Selegiline
Pronunciation: Not established in the sources reviewed..
- Generic name
- selegiline
- Brand names
- EMSAM
- Drug class
- Selective monoamine oxidase-B (MAO-B) inhibitor
- Form
- Selegiline hydrochloride oral capsules or tablets; EMSAM selegiline transdermal system
- Route
- Oral capsule or tablet; transdermal patch
- Legal status
- US prescription-status classification was not verified in the sources reviewed; availability and legal status outside the US are unresolved.
Availability and supply rules vary by country
Trade names by country: United States
Australia: · Full directory
What selegiline is and how it works
Selegiline is an MAO-B inhibitor available in distinct oral and transdermal products. Oral selegiline hydrochloride is used with levodopa/carbidopa for selected people with Parkinson's disease. EMSAM is a selegiline transdermal system used to treat adults with major depressive disorder. (1) (2)
The products have important differences. Oral selegiline has no demonstrated benefit without concurrent levodopa therapy and is not approved for depression. EMSAM loses MAO-B selectivity progressively at higher doses, requiring dose-specific dietary tyramine restrictions and having different contraindications.
Mechanism of action: how selegiline works
Selegiline is a selective MAO-B inhibitor. Selectivity is not guaranteed above 10 mg per day with oral selegiline. With EMSAM, MAO-B selectivity is progressively lost at higher transdermal doses. (1) (2)
What selegiline is used for
Parkinson's disease: oral selegiline hydrochloride
Oral selegiline hydrochloride is approved as an adjunct in the management of Parkinson's disease in people receiving levodopa/carbidopa who have deterioration in the quality of their response to that therapy. No benefit has been demonstrated for oral selegiline without concurrent levodopa therapy. (1)
Major depressive disorder: EMSAM transdermal system
EMSAM is approved for treatment of major depressive disorder in adults. The oral capsule/tablet form of selegiline is not approved for depression. (2)
Before taking selegiline
Do not take / not appropriate for
- Do not use oral selegiline if there is known hypersensitivity to selegiline. (Oral selegiline hydrochloride capsules or tablets) (1)
- Do not use oral selegiline concurrently with meperidine. Serious reactions, including stupor, muscular rigidity, severe agitation, elevated temperature, and death, have been reported. (Oral selegiline hydrochloride capsules or tablets) (1)
- EMSAM is contraindicated in people with pheochromocytoma and in children younger than 12 years. (EMSAM transdermal system) (2)
- Do not use EMSAM concurrently with serotonergic antidepressants, including SSRIs, SNRIs, clomipramine, and imipramine; with meperidine, tramadol, methadone, pentazocine, propoxyphene, or dextromethorphan; or with carbamazepine. (EMSAM transdermal system) (2)
Tell your clinician about
- Every prescribed, non-prescription, and other medicine, particularly antidepressants, meperidine, tramadol, methadone, pentazocine, propoxyphene, dextromethorphan, carbamazepine, sympathomimetic medicines, buspirone, or tricyclic antidepressants.
- Any previous medicine allergy or hypersensitivity to selegiline.
- For oral selegiline, whether levodopa/carbidopa adverse effects such as dyskinesia or hallucinations are present or worsening.
- For EMSAM, any history of pheochromocytoma, current or recent suicidal thoughts or behavior, or new worsening depression or unusual behavioral changes.
- Pregnancy, plans for pregnancy, or breastfeeding. Lactation-specific information was not established in the sources reviewed.
- For EMSAM at 9 mg/24 hours or 12 mg/24 hours, whether dietary tyramine restrictions can be followed.
How to take selegiline
- Use only the formulation and schedule prescribed for the specific condition. Oral selegiline and EMSAM patches are not interchangeable.
- Oral selegiline for Parkinson's disease is used with levodopa/carbidopa. The clinician may assess whether the levodopa/carbidopa dose needs modification after selegiline is started.
- For oral selegiline, do not exceed the prescribed daily amount. Doses above 10 mg per day may lose MAO-B selectivity and increase the risk of non-selective MAO inhibition and hypertensive dietary-tyramine reactions.
