No, you cannot and should not cut these patches. Only change your dose if instructed to do so by your physician. Emsam selegiline prevents the breakdown of chemicals in the brain that are often imbalanced in people with depression.
Emsam transdermal patches are used to treat major depressive disorder in adults and adolescents who are at least 12 years old. It may take up to 12 hours before you have these symptoms, and they may be worse 24 to 48 hours after you apply your EMSAM patch.
Does selegiline help with anxiety? Parkinson's disease PD , a neurodegenerative disorder, is accompanied by various non-motor symptoms including depression and anxiety, which may precede the onset of motor symptoms. Is selegiline a stimulant? Selegiline is a methamphetamine derivative and a potent, irreversible, monoamine oxidase B—selective inhibitor primarily used for the treatment of Parkinson's disease. Selegiline may be an interesting alternative to the more classical stimulants as its potential for abuse has been reported to be very low.
What medication is contraindicated with selegiline? Selegiline is contraindicated in patients with a known hypersensitivity to this drug. This contraindication is often extended to other opioids. What are the side effects of selegiline? Dizziness, abdominal pain, dry mouth, nausea, stomach upset, trouble sleeping, and headache may occur.
If any of these effects persist or worsen, notify your doctor or pharmacist promptly. If you are also taking levodopa, you may experience more side effects from the levodopa when taking selegiline.
In the premarketing clinical trial data set of 2, patients, there were no completed suicides. The package insert states that 0. This updated report found that four cases had completed suicide and four more made suicide attempts. Of the completed suicides, all cases used multiple drugs, particularly those that were contraindicated with EMSAM usage, such as crystal methamphetamine and bupropion taken in overdose quantities.
One case did make an overdose with 28 EMSAM patches applied to him concomitantly with numerous doses of amphetamine, but survived.
Theoretically, it would be possible to administer enough EMSAM patches to successfully commit suicide although the lethal amount of patches necessary is unclear. Although clearly rare events, a few isolated reports in the literature cite suicidal behavior with other transdermal patches. Wiesbrock et al and LoVecchio and Ramos each reported a successful suicide with fentanyl an opioid transdermal patches, with one patient applying 20 patches and the other eleven patches, respectively.
Therefore, EMSAM might be a preferred treatment in depressed patients who have a history of previous suicidal behavior or who are currently suicidal. An early analysis of Phase III clinical trial data found that 0. In a week open-label EMSAM study where responders were entered into a double-blind placebo- controlled discontinuation phase lasting 52 weeks , the data are as follows: of patients treated openly, one 0.
This information should diminish any safety concerns and increase the interest of clinicians in prescribing EMSAM. This is unfortunate since earlier literature on oral MAOIs suggested that they were effective for various anxiety symptoms. They found that both anxious and non-anxious depressives did significantly better with EMSAM versus placebo. In addition, the clinical response of anxious depressives to EMSAM did not differ from that of non-anxious depressives. Whether EMSAM might be more effective than other antidepressants in anxious depression awaits to be studied.
Furthermore, those that remitted took longer to go into remission than non-atypicals. EMSAM was equally efficacious in atypical and non-atypical depressives. Nonetheless, these recent findings should provide clinicians at least a sense of confidence in administering EMSAM to patients with MDD since atypical depression did not have a negative influence on treatment response. EMSAM is clearly an underutilized antidepressant which may be due partially to fears about MAOI side effects, clinical trials that did not address enough clinical questions, inadequate analyses of data, minimal postmarketing studies, and inadequate marketing in general.
The pharmaceutical industry should not be shortsighted when developing a novel drug for the treatment of a highly prevalent disorder such as MDD. This is particularly relevant when the drug is an MAOI with a long prior history of adverse events particularly the cheese reaction leading to a number of deaths, with the FDA temporarily removing the drug from the market.
The hesitancy to prescribe such drugs by clinicians is thus understandable, particularly when the marketplace has many other safer and less-restrictive antidepressant choices; therefore, the safety and potential efficacy of a new MAOI, even one that is touted to have many advantages over prior MAOIs and other antidepressants, must be demonstrated beyond any doubt.
In an era of many antidepressant-treatment choices, why to prescribe a particular antidepressant must be clearly spelled out to ensure its usage.
If misuse of a drug or idiosyncratic reactions to it could lead to medical mishaps, the clinical usage of it will be minimal. This is most relevant in the current harsh medical—legal environment where frequent public advertisements are aired soliciting patients to report potential harmful effects experienced from a drug so that litigation can proceed against a physician and pharmaceutical company. As suggested in this article, a number of opportunities in researching and marketing EMSAM have been missed.
With over 14 years left in the patent of EMSAM, Mylan has the opportunity to still conduct some further basic studies in MDD and provide important medical education to the health community. Henderson reports no conflicts of interest in this work. National Center for Biotechnology Information , U. Journal List Neuropsychiatr Dis Treat v. Neuropsychiatr Dis Treat. Published online Oct 6. Author information Copyright and License information Disclaimer. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
This article has been corrected. See Neuropsychiatr Dis Treat. This article has been cited by other articles in PMC. Fear of possible side effects and shortcomings in EMSAM development The cheese reaction The first area that probably contributed most widely to the hesitancy of prescribing EMSAM by clinicians is a continued fear of an MAOI-induced hypertensive crisis the tyramine-based cheese reaction , most notably seen in the s prior to dietary restrictions being imposed, as well as drug—drug interactions and serotonin syndrome.
