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Re: Hanging from a thread - E, Z...

Posted by Adam on December 15, 1999, at 22:44:55

In reply to Re: Parnate: weight gain, & the literature - Zeke, posted by Elizabeth on December 15, 1999, at 21:10:30

> I hope you just mean selegiline (you *do* know what happens when you take a nonselective MAOI with MDMA, right? do we actually know this won't happen with selegiline? especially with an SSRI too?).

Here's a review that addresses some of those issues:

Drug Saf 1998 Jul;19(1):11-22

Safety of selegiline (deprenyl) in the treatment of Parkinson's disease.

Heinonen EH, Myllyla V
Orion Pharma, CNS Drugs, Turku, Finland.

Selegiline (deprenyl), a selective, irreversible inhibitor of monoamine oxidase type B (MAO-B) is widely used in the treatment of Parkinson's disease. As the first MAO-B inhibitor approved for the treatment of Parkinson's disease, concerns were raised about the safety of the drug based on the adverse effect profiles of older, nonselective MAO inhibitors. Unlike the nonselective MAO inhibitors, selegiline does not significantly potentiate tyramine-induced hypertension (the 'cheese effect') at the dosages (5 to 10 mg daily) used for the treatment of Parkinson's disease. Selegiline has been well tolerated when given alone. The most frequent adverse events seen during monotherapy have been insomnia, nausea, benign cardiac arrhythmias, dizziness and headache. When combined with levodopa, selegiline can potentiate the typical adverse effects of levodopa, if the dose of levodopa is not reduced sufficiently. Thus, the most common adverse effects associated with this combination are nausea, dizziness, fatigue, constipation and insomnia. At the later stages of Parkinson's disease when fluctuations in disability occur, peak dose dyskinesias, psychiatric complications like hallucinations and insomnia, and orthostatic hypotension are further potentiated by selegiline. Mortality was recently reported to be increased when selegiline and levodopa were given together in comparison with treatment with levodopa alone, but a large meta-analysis of 5 long term studies and 4 separate studies did not support this conclusion. Selegiline seems to be generally well tolerated in combination with other drugs. However, when pethidine (meperidine) has been given to patients who are receiving selegiline therapy, severe adverse effects have been reported. Thus, the concomitant use of these drugs is not recommended. A low tyramine diet is recommended if selegiline is used together with nonselective MAO inhibitors or the selective, reversible MAO-A inhibitor, moclobemide. Several adverse effects have been reported when fluoxetine and selegiline have been used together. A recent survey revealed that the incidence of a true serotonin syndrome is, however, very low with this combination. Concomitant use of selegiline and other selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) like citalopram, which have generally less interactions than fluoxetine, seems to be well tolerated. Nevertheless, caution is advised when combining a SSRI or a tricyclic antidepressant and selegiline.

It seems like a lot of this talk about combining low-dose selegiline with MAOIs, RIMAs, SSRIs, etc., comes out of Finland. Maybe the habit of sitting in a 50+ deg. C sauna for as long as one can stand it, then jumping naked into a snow bank heightens their overall sense of adventure. Anyway, one particularly bad drug interaction that I've come across here and a couple other places is with meperidine (Demerol). I don't know if MDMA-induced 5-HT release is of the order caused by meperidine, but I get the feeling that even low-dose selegiline+MDMA could be unacceptably risky. I can't find any specific cases to support this, though. I don't imagine there are very many Parkinson's sufferer's doing E.




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