- For EMSAM, apply one patch daily as prescribed. Dose increases, if needed, are made by the prescriber at intervals of 2 weeks or longer.
- Do not change the product, patch strength, dose, timing, or other Parkinson's or depression treatment without prescriber advice.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2)
Missed dose
A specific missed-dose protocol was not established in the sources reviewed. Contact the prescriber or pharmacist for instructions; do not take an extra oral dose or apply an additional patch without professional advice.
Overdose
Specific overdose-management details were not extracted from the sources reviewed. If too much selegiline may have been taken or more than the intended patch exposure may have occurred, contact emergency services, a poison-information service, or the prescribing service urgently. (1) (2)
Side effects
Adverse effects differ between oral selegiline used with levodopa/carbidopa and the EMSAM transdermal system.
Nausea, dizziness or lightheadedness, abdominal pain, dry mouth, confusion, hallucinations, or vivid dreams
What to notice: These reactions were reported in clinical trials of oral selegiline.
What to do: Discuss persistent, troublesome, or worsening symptoms with the prescribing clinician. (1)
Application-site reaction
What to notice: EMSAM application-site reactions occurred in 24% of treated patients compared with 12% receiving placebo. They were mostly mild to moderate, predominantly redness, and often resolved spontaneously.
What to do: Tell the prescribing clinician about severe, persistent, worsening, or widespread skin reactions. (2)
Headache, insomnia, diarrhea, dry mouth, dyspepsia, rash, pharyngitis, or sinusitis
What to notice: These were among the common adverse reactions reported with EMSAM.
What to do: Discuss persistent or troublesome symptoms with the prescribing clinician. (2)
Worsening levodopa-associated adverse effects
What to notice: New or worsening dyskinesia, hallucinations, or other adverse effects associated with levodopa treatment.
What to do: Contact the treating clinician promptly. The clinician can assess whether the levodopa/carbidopa regimen needs modification. (1)
Clinical worsening or new behavioral symptoms with EMSAM
What to notice: Worsening depression, unusual changes in behavior, or emergence of suicidal thoughts or behaviors, particularly early in treatment or after a dose change.
What to do: Contact the prescribing clinician promptly for assessment. For immediate danger or imminent self-harm risk, call emergency services. (2)
Serious warnings
Serotonin syndrome or serious central nervous system toxicity — emergency
Symptoms: Hyperthermia, rigidity, myoclonus, autonomic instability, mental-status changes, or severe agitation.
Action: Seek emergency medical care immediately. Ensure the treating team knows about all current and recently used medicines, including antidepressants, opioid medicines, and dextromethorphan-containing products. (1) (2)
Hypertensive reaction — emergency
Symptoms: A substantial elevation in blood pressure or symptoms of a hypertensive crisis.
Action: Seek emergency medical care immediately. This risk is associated with tyramine-containing foods and can also occur with sympathomimetic medicines; EMSAM at 9 mg/24 hours and 12 mg/24 hours requires dietary tyramine restrictions. (1) (2)
Suicidal thoughts and behaviors with EMSAM — urgent
Symptoms: Suicidal thoughts or behavior, clinical worsening, or unusual behavioral changes.
