Transdermal selegiline administration requires careful attention to dosing protocols, dietary restrictions, and skin monitoring. The standard starting dose is 6 mg/24 hours, with potential titration up to 12 mg in 3 mg increments every two weeks. Higher doses (9 mg or 12 mg) necessitate strict avoidance of tyramine-rich foods to prevent hypertensive crises, while the 6 mg dose typically doesn't require dietary modifications. Elderly patients (65+) should generally remain on the 6 mg dose. Regular skin examinations are crucial due to the transdermal delivery method. These guidelines balance therapeutic efficacy with safety considerations unique to this MAO inhibitor's transdermal formulation.
Key Points Explained:
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Dosing Protocol
- Initial Dose: 6 mg/24 hours via Selegiline Transdermal Patch applied once daily.
- Titration: May increase by 3 mg every two weeks, max 12 mg/24 hours.
- Geriatric Consideration: Patients ≥65 years should typically stay at 6 mg due to increased sensitivity.
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Dietary Restrictions
- 6 mg Patch: No dietary modifications needed.
- 9 mg/12 mg Patches: Strict avoidance of tyramine-rich foods (aged cheeses, cured meats, fermented products) during treatment and for two weeks after discontinuation to prevent hypertensive crisis.
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Skin Monitoring
- Periodic examinations are mandatory to assess for irritation, allergic reactions, or adhesive-related dermatitis. Rotate application sites (e.g., upper torso, thigh) to minimize skin sensitivity.
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Application Guidelines
- Apply to clean, dry, intact skin; avoid areas with cuts or irritation.
- Press firmly for 30 seconds to ensure adhesion.
- Dispose of used patches safely (fold adhesive side inward) to prevent accidental exposure.
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Safety Considerations
- Avoid concurrent use with serotonergic drugs (e.g., SSRIs) due to serotonin syndrome risk.
- Monitor for orthostatic hypotension, especially in elderly patients.
- Educate patients to recognize symptoms of tyramine reaction (severe headache, palpitations).
These instructions optimize therapeutic outcomes while mitigating risks inherent to transdermal MAO inhibitor therapy.
Summary Table:
| Key Aspect | Guidelines |
|---|---|
| Initial Dose | 6 mg/24 hours (once daily application) |
| Titration | Increase by 3 mg every 2 weeks (max 12 mg); geriatric patients stay at 6 mg |
| Dietary Restrictions | Avoid tyramine-rich foods (aged cheeses, cured meats) for 9 mg/12 mg doses |
| Skin Monitoring | Rotate application sites; check for irritation/adverse reactions |
| Safety Alerts | No SSRIs; watch for orthostatic hypotension or tyramine reactions |
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