Posted by Pops_1 on June 14, 2006, at 17:22:25
In reply to Re: EMSAM stronger than oral selegline, posted by notfred on June 14, 2006, at 14:11:55
> > Your original speculation - that EMSAM doesn't require dietary restrictions b/c it is essentially equivalent to sub-therapeutic oral selegline dose levels - is interesting but incorrect on two points.
> >
>
> Reread a bit and you will see that is not what I was saying.
>
> (See http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=400 for excellent overview of MAO Inhibitors and EMSAM's pharmokinetics).
>
> The manufacture says there is "limited clinical experience" with this.Um, sorry if I interpolated your posts incorrectly, but I took from your following two statements...
"Deprenyl and EMSAM contain the same active ingredient. The doses for depression are far higher that those mentioned on this board."
"Yes, that is fundamental and well known as to why there are no dietary restrictions at lower doses. EMSAM does not inhibit MAO-A at lower doses. This alone and not its transdermal delivery system accounts for the lack of dietary restrictions."...that you assumed:
a. EMSAM & deprenyl dosing were equivalent (e.g., if you needed 40mg-60mg oral dose for AD, you would need 40-60mg EMSAM dose for AD)
b. MAO-A inhibition is what produces antidepressant efficacy
c. MAO-A inhibition is what creates dietary restrictions
d. Since EMSAM 20mg doesn't have dietary restrictions, it must not inibit MAO-A
What did you actually mean to suggest?
As indicated in the article I linked, EMSAM 20mg achieves cortical MAO-A inhibition equivalent to 60mg-120mg of oral deprenyl (way beyond doses required for AD efficacy) without impacting GI MAO-A levels sufficiently to warrant dietary restrictions. "STS allows inhibition of brain MAO-A and MAO-B enzymes with reduced effects on GI MAO-A, thereby reducing the risk of possible interactions with tyramine-rich foods at therapeutic doses."
If you read the full article, you'll see that even the 30mg & 40mg patches are likely to not cause dietary problems, but that data from the test trials indicated that the most tyramine-sensitive patient could in theory have a hypertensive crisis at these doses if they ate a really, really tyramine rich meal, which is probably why Somerset was OK with the dietary restrictions on labelling for the higher doses.
poster:Pops_1
thread:655515
URL: http://www.dr-bob.org/babble/20060610/msgs/656995.html