Action: Obtain urgent clinical assessment. Call emergency services for immediate danger or imminent self-harm risk. (2)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Antidepressants and other serotonergic medicines | Oral selegiline has reported severe central nervous system toxicity, hyperpyrexia, and deaths with tricyclic antidepressants, and reported serious reactions with SSRIs. EMSAM is contraindicated with SSRIs, SNRIs, clomipramine, and imipramine because of serotonin-syndrome risk. | The prescriber and pharmacist must review all current and recently used antidepressants before treatment is started or changed. For oral selegiline, at least 14 days is required after discontinuation before a tricyclic antidepressant or SSRI is started; a minimum 5-week interval is required after fluoxetine is discontinued before oral selegiline is started. For EMSAM, the label describes an approximately 1-week interval after most contraindicated serotonergic agents or after EMSAM, and a minimum 5-week interval after fluoxetine before EMSAM. Timing decisions must be managed by the prescriber. (1) (2) |
| Opioid and cough medicines | Oral selegiline is contraindicated with meperidine. EMSAM is contraindicated with meperidine, tramadol, methadone, pentazocine, propoxyphene, and dextromethorphan. | Ask a prescriber or pharmacist to check prescription pain medicines and non-prescription cough products before use. (1) (2) |
| Sympathomimetic medicines and buspirone | A hypertensive crisis has been reported with oral selegiline and ephedrine. With EMSAM, sympathomimetic agents and buspirone can cause substantial blood-pressure elevation. | Have the prescriber or pharmacist review these medicines before they are used with selegiline. (1) (2) |
| Carbamazepine and alcohol | Carbamazepine is contraindicated with EMSAM because it approximately doubles selegiline exposure. Alcohol is not recommended with EMSAM, although no direct pharmacokinetic interaction was demonstrated. | Discuss any carbamazepine or alcohol use with the prescriber before EMSAM treatment. (2) |
| Tyramine-containing foods | Rare hypertensive reactions have been reported with oral selegiline at 10 mg per day. For EMSAM, dietary tyramine restriction is not required at 6 mg/24 hours but is required at 9 mg/24 hours and 12 mg/24 hours because MAO-B selectivity is progressively lost at higher doses. | For EMSAM at 9 mg/24 hours or 12 mg/24 hours, avoid aged cheeses, fermented or cured meats, soy products or sauces, concentrated yeast extracts, and non-pasteurized beer. Restrictions continue for 2 weeks after a clinician-directed reduction below 9 mg/24 hours or after discontinuation. (1) (2) |
Pregnancy, breastfeeding, kidney/liver function, age
Children and adolescents
EMSAM is contraindicated in children younger than 12 years. The oral Parkinson's disease product's safety and effectiveness in pediatric patients were not established in the sources reviewed. EMSAM's boxed warning states that antidepressants increased the risk of suicidal thoughts and behaviors in short-term studies in children, adolescents, and young adults. (2) (1)
Older adults
For EMSAM, 6 mg/24 hours is the recommended dose for people aged 65 years and older. Oral-product geriatric dosing information was not established in the sources reviewed. (2) (1)
Pregnancy and breastfeeding
The oral label uses the older FDA Category C designation: animal studies did not show teratogenic effects at standard doses, but higher doses were associated with decreased fetal body weight and pup survival; adequate, well-controlled human studies were not available. EMSAM labeling states that it may cause fetal harm; animal studies showed increased malformations and developmental effects at high doses, and hypertensive-crisis risk in pregnancy should be weighed. Lactation-specific information was not established in the sources reviewed. (1) (2)
Renal or hepatic impairment
Specific renal- or hepatic-impairment dose-adjustment information for either formulation was not established in the sources reviewed. A clinician should assess the individual situation using current product information. (1) (2)
Monitoring
Before starting
- Confirm the intended formulation and approved indication: oral selegiline with levodopa/carbidopa for Parkinson's disease, or EMSAM for major depressive disorder in adults.
- Review all current and recently used medicines for contraindicated serotonergic, opioid, cough, sympathomimetic, carbamazepine, buspirone, and tricyclic-antidepressant interactions, including required washout timing.
- For EMSAM, assess suicidal thoughts and behaviors, clinical worsening, age, and whether dietary tyramine restriction will be needed at the intended dose.
- For oral selegiline, assess levodopa/carbidopa response and adverse effects such as dyskinesia and hallucinations.
During treatment
- Monitor for clinical worsening and emergence of suicidal thoughts or behaviors with EMSAM, especially early in treatment and after dose changes.
- Monitor for symptoms of serotonin syndrome, severe central nervous system toxicity, or hypertensive reactions.
- For oral selegiline, reassess levodopa-associated adverse effects; the treating clinician may determine whether levodopa/carbidopa modification is needed.
- For people with Parkinson's disease, consider periodic skin monitoring because Parkinson's disease is associated with a higher baseline risk of melanoma than the general population. This is not established as a selegiline-specific causal risk.
Storage
Storage-temperature and other product-specific storage details were not established in the sources reviewed. Follow the current dispensing label, package instructions, and pharmacist guidance for the exact oral product or EMSAM patch.
