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EMSAM Fact Sheet

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Medication Name (brand): 
EMSAM
Medication Name (clinical): 
selegiline transdermal patch
Manufacturer: 

BrBristol-Myers Squibb and Somerset; market exclusivity expires 2009.

Indications: 

Major Depressive Disorder

Mechanism: 

Monoamine Oxidase Inhibitor (MAOI)

Dosing: 
  • Supplied in 6 mg, 9 mg, and 12 mg patches.

  • Start at 6 mg/day, titrate gradually up to 12 mg/day as needed.
  • No dose adjustment needed in mild to moderate hepatic or renal impairment.

Side Effects: 
  • Most common are insomnia, diarrhea, rash at patch application site, orthostatic hypotension. Other MAOIs cause side effects such as sexual dysfunction and sedation.

  • When taken with high tyramine foods, EMSAM doses 9 mg/day or higher can cause acute hypertension with symptoms such as intense headache, blurred vision, and stroke.
  • When taken with serotonergic medications (especially SSRIs), all doses of EMSAM can cause serotonin syndrome, with tremor, rigidity, fever, tachycardia, confusion.
  • Black Box Warning: In clinical trials, SSRIs and SNRIs increased the risk of suicidality in children (from 2% to 4%). No actual suicides occurred in these trials, and none of the trials included MAOIs, but all antidepressants are required to carry this warning anyway.

Drug-drug Interactions: 
  • Contraindicated with all known antidepressants, including St. John’s Wort and other MAOIs (although many clinicians have safely combined MAOIs with tricyclics, trazodone, and mirtazepine); certain pain medications: meperidine, methadone, Darvon (caution advised with Ultram); the triptans Imitrex and Maxalt (other triptans are safe); dextromethorphan (in Robitussin DM; other forms of Robitussin are fine); Sudafed (other cold remedies and all antihistamines are safe).

  • At 9 mg/day or higher, contraindicated with high tyramine foods (a high tyramine food list is available at www.TheCarlatReport.com).
  • Pregnancy Risk Category C

Pearls: 
  • While dietary restrictions are recommended above 6 mg/day, in clinical trials the 9 mg/day dose caused only rare tyramine reactions.

  • Called “EMSAM” after “Emily” and “Sam,” the children of a Somerset employee.

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