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Emsam
Emsam (generic name: selegiline) is a monoamine oxidase inhibitor (MAOI) used as a transdermal patch for the treatment of major depressive disorder (MDD) in adults. It works by increasing the levels of neurotransmitters such as dopamine, serotonin, and norepinephrine in the brain, which are often imbalanced in people with depression. Emsam is unique in that it bypasses the digestive system, reducing some of the dietary restrictions typically associated with MAOIs taken orally.
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Frequently Asked Questions
How long does it take for Emsam to start working?
It may take several weeks for patients to experience the full effects of Emsam in relieving depressive symptoms.
Can I swim or bathe with the Emsam patch on?
Yes, the Emsam patch is water-resistant and can be worn while bathing, swimming, or showering. However, avoid exposing the patch to excessive heat or steam.
Do I need to avoid certain foods while using Emsam?
At the 6 mg/24 hours dose, no dietary restrictions are needed. However, at higher doses, you should avoid tyramine-rich foods to prevent dangerous increases in blood pressure.
What should I do if the patch falls off?
If the patch falls off, apply a new patch as soon as possible and continue with your regular dosing schedule.
Can I stop using Emsam suddenly?
No, discontinuing Emsam suddenly can lead to withdrawal symptoms. Speak to your healthcare provider about gradually tapering the dose if needed.
Comprehensive Drug Guide
How Does Emsam Work?
Emsam works by inhibiting monoamine oxidase (MAO), an enzyme responsible for breaking down neurotransmitters like serotonin, dopamine, and norepinephrine. By blocking this enzyme, Emsam increases the levels of these mood-regulating chemicals in the brain, helping to alleviate symptoms of depression.
Common Dosages
- 6 mg/24 hours
- 9 mg/24 hours
- 12 mg/24 hours
Typical Dosing
- Apply one patch daily, starting with the 6 mg/24 hours dose. The patch should be worn for 24 hours, after which it is removed and replaced with a new patch. Higher doses may be prescribed if necessary, depending on the patient's response.
Typical Dosing
FDA Approved Indications
- Major depressive disorder (MDD) in adults
Who Shouldn't Take Emsam?
- Pheochromocytoma
- Concurrent use of other MAOIs or SSRIs
- Tyramine-rich foods (for higher doses)
- Uncontrolled hypertension
Advice From The Pharmacist
- Apply the patch to a dry, clean area of skin on the upper body or thigh, rotating the application site each time to avoid skin irritation.
- At the 6 mg/24 hours dose, dietary restrictions are not required, but higher doses may require avoiding tyramine-rich foods (e.g., aged cheeses, cured meats, and fermented products) to prevent hypertensive crisis.
- Emsam should not be used in combination with other antidepressants, particularly SSRIs, SNRIs, or other MAOIs.
- Notify your doctor if you experience symptoms like headache, sweating, or palpitations, as these could indicate high blood pressure.
Side Effects of Emsam
Common Side Effects
- Skin irritation at the patch site
- Dizziness
- Insomnia
- Dry mouth
Uncommon/Severe Side Effects
- Hypertensive crisis
- Serotonin syndrome (especially when combined with other serotonergic drugs)
- Orthostatic hypotension
Risks and Warnings of Emsam
- Tyramine Sensitivity: At higher doses, Emsam requires dietary restrictions to avoid hypertensive crisis. Patients should avoid foods high in tyramine, such as aged cheeses, fermented foods, and certain meats.
- Serotonin Syndrome: Combining Emsam with other serotonergic agents (such as SSRIs, SNRIs, or triptans) can result in serotonin syndrome, a potentially life-threatening condition.
- Orthostatic Hypotension: Emsam can cause dizziness or lightheadedness upon standing, especially during the first few weeks of treatment.
Interactions with Emsam
Common Drug Interactions
- SSRIs or SNRIs: Can increase the risk of serotonin syndrome when combined with Emsam.
- Tyramine-rich foods: At doses above 6 mg/24 hours, patients must avoid foods high in tyramine to prevent a hypertensive crisis.
- Sympathomimetic drugs (e.g., pseudoephedrine): Can increase the risk of high blood pressure.
Alternatives to Emsam
- Nardil (phenelzine): Another MAOI used to treat depression.
- Parnate (tranylcypromine): A more traditional oral MAOI for treating depression.
- SSRIs or SNRIs: First-line treatment for depression in patients who cannot tolerate MAOIs.
- Wellbutrin (bupropion): An antidepressant that affects norepinephrine and dopamine but does not require dietary restrictions.