Lack of studies with antidepressant comparators None of the registration studies evaluating EMSAM in MDD used an antidepressant comparator; the FDA approval process does not mandate an antidepressant comparator it does mandate a placebo comparator. A limited age range was studied MDD affects a wide age range from childhood to the elderly.
Other treatment options are widely available A multitude of various antidepressants from various drug classes have been approved and are used as a primary treatment or when someone is refractory to a particular antidepressant in MDD. Failure to point out potential advantages of EMSAM over other antidepressants No swallowing issues Many patients have problems swallowing oral medications. Decreased gastrointestinal sensitivity Many patients have clear gastrointestinal sensitivity to antidepressants, particularly SSRIs.
Better pharmacokinetic profile Another potential benefit of transdermal over oral administration of antidepressants is that there is a large intraindividual variability of absorption and metabolism of oral antidepressants in contrast to transdermal preparations, as demonstrated for selegiline. Possibly reduced suicidal behavior Patients with MDD frequently exhibit suicidal behavior. Conclusion EMSAM is clearly an underutilized antidepressant which may be due partially to fears about MAOI side effects, clinical trials that did not address enough clinical questions, inadequate analyses of data, minimal postmarketing studies, and inadequate marketing in general.
References 1. Am J Psychiatry. Roose SP. Eur Neuropsychopharmacol. Jakubovski E, Bloch MH. J Clin Psychiatry. American Psychiatric Association Practice guidelines for the treatment of patients with major depressive disorder Revision Am J Psychiatry. Alternative formulations, delivery methods, and administration options for psychotropic medications in elderly patients with behavioral and psychological symptoms of dementia. Am J Geriatr Pharmacother.
Intravenous antidepressants: a review. Depress Anxiety. J Clin Pharmacol. The selegiline transdermal system in major depressive disorder: a systematic review of safety and tolerability. J Affect Disord. Transdermal selegiline in major depression: a double-blind, placebo-controlled, parallel-group study in outpatients. Amsterdam JD. A double-blind, placebo-controlled trial of the safety and efficacy of selegiline transdermal system without dietary restrictions in patients with major depressive disorder.
Selegiline trandermal system for the treatment of major depressive disorder: an 8-week, double-blind, placebo-controlled, flexible-dose titration trial. Selegiline transdermal system in the prevention of relapse of major depressive disorder: a week, double-blind, placebo-substitution, parallel-group clinical trial.
J Clin Psychopharmacol. Half a century of antidepressant drugs: on the clinical introduction of monoamine oxidase inhibitors, tricyclics, and tetracyclics. Part I: monoamine oxidase inhibitors. Columbia atypical depression. A subgroup of depressives with better response to MAOI than to tricyclic antidepressants or placebo. Br J Psychiatry Suppl. Treatment of depression with atypical features: a meta-analytic approach.
Psychiatry Res. Phenelzine treatment of melancholia. A placebo-controlled study of fluoxetine versus imipramine in the treatment of atypical depression. High-dose selegiline in treatment-resistant older depressive patients. Arch Gen Psychiatry. Morgan PT. Treatment-resistant depression: response to low-dose transdermal but not oral selegiline. Ashton AK. A case report of high-dose transdermal selegiline in the treatment of major depressive disorder.
Ann Clin Psychiatry. Krishnan KR. Revisiting monoamine oxidase inhibitors. Bipolar Disord. Anidepressants in bipolar disorder: the case for caution. Results of a brief survey of the prescribing practices for monoamine oxidase inhibitor antidepressants. A survey of prescribing practices for monoamine oxidase inhibitors. Psychiatric Services.
Refining the MAOI diet: tyramine content of pizzas and soy products. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the British Association for Psychopharmacology guideines. J Psychopharmacol. Psychiatry Edgmont ; 4 6 — However, the manufacturers do not guarantee stability or utility of cut estradiol patches.
Decide where you will place the new patch. Your doctor's instructions and the drug's label or package insert should give information on where to put it. For instance, certain patches should be applied to the upper chest or the upper, outer arm.
Others should be placed on the lower abdomen or hip. After you take off the patch , wash the skin area where the patch was placed. Only one patch should be used at any time. Do not cut it. You will also need to throw away old patches after the expiration date has passed.
The matrix system has a drug layer of a semisolid matrix containing a drug solution or suspension. The adhesive layer in this patch surrounds the drug layer, partially overlaying it. Also known as a monolithic device. Nausea, vomiting, constipation, lightheadedness, dizziness, drowsiness, dry mouth, or headache may occur.
Irritation, itching, or redness at the application site may also occur. Some of these side effects may decrease after you have been using this medication for a while. Dividing the scopolamine patch is not recommended by the manufacturer. DO NOT cut the actual patch. Patch is to remain in place over 3 days. Which transdermal patches can be cut? Category: healthy living smoking cessation. The administration of half a patch is unlicensed.
Please check with the pharmacist or prescribing doctor. The second half of the patch cannot be kept for future use. How quickly does emsam work? How long does it take the Emsam patch to work? How does emsam patch work? Is emsam generic? Does emsam cause weight gain?
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