Emsam
Emsam, the brand name for selegiline patch, is used to treat depression in adults. It belongs to a group of medications called monoamine oxidase inhibitors (MAOIs) that work by raising certain chemicals in the brain to help improve mood. You apply the patch to your skin once a day, and it comes in three different dosages. Common side effects of this antidepressant include application site reactions, trouble sleeping, and headaches.
What is Emsam (selegiline)?
What is Emsam (selegiline) used for?
How Emsam (selegiline) works
Emsam (selegiline) is a monoamine oxidase inhibitor (MAOI). It's not fully understood how this medication helps with depression, but it's likely that blocking a protein called monoamine oxidase helps raise certain chemicals in the brain. This is thought to improve your mood and emotions.
Drug Facts
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What are the side effects of Emsam (selegiline)?
Common Side Effects
- Application site reactions (24%)
- Headache (18%)
- Trouble sleeping (12%)
- Diarrhea (9%)
- Dry mouth (8%)
- Indigestion (4%)
- Rash (4%)
- Sinus infection (3%)
- Sore throat (3%)
Other Side Effects
- Sexual problems
- Low blood pressure
- Weight gain
- Weight loss
- Reduced appetite
- Itchiness
- High heart rate
- Tremors
Serious Side Effects
- Suicidal thoughts and behavior
- Serotonin syndrome: agitation, hallucinations, confusion, coma, fast heart rate, sudden changes in blood pressure, dizziness, sweating, blushing, high body temperature, tremor, stiffness, muscle jerks, seizures
- Dangerously high blood pressure: chest pain, severe headaches, fast heartbeat, stiff or sore neck, nausea, vomiting, sweating, wide pupils, light sensitivity
Source:Â DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Chills
cold sweats
confusion
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
Incidence not known
Confusion about identity, place, and time
seeing things that are not there
seizures
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Burning, itching, redness, skin rash, swelling, or soreness where the patch was placed
headache
trouble sleeping
Less common
Belching
body aches or pain
change or problem with discharge of semen
congestion
dryness or soreness of the throat
hoarseness
indigestion
pain or tenderness around the eyes and cheekbones
rash
stomach discomfort, upset, or pain
stuffy or runny nose
tender, swollen glands in the neck
tightness of the chest
trouble swallowing
troubled breathing
voice changes
weight changes
Rare
Decreased interest in sexual intercourse
inability to have or keep an erection
loss in sexual ability, desire, drive, or performance
not able to have an orgasm
Incidence not known
Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
tension
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Emsam (selegiline)
Pros
Only need to be applied once a day
Good option for people who have trouble swallowing pills
Available in multiple strengths
Cons
Can cause irritation to the skin
Higher doses require a low-tyramine diet
Can interact with many medications
Pharmacist tips for Emsam (selegiline)
Apply a new Emsam (selegiline) patch around the same time every day. Always remove the old patch first because you can only wear one patch at a time. Choose a new area of skin every time you change your patch to avoid skin irritation.
Don't cut the Emsam (selegiline) patch into pieces. This can affect how the medication is absorbed into your body and might make it work less well.
Avoid direct heat while wearing the Emsam (selegiline) patch — no saunas, heating pads, hot tubs, or long sun exposure. Heat can cause too much of the medication to enter your body, which can put you at higher risk for side effects.
Don’t drink alcohol while using Emsam (selegiline). Even though it hasn't been shown to cause serious problems together, it's usually best for people with depression to avoid alcohol.
Be careful driving or using machinery until you know how Emsam (selegiline) affects you. It might make some people feel sleepy or unsteady.
Keep an eye out for mood changes or suicidal thoughts, especially when starting or changing your dose of Emsam (selegiline).
Let your prescriber know if you're pregnant or planning to become pregnant, since Emsam (selegiline) might not be safe in pregnancy. Talk with your prescriber if you have questions about treating depression while pregnant.
Don't breastfeed while using Emsam (selegiline), or for 5 days after stopping it, because it’s not known if the medication passes into breast milk.
If you're using the 9 mg or 12 mg Emsam (selegiline) patch, avoid tyramine-rich foods like aged cheeses, cured meats, red wine, and certain fruits. This helps prevent a serious reaction that can raise your blood pressure.
Tell your care team about all prescription, over-the-counter, and herbal medications before using Emsam (selegiline). Some medications, like fluoxetine, carbamazepine, or buspirone, can cause dangerous interactions.
How to use Emsam (selegiline):
Apply Emsam (selegiline) to clean, dry skin on your torso (below your neck and above your waist), upper thigh, or outer upper arm. Avoid hairy, broken, or oily skin.
