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(seh-LEH-jih-leen HIGH-droe-KLOR-ide)
Carbex, Eldepryl, Selegiline HCl
Class: Antiparkinson

 Action Selective type B monoamine oxidase (MAO) inhibitor thought to increase dopaminergic activity. MAO enzyme breaks down catecholamines and serotonin. Selegiline may also interfere with dopamine reuptake at synapse.

 Indications Adjunct to levodopa/carbidopa in idiopathic Parkinson’s disease, postencephalic parkinsonism/symptomatic parkinsonism.

 Contraindications Standard considerations.

 Route/Dosage

ADULTS: PO 10 mg/day as divided dose of 5 mg each taken at breakfast and lunch. Do not exceed 10 mg/day. After 2 to 3 days of treatment, try reducing levodopa/carbidopa dose by 10 to 30%. Further reductions may be possible during continued selegiline therapy.

 Interactions

Fluoxetine: May produce a “serotonin” syndrome (CNS irritability, increased muscle tone, altered consciousness). Meperidine: Could result in agitation, seizures, diaphoresis and fever, which may progress to coma, apnea and death. Reactions may occur several wks following withdrawal of selegiline.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Palpitations; orthostatic hypotension; arrhythmia; hypertension; new or increased angina; syncope. CNS: Dizziness; lightheadedness; fainting; confusion; hallucinations; vivid dreams; headache; anxiety; tension; insomnia; lethargy; depression; loss of balance; delusions; dyskinesias; increased akinetic involuntary movements; bradykinesia; chorea. DERM: Sweating; rash; photosensitivity. EENT: Diplopia; blurred vision. GI: Nausea; abdominal pain; dry mouth; diarrhea. GU: Sexual dysfunction; urinary retention, frequency, hesitancy. OTHER: Generalized ache; leg pain; low back pain; weight loss.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Effects have not been evaluated. Maximum: Do not exceed recommended daily dose of 10 mg/day because of risks associated with nonselective inhibition of MAO (potentially serious food or drug interactions may occur at higher doses). Hypertensive crisis risk: Selegiline can be given with active amine-containing medications and tyramine foods as long as recommended dose is not exceeded. However, report any possible symptoms suggestive of hypertensive crisis.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer 5 mg with breakfast and with lunch.
  • Do not exceed 10 mg daily.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Monitor vital signs, especially BP and respirations.
  • Assess patient for decrease in akathisia and mood.
  • Assess patient’s mental status: affect, mood, behavioral changes, depression.
  • Dosage of levodopa/carbidopa may be reduced after 2 to 3 days of treatment.
  • Assess for side effects, particularly nausea, dizziness, lightheadedness, abdominal pain, confusion, hallucination.
  • Assist patient with ambulation at beginning of therapy.
  • Assess diet for tyramine-containing foods.
  • Implement safety measures to prevent falls, especially during initial treatment.
OVERDOSAGE: SIGNS & SYMPTOMS
  Hypotension, psychomotor agitation

 Patient/Family Education

  • Encourage patient to change position slowly to prevent orthostatic hypotension.
  • Instruct patient to avoid driving or other potentially hazardous activities until effect of medication is determined.
  • Explain that dosage of levodopa/carbidopa may be reduced after initiation of adjunctive therapy.
  • Identify tyramine-containing foods; explain rationale for exclusion from diet.
  • Instruct patient to report these side effects: twitching, eye spasms.
  • Caution patient to use drug exactly as prescribed. Explain that if drug is discontinued, parkinsonian crisis may occur.
  • Advise patient not to exceed 10 mg/day dose.
  • Inform patient and family of symptoms of hypertensive crisis and when to call physician. Instruct them to report severe headache or other unusual symptoms.

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