Selegiline patches, a transdermal form of the monoamine oxidase inhibitor (MAOI) used to treat depression, have significant interactions with numerous medications and substances. These interactions can lead to serious side effects like hypertensive crises, serotonin syndrome, or reduced efficacy of either drug. The patch's unique delivery system doesn't eliminate MAOI dietary restrictions but may lessen some risks compared to oral MAOIs. Key interacting substances include other antidepressants, stimulants, certain pain medications, and even some over-the-counter products. Patients must disclose all medications, supplements, and herbal products to their healthcare provider before using (Selegiline Patch)[/topic/selegiline-patch].
Key Points Explained:
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Antidepressant Interactions
- SSRIs/SNRIs (e.g., fluoxetine, citalopram): Risk of serotonin syndrome—a potentially fatal condition causing agitation, hallucinations, and rapid heart rate. Fluoxetine requires a 5-week washout period before starting selegiline.
- Tricyclics (e.g., amitriptyline): May cause hypertensive episodes or seizures.
- Other MAOIs (including rasagiline/safinamide): Amplified MAOI effects, increasing blood pressure dangerously.
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Stimulants and ADHD Medications
- Amphetamines/dextromethorphan: Found in ADHD treatments and cough syrups, these can trigger hypertensive crises when combined with MAOIs.
- Atomoxetine: Increases norepinephrine levels, risking severe blood pressure spikes.
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Pain Medications
- Opioids (e.g., meperidine): High risk of serotonin syndrome or respiratory depression. Tramadol and methadone are also contraindicated.
- Cyclobenzaprine: A muscle relaxant with serotonergic effects that may interact unpredictably.
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Over-the-Counter (OTC) Products
- Decongestants (e.g., pseudoephedrine): Vasoconstrictors that compound blood pressure risks.
- St. John’s Wort: An herbal antidepressant that heightens serotonin dangerously.
- Dextromethorphan: Common in cough medicines, it can cause psychosis or toxicity.
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Other Notable Interactions
- Carbamazepine: Reduces selegiline’s effectiveness by accelerating its metabolism.
- Buspirone: May lead to serotonin syndrome despite being an anxiolytic.
- Alcohol: Can worsen dizziness or sedation and increase blood pressure unpredictably.
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Special Considerations
- Application Site Reactions: While not a drug interaction, skin irritation from the patch may mimic allergic reactions, complicating adherence.
- Gradual Introductions: When switching from interacting drugs, strict washout periods are essential to avoid overlap toxicity.
Patients should monitor for symptoms like severe headaches, chest pain, or confusion, which may indicate an interaction. Always consult a pharmacist or doctor before combining medications with selegiline patches.
Summary Table:
| Category | Examples | Risks |
|---|---|---|
| Antidepressants | SSRIs (fluoxetine), SNRIs, Tricyclics | Serotonin syndrome, hypertensive crises |
| Stimulants/ADHD Meds | Amphetamines, atomoxetine | Hypertensive crises, norepinephrine spikes |
| Pain Medications | Meperidine, tramadol, cyclobenzaprine | Serotonin syndrome, respiratory depression |
| OTC Products | Pseudoephedrine, St. John’s Wort | Blood pressure spikes, serotonin toxicity |
| Other Medications | Carbamazepine, buspirone, alcohol | Reduced efficacy, serotonin syndrome, unpredictable blood pressure effects |
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