Tear the pouch open at the notches and avoid touching the sticky side of the patch. Wash your hands with soap and water after applying the patch to wash off any medication that might've gotten on your hands.
Press the sticky side flat on your skin, smoothing out any bumps or folds. Make sure it’s sticking all the way around the edges.
To remove the patch, peel it off slowly. If it's hard to remove, use soap and water or a little olive oil to loosen it.
Then fold the used patch in half with the sticky sides together and throw it away in a sealed container, far from pets or kids.
If the patch falls off, press it back on. If it won't stay, use a new patch but keep your same schedule for changing patches.
Frequently asked questions about Emsam (selegiline)
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What are the risks and warnings for Emsam (selegiline)?
Emsam (selegiline) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Suicidal thoughts and behaviors
Risk factors: Children and young adults
Medications for depression, including Emsam (selegiline), can raise the risk of suicidal thoughts and behavior in children and young adults. Ask your loved ones to help you watch for changes in your mood or behavior, and tell your prescriber right away if anything feels wrong — especially during the first few months or if your dose changes. If your depression gets worse or you start having thoughts of self-harm, your prescriber might decide to change your treatment or stop Emsam (selegiline).
Serotonin syndrome
Risk factors: Taking medications that raises serotonin levels
Using Emsam (selegiline) with certain medications that affect serotonin levels — like SSRIs or SNRIs — can cause a rare but life-threatening condition called serotonin syndrome. This can also happen if you recently stopped a serotonin medication and then start Emsam (selegiline) too soon after.
Before starting Emsam (selegiline), make sure your prescriber knows all the medications you’re taking. Get emergency help right away if you notice symptoms like agitation, hallucinations, confusion, fast heart rate, dizziness, sweating, flushing, high fever, tremors, or muscle stiffness.
Dangerously high blood pressure
Risk factors: Children 12 years old and under | Eating foods that have high levels of tyramine and taking Emsam (selegiline) 9 mg or 12 mg| Also taking certain medications
Rarely, Emsam (selegiline) can cause dangerously high blood pressure because it blocks your body from breaking down tyramine, a chemical that affects blood pressure. If you're using the 9 mg or 12 mg, you should eat only low-tyramine foods while using these patches and for 2 weeks after stopping.
Before starting Emsam (selegiline), make sure your prescriber knows about all your medications and supplements. Taking Emsam (selegiline) with certain medications — like buspirone, amphetamine salts, or pseudoephedrine — can also raise your risk of dangerously high blood pressure. You might have to wait at least a week between stopping certain medications and starting this one.
Stop using the patch and call 911 right away if you have chest pain, a severe headache, fast heartbeat, stiff neck, nausea, vomiting, sweating, large pupils, or light sensitivity. These might be signs of a serious medical emergency.
Mania
Risk factors: Bipolar disorder | Family history of bipolar disorder
Rarely, Emsam (selegiline) can cause a manic episode in people with bipolar disorder. Symptoms might include extreme excitement, unusual happiness, fast talking, or delusions. Let your prescriber know before starting Emsam (selegiline) if you or someone in your family has bipolar disorder. Get medical help right away if you notice any sudden or unusual changes in behavior.
Avoid heat on patch area
Though it's not exactly known how head affects Emsam (selegiline), it’s possible that heat could cause too much medication to be absorbed, leading to higher levels in your body, and thus higher risk for side effects. To stay safe, avoid putting heat directly on the patch area, including heating pads, electric blankets, heat lamps, saunas, hot tubs, heated water beds, or long periods in direct sunlight.
Emsam (selegiline) dosage forms
Typical dosing for Emsam (selegiline)
The typical starting dose is one 6 mg/24 hour patch applied to the skin every 24 hours. The maximum dose is one 12 mg/24 hour patch per day.