Study the drug class: Antiparkinsonian agents
Professional information
Clinician-facing context only. Use the current FDA-approved prescribing information for the exact oral or transdermal product, including contraindications, washout requirements, dietary restrictions, and monitoring.
United States
Indication: Oral selegiline hydrochloride as adjunct treatment in Parkinson's disease with levodopa/carbidopa
Dose summary: 10 mg per day orally as 5 mg at breakfast and 5 mg at lunch. Do not exceed 10 mg per day. After 2 to 3 days, the clinician may consider a 10% to 30% levodopa/carbidopa reduction based on clinical judgment.
Renal context: Specific renal- or hepatic-impairment dose-adjustment data were not established in the sources reviewed. (1)
United States
Indication: EMSAM transdermal system for major depressive disorder in adults
Dose summary: Start at 6 mg/24 hours using one patch daily. The prescriber may titrate in 3 mg/24-hour increments at intervals of 2 weeks or longer, to a maximum of 12 mg/24 hours. For patients aged 65 years and older, the recommended dose is 6 mg/24 hours. Dietary tyramine restriction is not required at 6 mg/24 hours; it is required at 9 mg/24 hours and 12 mg/24 hours.
Renal context: Specific renal- or hepatic-impairment dose-adjustment data were not established in the sources reviewed. (2)
Hepatic guidance
Hepatic-impairment guidance was not established in the sources reviewed; use current product information and clinical judgment.
Overdose note
Specific overdose-management protocol details were not extracted in this research pass. (1) (2)
Frequently asked questions
Are oral selegiline and EMSAM patches interchangeable?
No. Oral selegiline is approved as adjunct treatment with levodopa/carbidopa for Parkinson's disease, while EMSAM is approved for major depressive disorder in adults. Their doses, interaction restrictions, and dietary instructions differ. (1) (2)
Do I need to avoid tyramine-containing foods while using selegiline?
For EMSAM, no dietary tyramine restriction is required at 6 mg/24 hours. At 9 mg/24 hours and 12 mg/24 hours, tyramine-rich foods must be avoided and restrictions continue for 2 weeks after a clinician-directed reduction below 9 mg/24 hours or after discontinuation. Rare hypertensive reactions have also been reported with oral selegiline at the recommended 10 mg daily dose. (1) (2)
Why does my clinician need to review antidepressants and cough or pain medicines?
Selegiline can have serious interactions with serotonergic antidepressants and certain opioid or cough medicines. These combinations can cause serotonin syndrome, serious central nervous system reactions, or other severe effects. Required washout timing depends on the medicine and formulation and must be managed by a clinician. (1) (2)
What is the mechanism of action of selegiline?
Selegiline is a selective MAO-B inhibitor. Selectivity is not guaranteed above 10 mg per day with oral selegiline. With EMSAM, MAO-B selectivity is progressively lost at higher transdermal doses. (1) (2)
References
- Selegiline Hydrochloride Tablets/Capsules — prescribing informationU.S. Food and Drug Administration (DailyMed) · United States · accessed 2026-08-05 · source 1
- EMSAM (selegiline transdermal system) — prescribing informationU.S. Food and Drug Administration (DailyMed) · United States · accessed 2026-08-05 · source 2
- ZELAPAR (SELEGILINE HYDROCHLORIDE) TABLET, ORALLY DISINTEGRATING [BAUSCH HEALTH US, LLC] — US prescribing information (DailyMed SPL)U.S. National Library of Medicine (DailyMed) · US · accessed 2026-08-14 · source 3
- Selegiline — patient drug information (MedlinePlus)U.S. National Library of Medicine (MedlinePlus) · US · accessed 2026-08-14 · source 4
- Selegiline Hydrochloride — FDA approval record (Drugs@FDA ANDA074871)U.S. Food and Drug Administration · US · accessed 2026-08-14 · source 5
- selegiline — RxNorm normalized drug concept (RXCUI 203137)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 6
Brand names by country
Single-ingredient selegiline names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- EMSAM12 mg/24h, 9 mg/24h, 6 mg/24h · viatris specialty llc
- ZELAPAR1.25 mg · bausch health us, llc