The dosing guidelines for selegiline transdermal in treating depression involve a structured titration approach to balance efficacy and tolerability. Treatment begins with a 6 mg/24-hour patch applied daily, with potential increases of 3 mg every two weeks based on response, up to a maximum of 12 mg/24 hours. This method allows for gradual adjustment while minimizing side effects. The Selegiline Transdermal Patch is typically reserved for atypical or treatment-resistant depression due to its cost and MAO inhibitor classification. Proper application on intact skin (upper arm, torso, or thighs) is critical, and patches should never be cut.
Key Points Explained:
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Initial Dosage
- The starting dose is 6 mg/24 hours, delivered via a transdermal patch applied daily. This low initial dose helps assess patient tolerance and reduces the risk of adverse effects common with MAO inhibitors.
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Titration Schedule
- Dosage may be increased by 3 mg/24 hours every two weeks if the response is inadequate. For example:
- Week 1–2: 6 mg/24 hours
- Week 3–4: 9 mg/24 hours (if needed)
- Week 5+: 12 mg/24 hours (maximum dose).
- This stepwise approach ensures gradual adaptation and minimizes risks like hypertension or serotonin syndrome.
- Dosage may be increased by 3 mg/24 hours every two weeks if the response is inadequate. For example:
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Maximum Dosage
- The 12 mg/24-hour patch is the ceiling dose. Exceeding this limit is not recommended due to increased side-effect risks and lack of proven additional benefits.
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Application Guidelines
- Patches must be applied to intact skin (avoiding irritated or hairy areas) on the upper arm, torso, or thighs.
- Rotate application sites to prevent skin irritation.
- Never cut patches, as this disrupts controlled drug release.
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Special Considerations
- Reserved for treatment-resistant or atypical depression due to cost and MAO inhibitor interactions (e.g., dietary tyramine restrictions).
- Requires close monitoring for side effects (e.g., insomnia, dizziness) and drug interactions (e.g., SSRIs, opioids).
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Available Strengths
- Patches come in 6 mg, 9 mg, and 12 mg/24-hour formulations, aligning with the titration protocol.
By following these guidelines, clinicians can optimize therapeutic outcomes while managing risks associated with transdermal selegiline therapy.
Summary Table:
| Key Aspect | Guideline |
|---|---|
| Initial Dosage | 6 mg/24-hour patch applied daily |
| Titration Schedule | Increase by 3 mg every 2 weeks (max 12 mg/24 hours) if response is inadequate |
| Maximum Dosage | 12 mg/24-hour patch (no further increase recommended) |
| Application Sites | Upper arm, torso, or thighs (intact skin; rotate sites) |
| Critical Precautions | Never cut patches; monitor for drug interactions/side effects |
| Target Patients | Treatment-resistant or atypical depression cases |
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