it sticks to itself with the medicine inside. Then dispose of it safely away from children and pets.

What if I miss a dose?

If you forget to change the patch, change it as soon as you remember. Do not apply extra patches to make up for a missed dose. If you are not sure of what to do, 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: drowsiness, dizziness, fainting, irritability, hyperactivity, agitation, severe headache, hallucinations, jaw tightness, trouble breathing, sweating, fever, cool or clammy skin, stiffness or arching of the back, fast or irregular heartbeat, seizures, coma.

What should I watch out for?

This medicine may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment or if the dose changes. Talk with your provider about this. Contact your provider right away if you or your family notice any disturbing changes in your thoughts or behavior, such as:

• More outgoing or aggressive behavior than normal
• Confusion
• Hallucinations
• Worsening of depression
• Suicidal thoughts

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 cause an increase in blood pressure. You must avoid certain foods or drinks while using this medicine, and for 2 weeks after stopping this medicine. Read the information about these foods or drinks included in the medicine package carefully. Talk with your healthcare provider if you have any questions.

Your healthcare provider will want to see you regularly to check on your progress and dosage. Keep all appointments.

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.

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

Do not drink alcohol while taking this medicine. Do not take other medicines without your healthcare provider's approval. Certain foods, drinks, and medicines can cause dangerously high blood pressure while you are taking this medicine. Talk with your healthcare provider about this.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine. You may need to stop using the patch for several days before you have a surgery.

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); sudden weakness, numbness, or tingling, especially on one side of your body; sudden or severe headache; sudden trouble with vision, speech, balance, or walking.

Serious (Report these to your healthcare provider right away.): Chest pain; hallucinations; bloody or tarry bowel movements; trouble urinating; trouble breathing; enlarged pupils; fast or slow heartbeat; irregular heartbeat; increased sensitivity to light; increased sweating (possibly with fever or cold, clammy skin); severe nausea and vomiting; severe diarrhea; stiff or sore neck; unusual mood changes; confusion; thoughts of suicide; unusual behavior; new or worsening depression; unusual nervousness or anxiety; severe dizziness or fainting; trouble controlling movements of body; seizures.

Other: dizziness, lightheadedness, diarrhea, constipation, gas, runny or stuffy nose, dry mouth, weight loss, stomach cramps, mild headache, trouble sleeping, change in sexual ability or desire, itching or redness where you put the patch.

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:

• ACE inhibitors such as benazepril (Lotensin), captopril, enalapril (Vasotec), fosinopril, lisinopril (Prinivil, Zestril), quinapril (Accupril), and ramipril (Altace)
• Allergy, cold, or cough medicines such as cyproheptadine, dextromethorphan (Robitussin DM), ephedrine, naphazoline, oxymetazoline (Afrin, Dristan), phenylephrine (Neo-Synephrine, Sudafed PE), pseudoephedrine (Sudafed), and tetrahydrozoline (Tyzine, Visine)
• Alosetron (Lotronex)
• Alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), tamsulosin (Flomax), and terazosin
• Angiotensin receptor blockers (ARBs) such as azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan)
• Antidepressants such as amitriptyline, amoxapine, citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), 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), and vilazodone (Viibryd) (Do not take this medicine and an antidepressant within 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)
• Bupropion (Aplenzin, Forfivo, Wellbutrin, Buproban, Zyban)
• Buspirone
• Cabergoline
• Caffeine
• Calcium channel blockers such as amlodipine (Norvasc), amlodipine/atorvastatin (Caduet), diltiazem (Cardizem, Cartia, Tiazac), felodipine, isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat CC, Procardia), and verapamil (Calan, Covera, Verelan)
• Clonidine (Catapres, Kapvay)
• Diuretics (water pills) such as amiloride, bumetanide, chlorothiazide (Diuril), chlorthalidone, furosemide (Lasix), hydrochlorothiazide (Microzide), spironolactone (Aldactone), torsemide (Demadex), and triamterene (Dyrenium)
• Doxepin (Silenor)
• Epinephrine (Adrenalin, Asthmanefrin, Auvi-Q, EpiPen)
• Erectile dysfunction medicines such as avanafil (Stendra), sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra, Staxyn)
• Hormonal birth control implants, IUDs, patches, pills, shots, and vaginal rings
• Hydralazine
• Linezolid (Zyvox)
• Lithium (Lithobid)
• Lorcaserin (Belviq)
• Medicines to treat breathing or lung problems such as albuterol (ProAir, Proventil, Ventolin), arformoterol (Brovana), 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), ergotamine (Ergomar), 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 ephedra, guarana, kava, phenylalanine, SAMe, St. John's wort, tryptophan, tyramine, tyrosine, valerian, and yohimbe
• Nausea medicines such as dolasetron (Anzemet), ondansetron (Zofran), prochlorperazine (Compro), and promethazine
• Nevirapine (Viramune)
• Other 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.)
• Pain medicines such as buprenorphine (Buprenex, Butrans), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), methadone (Dolophine, Methadose), oxymorphone (Opana), tapentadol (Nucynta), and tramadol (ConZip, Ultram)
• Parkinson’s disease medicines such as bromocriptine (Cycloset, Parlodel), entacapone (Comtan), levodopa/carbidopa (Duopa, Rytary, Sinemet), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), and tolcapone (Tasmar)
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Procarbazine (Matulane)
• Products that contain methylene blue (Hyophen, Prosed DS, Urophen, Uta)
• Propranolol (Hemangeol, Inderal, InnoPran)
• Rifampin (Rifadin)
• 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)
• Tetrabenazine (Xenazine)
• 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, dried fruits, smoked fish, meat, or poultry; sauerkraut; soy sauce; red wine; or tap beer. Talk with your healthcare provider about this.

Do not drink alcohol while using this medicine 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 pouches sealed until ready to use. Protect the medicine from heat, high humidity, and bright light.

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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.