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Re: Selegiline Oral Dosage - Adam?

Posted by Adam on November 3, 1999, at 17:24:31

In reply to Selegiline Oral Dosage - Adam?, posted by Judy on November 2, 1999, at 19:39:38

Hey, Judy,

Well, I'm not a doctor, but I've seen and heard of doses as high
as 60mg/day of selegiline. The low end seems to be around 40mg/day.
But, as you pointed out, there isn't much info out there. Check
out the Dr. Bob Tips section that I referenced in my last post.

I would imagine a good approach would be to get up to 40mg/day
as quick as you can and then titrate more carefully based on how
your mood responds after that point. This post in the Tips looks
like it contains useful information on dosing:

>From: (David Reiser, M.D.)
>Date: Wed, 8 Jan 1997 20:12:43 -0800
>Subject: Selegiline for depression

>Selegiline is a good antidepressant. Doses use to treat depression, unlike those for
>Parkinsons's disease, are in the 40 to 60 mg per day range. I give selegiline to my depressed
>patients all the time, usually in the 15 to 30 mg bid range. I start at no more than 5 mg bid and
>work up slowly. What you must be sure to tell your patient is that at these higher doses
>selegiline becomes non-selective and can produce a full blown MAOI food reaction, just as
>any MAOI can. Hence, your patient will need to be educated about food restrictions, drug
>restrictions, and the use of sublingual nifedipine in an emergency. MAOI rises at these higher
>doses of selegiline can and do occur.

Now as far as how long it will take to ramp up, I really don't know. That
may really depend on your level of comfort. Interestingly, a potential
scenerio for me is that I went for eight weeks on no selegiline at all and
was suddenly switched to a 20mg/day patch immediately. Perhaps this could
be done so easily because of the different metabolite profile in transdermal
vs. oral delivery of selegiline. From what I've read, you will get more
L-amphetamine and L-methamphetamine production taking it orally, which could
be a bit of a nuisance. My guess is you could get up to a therapeutic dose
pretty quickly, given the mildness of the side effects. I imagine it is a
very individual thing. One famous poster to psychobabble couldn't tolerate
selegiline at 40mg/day doses, and got no antidepressant effect anyway. Others
find it easlily tolerated and very efficacious.

Good luck to you!

> Adam,
> There is possibly more information in your October 24th post about the use of Selegeline as an AD than there is on the entire web! I had read your post before my Pdoc appointment last Friday, but unfortunately I didn't commit it to memory. If I'd had your phone number, I swear I would have called you from his office!
> I took Selegeline about three years ago after my Pdoc spotted a small blurb on it's possibility as an AD (probably in the What's New & Whacky column) of one of his Psych Journals. Since I thrive on Nardil but can't endure the side effects (severe edema and almost total bladder and bowel shut-down), he was grasping at the straw that Selegeline might prove beneficial as well, with less side effects. As a matter of fact, it did help with the depression (at only 15 mg per day) but, as you read somewhere, it was less effective for anxiety and I needed to add Xanax to keep that at bay.
> Three years later, I have exhausted just about all the AD's in all the classes, and asked my Pdoc on Friday if I could revisit Selegeline, at higher doses this time. After looking through every book in his office, he could find no information regarding dosage except for use in treating Parkinson's. I was telling him about your transdermal patch study and the other things I had learned from the web, and as he started to write the prescription, he halted, looked up at me and said, "Did anyone mention what oral dose they were taking?" It was funny, but sad too because there's NO information out there!
> SO, my question to you or anyone else who might know, is have you seen a 'guestimate' anywhere hinting at what oral dose Selegeline becomes relatively effective as an AD. My suspicion is that if I take a high dose, I will be right back in the full-MAOI realm of side effects. I'm starting at 10 mg per day, as of today, increasing to 20 mg per day, and then I'll give that some time before increasing again. Also, any clue at what oral dose one would have to begin monitoring the diet for tyramines? (Not that it's a problem for me - I've taken MAOI's so many times that I almost follow the diet/OTC drug restrictions out of habit whether I'm taking an MAOI or not!)
> Thanks,
> Judy




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