Selegiline Transdermal Patch-MAOI

Hi,

since i am not able to take any SSRI antidepressant drugs, my doctor is planning to put me on Selegiline Transdermal Patch, a type of MAOI.

Does anyone here know anything about this patch?  Everyone says MAOI is dangerous, but it is very effective for anxiety.

Is it true?  Is it safe?

I am also on Ativan 0.75 mg daily, wondering if MAOI is going to interact with Ativan?

will it interact with cold medicine, antiacid, pain killers, nasual spread, common over the counter drugs?

Thanks. 

I'm on Emsam! I've never met another Emsam user!

I'm on the lowest dose [6 mg/ 24 patch]. There are no dietary restrictions with this dose - that was the big worry about older MAOIs. If you go up to a higher dose patch, there are food restrictions that you do need to be careful about.

MAOIs do have some special medication interactions that you do need to be aware of. The full prescribing information about which medications to avoid can be found here: http://www.emsam.com/

I am on Klonopin and Restoril [both benzos] and have not experienced any difficulties with interactions, nor was told about interactions by my doctor or pharmacist. There are some interactions with certain types of cold medicines [those that contain dextromethorphan]. I don't believe antacids should be a problem. I take oxycodone very occasionally without problem. Most OTC meds should be safe, but diet pills and certain supplements that contain seratonin - you should be cautious of. The full prescribing information goes into detail about what should be avoided and you can use a drug interaction checker for specific medications, and ask your doctor or pharmacist.

Emsam has been very effective for my depression, and I have not had any safety concerns while on it. If I start a new med, I make sure to tell my doctor/pharmacist that I'm on an MAOI.

The one side effect that I noticed, for me personally, was insomnia. I worked with my doctor to adjust my dosing time, etc. to counter this. I also had to add Seroquel 25 mg. This may not be an issue for you, as everyone is different.

This is the person who ran the clinical trials for Emsam: http://www.mclean.harvard.edu/about/bios/detail.php?username=abodkin

I have emailed him a few times with questions about the med and he always responds with caring and thoughtful answers that I have passed along to my p-doc.

Feel free to PM me if you have other questions about my experience with it, etc.

Best,

CB

cherry,

thanks a lot! your post is very informative!

do you know if it is good for anxiety disorder?

how long did you have to take the medication to feel it is effective?  how long to you have to be on it?  do you know if there is any withdraw symptom?  how do you tapper off a patch?  cut the patch?  or use the patch every other day?  Is MAOI addictive?

when you need cold medication, what can you do while taking MAOI?

while taking MAOI, it is a good time to tapper off Ativan?  I hate Ativan.  I cannot tell my discomfort is from the Ativan side effect or my real anxiety.  I am trying to tapper off my ativan 10% a week, but I feel the uncomfort from it.  Was there anyone who is not able to tapper off Ativan?  Once you are on it, you are on it lifetime?

Hi Joy,

I am taking it for depression, and I believe that it is only FDA approved for depression. But if you are unable to tolerate another type of AD, an MAOI might help with anxiety - I'm not sure - that would be your doctor's call. There are other non-SSRI/SNRIs, such as tricyclic ADs to look at, but again, I don't know how those treat anxiety.

Since I am taking it for depression, my experience might be different than for the use of anxiety. I was severely depressed and dx with treatment resistant depression. I was taking Lexapro and had to basically c/t that [a very rapid taper] because an SSRI has to be out of our your system for ~3 weeks before starting an MAOI. So I was already very depressed, went off an anti-depressant, and then started the Emsam. I would say it took about 3 weeks before I noticed a real improvement in my depression. It has been extremely effective for depression.

I am on a lot of CNS depressants right now, which might be contributing to my overall depression. Once I am off of those, I might look at switching ADs to something that doesn't cause insomnia, but it really depends on how I am doing. So far, the Emsam has been the most effective AD I have been on, so I don't have plans to taper off of it anytime soon.

I don't know what the discontinuation protocol would be for the patch. I have spoken to Dr. Bodkin with some questions relating to my own situation and he advised I could cut the patch or wear it for restricted periods during the day [this effectively reduces the amount of selegiline entering your bloodstream over a 24 hour period]. I verified that this would be OK with my doctor. I would envision this might be how you would "taper" the patch. I don't think Emsam is addictive - there is probably some discontinuation syndrome associated with it, but since this is the first MAOI I've tried and am still on it, I don't know what the withdrawal might be like.

Luckily, I haven't had to take any cold medications while on the Emsam. When I've gotten sick, I drink tea and use throat drops, Vicks, etc. However, I would just ask my Pharmacist about a cold med that I was interested in - I like Nyquil, for example, and whether that would be safe with the Emsam. I don't think you are totally out of luck while on it - there are just certain ingredients to avoid.

I am not tapering from Ativan, but there are many on here who are that can provide insight into that process. I have had no problems with tapering from Klonopin while taking Emsam. I know that some people who are tapering Ativan can experience anxiety, and sometimes switch to a benzo with a longer half-life, spaced out into several daily doses to help with anxiety from inter-dose withdrawal. You may wish to talk to your doctor about doing something like this to see if that helps with your anxiety, before adding something like Emsam, which is primarily indicated for depression. I believe there are many people on the board who have successfully come off of Ativan, so I don't think it is a life sentence!

Was your Ativan prescribed for an anxiety disorder initially? Anxiety can also be a common side effect from benzo w/d. But you and your doctor will best know how to work together to determine what course of action will best help you at this time.

Best,

CB