Eldepryl (selegiline hydrochloride) represents a cornerstone in modern Parkinson’s disease therapy, offering targeted monoamine oxidase-B inhibition to enhance dopaminergic activity in the central nervous system. This second-generation MAO-B inhibitor provides neurologists and movement disorder specialists with a well-tolerated adjunct therapy that effectively extends the therapeutic window of levodopa treatment. Through selective enzyme inhibition, Eldepryl modulates neurotransmitter metabolism while maintaining a favorable safety profile compared to non-selective MAO inhibitors. Clinical evidence supports its role in both early and advanced Parkinson’s disease management, making it a versatile option in comprehensive treatment algorithms.

Features

• Contains selegiline hydrochloride 5 mg oral tablets
• Selective and irreversible monoamine oxidase-B inhibitor
• Blood-brain barrier permeable formulation
• Minimal dietary tyramine restrictions at recommended doses
• Compatible with most antiparkinsonian regimens
• Established pharmacokinetic profile with predictable metabolism

Benefits

• Extends therapeutic efficacy of levodopa/carbidopa therapy
• Reduces “off” time and motor fluctuations in advanced Parkinson’s disease
• May provide neuroprotective effects through reduced oxidative stress
• Delays need for levodopa initiation in early disease stages
• Improves overall motor scores and activities of daily living
• Offers flexible dosing options with once or twice daily administration

Common use

Eldepryl is primarily indicated as adjunct therapy in the management of Parkinson’s disease patients being treated with levodopa/carbidopa who exhibit deterioration in quality of response. It is employed when patients experience end-of-dose akinesia, wearing-off phenomena, or other motor complications despite optimized levodopa dosing. In selected cases, neurologists may initiate Eldepryl as monotherapy in newly diagnosed Parkinson’s disease to delay the introduction of levodopa, particularly in younger patients or those with mild symptoms. The medication finds additional off-label applications in certain refractory depression cases under specialist supervision, though this requires careful risk-benefit assessment.

Dosage and direction

The recommended initial dosage for adjunct therapy in Parkinson’s disease is 5 mg administered orally twice daily, typically with breakfast and lunch. Administration with meals may minimize potential gastrointestinal discomfort. The maximum recommended daily dose is 10 mg, as higher doses increase the risk of non-selective MAO inhibition and associated adverse effects. For monotherapy in early Parkinson’s disease, 5 mg once or twice daily may be initiated. Dose adjustments should be made gradually, with at least two-week intervals between changes. When used as adjunct therapy, concurrent levodopa dosage may require reduction by 10-30% to avoid excessive dopaminergic stimulation. Elderly patients or those with hepatic impairment may require lower initial doses and more gradual titration.

Precautions

Patients should be monitored for emerging or worsening dyskinesias, particularly during dose escalation periods. Orthostatic hypotension may occur, necessitating blood pressure monitoring, especially during initial treatment. Caution is advised in patients with pre-existing psychiatric conditions, as selegiline may exacerbate or precipitate psychosis, hallucinations, or confusion. Regular assessment of cognitive function is recommended, particularly in elderly patients. Those with significant hepatic impairment require careful dose titration and monitoring. Patients should be educated about the potential for serotonin syndrome if combined with serotonergic agents. Dental professionals should be informed of Eldepryl use due to potential interactions with vasoconstrictors.

Contraindications

Eldepryl is contraindicated in patients with known hypersensitivity to selegiline hydrochloride or any component of the formulation. Concurrent use with meperidine is absolutely contraindicated due to risk of severe reactions including hyperpyrexia, excitation, and coma. Combination with other MAO inhibitors (including linezolid and intravenous methylene blue) is prohibited. Use within 14 days of discontinuing other MAO inhibitors requires careful washout period observation. Patients with pheochromocytoma should not receive Eldepryl due to potential hypertensive crisis. Severe hepatic impairment or uncontrolled hypertension represents additional contraindications to therapy.

Possible side effects

The most frequently reported adverse reactions include nausea (occurring in approximately 10-15% of patients), dizziness (7-10%), insomnia (5-8%), and abdominal pain (4-6%). Orthostatic hypotension may develop in 5-10% of patients, particularly during dose initiation. Dyskinesias occur in approximately 15-20% of patients when used as adjunct to levodopa. Less common but clinically significant effects include confusion (3-5%), hallucinations (2-4%), and vivid dreams (5-7%). Dry mouth, rash, and arrhythmias have been reported in 1-3% of patients. Serotonin syndrome manifestations, while rare at recommended doses, require immediate medical attention if suspected.

Drug interaction

Eldepryl demonstrates significant interactions with serotonergic agents including SSRIs, SNRIs, tricyclic antidepressants, and triptans, potentially leading to serotonin syndrome. Concomitant use with sympathomimetics may precipitate hypertensive crises. Opioid interactions vary by agent—meperidine is absolutely contraindicated, while other opioids require careful monitoring. Concurrent use with dextromethorphan may cause excitation or delirium. Carbamazepine and oxcarbazepine may reduce selegiline concentrations. Eldepryl may potentiate the effects of CNS depressants including alcohol, benzodiazepines, and sedating antihistamines. Anaesthetic agents require careful selection and monitoring during surgical procedures.

Missed dose

If a dose is missed, patients should take it as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Doubling of doses to make up for missed administration is not recommended due to increased risk of adverse effects. Patients experiencing multiple missed doses should contact their healthcare provider before resuming therapy, as dose re-titration may be necessary. Consistent daily administration is important for maintaining stable MAO-B inhibition and optimal therapeutic effect.

Overdose

Selegiline overdose may manifest as severe hypertension, agitation, hallucinations, hyperpyrexia, and tachycardia. Symptoms of serotonin syndrome including confusion, hyperreflexia, and autonomic instability may occur. Management requires immediate medical attention with supportive care including continuous vital sign monitoring. Hypertension should be managed with appropriate antihypertensive agents, avoiding beta-blockers which may paradoxically worsen hypertension. Benzodiazepines may be employed for agitation or seizures. Activated charcoal may be considered if ingestion occurred within one hour. Dialysis is not effective due to extensive tissue distribution. Specific antidotes are not available, necessitating symptomatic treatment.

Storage

Eldepryl tablets should be stored at controlled room temperature between 20-25°C (68-77°F), with excursions permitted between 15-30°C (59-86°F). The medication must be kept in its original container with the lid tightly closed to protect from moisture and light. Storage in bathrooms or other humid areas should be avoided. Keep out of reach of children and pets. Do not use tablets that show signs of discoloration, cracking, or other physical deterioration. Proper disposal of unused or expired medication should follow local regulations, typically through medication take-back programs.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Eldepryl is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual patient responses may vary, and treatment decisions should be based on comprehensive clinical assessment. The prescribing physician should be consulted regarding specific medical questions or concerns. Full prescribing information including boxed warnings should be reviewed before initiation of therapy. Patients should not alter their treatment regimen without medical guidance.

Reviews

Clinical studies demonstrate that approximately 60-70% of patients experience meaningful reduction in “off” time when Eldepryl is added to levodopa therapy. Movement disorder specialists frequently report improved motor scores (UPDRS Part III) by 20-30% in responsive patients. Long-term observational data suggests sustained benefit for 2-5 years in most patients, though some require additional therapeutic modifications over time. Patient-reported outcomes indicate improved quality of life measures related to mobility and daily activities. Neurology practice guidelines consistently recommend MAO-B inhibitors as first-line adjunct therapy for motor complications in Parkinson’s disease. The medication’s favorable interaction profile compared to non-selective MAO inhibitors is particularly valued in complex polypharmacy situations.