Transdermal selegiline (Selegiline Transdermal Patch)[/topic/selegiline-transdermal-patch] is a medication used primarily for treating major depressive disorder, with unique safety considerations due to its mechanism of action as a monoamine oxidase inhibitor (MAOI). At the standard 6 mg/24-hour dose, it avoids the need for tyramine dietary restrictions common with oral MAOIs. However, it carries significant risks of drug interactions, particularly with other antidepressants, stimulants, and certain medications that could lead to serotonin syndrome or hypertensive crisis. Special populations such as children, pregnant women (Category C), and patients with specific medical conditions require careful evaluation before use. Proper application technique and monitoring for side effects like drowsiness or dizziness are essential for safe use.
Key Points Explained:
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Dosage-Specific Safety Profile
- At the 6 mg/24-hour dose, dietary tyramine restrictions aren't required, unlike higher doses or oral MAOIs
- Lower transdermal doses bypass first-pass metabolism, reducing risks associated with gut MAO inhibition
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Critical Drug Interactions
- Contraindicated with many antidepressants (SSRIs, SNRIs, TCAs), stimulants, and certain pain medications (e.g., meperidine)
- Requires 1-2 week washout after discontinuing most contraindicated drugs (5 weeks for fluoxetine)
- Risk of serotonin syndrome or hypertensive crisis with improper combinations
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Special Population Considerations
- Pregnancy Category C: Use only if potential benefit justifies fetal risk
- Not approved for pediatric use due to increased suicidal ideation risk
- Caution in elderly patients due to potential for orthostatic hypotension
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Pre-Treatment Evaluation Requirements
- Full medication reconciliation including OTC drugs and supplements
- Screening for contraindicated conditions:
- Pheochromocytoma (absolute contraindication)
- Cardiovascular disease
- Seizure disorders
- Bipolar disorder (may trigger manic episodes)
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Application Safety Protocols
- Apply to clean, dry skin on upper torso or thigh (rotate sites)
- Ensure proper adhesion; replace if patch detaches
- Avoid external heat sources which may increase absorption
- Wash hands after application to prevent accidental exposure
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Monitoring & Adverse Effects
- Orthostatic hypotension monitoring, especially in elderly
- CNS effects: drowsiness, dizziness (caution with driving/operating machinery)
- Skin reactions at application site (contact dermatitis)
- Mood changes including suicidal ideation (particularly in young adults)
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Surgical Considerations
- Disclose use to anesthesiologists preoperatively
- May require discontinuation before elective surgery
- Potential interactions with anesthetic agents and vasopressors
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Lifestyle Factors
- Alcohol use may potentiate CNS depression
- No dietary restrictions at 6 mg dose, but higher doses may require tyramine avoidance
- Temperature regulation (avoid excessive heat/saunas which may alter drug delivery)
Summary Table:
| Safety Consideration | Key Details |
|---|---|
| Dosage Safety | 6 mg/24-hour dose avoids dietary restrictions; lower transdermal doses reduce gut MAO risks |
| Drug Interactions | Contraindicated with SSRIs, SNRIs, TCAs, stimulants; requires washout periods |
| Special Populations | Pregnancy Category C; not for pediatric use; caution in elderly |
| Pre-Treatment Screening | Medication reconciliation; screen for pheochromocytoma, CVD, seizure disorders |
| Application Protocols | Rotate sites; ensure adhesion; avoid heat sources; wash hands after application |
| Monitoring Needs | Orthostatic hypotension, CNS effects, skin reactions, mood changes |
| Surgical Considerations | Disclose use preoperatively; may require discontinuation |
| Lifestyle Factors | Alcohol may increase CNS depression; no dietary restrictions at 6 mg dose |
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