Interactions between Emsam (selegiline) and other drugs
More on Emsam (selegiline) interactions
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Amitriptyline
- Amoxapine
- Amphetamine
- Apraclonidine
- Atomoxetine
- Benzphetamine
- Brimonidine
- Bupropion
- Carbamazepine
- Carbinoxamine
- Citalopram
- Clomipramine
- Codeine
- Cyclobenzaprine
- Cyproheptadine
- Desipramine
- Desvenlafaxine
- Deutetrabenazine
- Dexfenfluramine
- Dexmethylphenidate
- Dextroamphetamine
- Dextromethorphan
- Diethylpropion
- Doxylamine
- Duloxetine
- Ephedrine
- Escitalopram
- Fenfluramine
- Fluoxetine
- Fluvoxamine
- Furazolidone
- Guanadrel
- Guanethidine
- Hydroxytryptophan
- Imipramine
- Iproniazid
- Isocarboxazid
- Isometheptene
- Levomethadyl
- Levomilnacipran
- Linezolid
- Lisdexamfetamine
- Maprotiline
- Mazindol
- Meperidine
- Methamphetamine
- Methotrimeprazine
- Methyldopa
- Methylene Blue
- Methylphenidate
- Milnacipran
- Mirtazapine
- Moclobemide
- Nefopam
- Nialamide
- Nortriptyline
- Opipramol
- Ozanimod
- Paroxetine
- Phendimetrazine
- Phenelzine
- Phenmetrazine
- Phentermine
- Phenylalanine
- Phenylephrine
- Phenylpropanolamine
- Procarbazine
- Propoxyphene
- Protriptyline
- Pseudoephedrine
- Rasagiline
- Reserpine
- Safinamide
- Serdexmethylphenidate
- Sertraline
- Sibutramine
- Solriamfetol
- St John's Wort
- Sumatriptan
- Tapentadol
- Tetrabenazine
- Tramadol
- Tranylcypromine
- Trazodone
- Trimipramine
- Tryptophan
- Venlafaxine
- Vilazodone
- Viloxazine
- Vortioxetine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alfentanil
- Alizapride
- Amineptine
- Amitriptylinoxide
- Atropine
- Benzhydrocodone
- Bromperidol
- Buprenorphine
- Buspirone
- Butorphanol
- Clovoxamine
- Dibenzepin
- Difenoxin
- Dihydrocodeine
- Diphenoxylate
- Dolasetron
- Domperidone
- Dothiepin
- Doxepin
- Droperidol
- Epinephrine
- Ethchlorvynol
- Femoxetine
- Fentanyl
- Fluspirilene
- Frovatriptan
- Granisetron
- Guarana
- Haloperidol
- Hydrocodone
- Hydromorphone
- Iobenguane I 123
- Iobenguane I 131
- Kava
- Lasmiditan
- Levorphanol
- Licorice
- Lithium
- Lofepramine
- Lorcaserin
- Ma Huang
- Mate
- Melitracen
- Mephentermine
- Metaraminol
- Metaxalone
- Methadone
- Metoclopramide
- Metopimazine
- Midodrine
- Morphine
- Morphine Sulfate Liposome
- Nalbuphine
- Naratriptan
- Nefazodone
- Norepinephrine
- Ondansetron
- Oxycodone
- Oxymetazoline
- Oxymorphone
- Palonosetron
- Penfluridol
- Pentazocine
- Pimozide
- Reboxetine
- Remifentanil
- Sufentanil
- Sulpiride
- Sultopride
- Tianeptine
- Tiapride
- Tyrosine
- Valbenazine
- Veralipride
- Ziprasidone
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acarbose
- Chlorpropamide
- Dopamine
- Ginseng
- Glimepiride
- Glipizide
- Glyburide
- Insulin
- Insulin Aspart, Recombinant
- Insulin Bovine
- Insulin Degludec
- Insulin Detemir
- Insulin Glargine, Recombinant
- Insulin Glulisine
- Insulin Lispro, Recombinant
- Metformin
- Nateglinide
- Repaglinide
- Tolazamide
- Tolbutamide
How much does Emsam (selegiline) cost?
Emsam (selegiline) contraindications
Taking selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), clomipramine or imipramine, meperidine, tramadol, methadone, pentazocine, propoxyphene, carbamazepine, and dextromethorphan together with Emsam (selegiline).
Starting Emsam (selegiline) within about 1 week of stopping the medications mentioned above or within 5 weeks of stopping fluoxetine
Starting any of the medications mentioned above within 2 weeks of stopping Emsam (selegiline)
Children younger than 12 years old
People with a tumor in the small glands on top of the kidneys (pheochromocytoma)
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References
Best studies we foundAsnis, G. M., et al. (2014). EMSAM (deprenyl patch): How a promising antidepressant was underutilized. Neuropsychiatric Disease and Treatment.
Burns, C., et al. (2022). Biochemistry, tyramine. StatPearls.
Chrisp, P., et al. (1991). Selegiline. A review of its pharmacology, symptomatic benefits and protective potential in Parkinson's disease. Drugs & Aging.
Laban, T. S., et al. (2023). Monoamine oxidase inhibitors (MAOI). StatPearls.
Viatris Specialty LLC. (2020). Emsam- selegiline patch [package insert]. DailyMed.
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