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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Iansf on May 24, 2006, at 16:22:26
Since taking selegiline sublingually also bypasses the gut, does anyone know if 6mg of sublingual selegiline would have the equivalent effect of a 6mg Emsam patch? Would it also avoid the tyramine interaction problem?
And are various forms of sublingual seleg. the same? Would Cyprenil or Jumex drops be equivalent to Zelapar tabs?
Posted by Phillipa on May 24, 2006, at 20:27:26
In reply to Emsam vs. sublingual selegiline, posted by Iansf on May 24, 2006, at 16:22:26
How does sublingual bipass the gut thought it just worked quicker. Love Phillipa
Posted by Iansf on May 25, 2006, at 0:59:03
In reply to Re: Emsam vs. sublingual selegiline » Iansf, posted by Phillipa on May 24, 2006, at 20:27:26
> How does sublingual bipass the gut thought it just worked quicker. Love Phillipa
Maybe you're right, but I thought it went directly into the system. The Zelapar instructions tell you not to take it with food or liquid and not to drink liquid for a certain period afterwards (5 minutes, I think), which suggests it's meant to be kept out of the digestive tract. I don't know that much about physiology, but I don't see how anything absorbed through the soft tissue under the tongue would be passed into the stomach. Wouldn't it be passed directly into the bloodstream?
Posted by Phillipa on May 25, 2006, at 18:49:45
In reply to Re: Emsam vs. sublingual selegiline, posted by Iansf on May 25, 2006, at 0:59:03
Believe it or not I started thinking about this and I do think it goes to the blood stream. As I thought of nitrogycerine and the fact that you take the blood pressure five minutes after you place it under your tongue. So it has to go to the bloodsream. Love Phillipa
Posted by Jost on May 25, 2006, at 21:57:03
In reply to Re: Emsam vs. sublingual selegiline » Iansf, posted by Phillipa on May 25, 2006, at 18:49:45
There are two types of mao: mao-a and mao-b. Mao-a is found primarily in the intestines and mao-b is primarily in the brain.
Parnate and Nardil, for example, are unselective and irreversible inhibitors of both types of mao. Selegiline is an irreversible but selective inhibitor, primarily of mao-b. It is also a weak inhibitor of mao-a, which is why, at high doses, oral selegiline (and possibly emsam, although many doubt this) requires the tyramine diet. Emsam goes directly into the bloodstream. (This is greatly oversimplified, for the purposes of the discussion.)
The difference between emsam and oral selegiline, that is, is that emsam avoids a first-pass through the intestines and liver, which means you can take much higher doses without triggering any adverse food reactions. .
Someone had a good, although rather technical online discussion, which I'll try to find.
Jost
Posted by Iansf on May 25, 2006, at 23:03:02
In reply to Re: Emsam vs. sublingual selegiline, posted by Jost on May 25, 2006, at 21:57:03
Jost, I think you've misunderstood. Again, I'm not talking about oral selegiline but sublingual - that is, dissolved under the tongue. This too, as I understand it, avoids first pass through the intestines and goes directly in to the bloodstream. So the question is, is 6mg of sublingually delivered selegiline equivalent to 6mg of selegiline delivered via a skin patch?
> There are two types of mao: mao-a and mao-b. Mao-a is found primarily in the intestines and mao-b is primarily in the brain.
>
> Parnate and Nardil, for example, are unselective and irreversible inhibitors of both types of mao. Selegiline is an irreversible but selective inhibitor, primarily of mao-b. It is also a weak inhibitor of mao-a, which is why, at high doses, oral selegiline (and possibly emsam, although many doubt this) requires the tyramine diet. Emsam goes directly into the bloodstream. (This is greatly oversimplified, for the purposes of the discussion.)
>
> The difference between emsam and oral selegiline, that is, is that emsam avoids a first-pass through the intestines and liver, which means you can take much higher doses without triggering any adverse food reactions. .
>
> Someone had a good, although rather technical online discussion, which I'll try to find.
>
> Jost
Posted by Jost on May 26, 2006, at 6:59:54
In reply to Re: Emsam vs. sublingual selegiline » Jost, posted by Iansf on May 25, 2006, at 23:03:02
If it's like most sublingual medications, it probably would avoid the first pass, which would presumbly make it like emsam. Is there a form of sublingual selegiline available?
Jost
Posted by Jost on May 26, 2006, at 7:33:44
In reply to Re: Emsam vs. sublingual selegiline » Jost, posted by Iansf on May 25, 2006, at 23:03:02
From a brief description I saw online, Zelapar is eight times as potent as the same amount of oral selegiline.
Jost
Posted by bulldog2 on May 26, 2006, at 8:04:49
In reply to Re: Emsam vs. sublingual selegiline, posted by Jost on May 26, 2006, at 7:33:44
That's interesting. I've always heard people say they liked the sublinqual better than the pills or tabs. I guess the longer you keep it under your tongue the it gets directly into the bloodstream.
Posted by rod on May 26, 2006, at 9:08:13
In reply to Re: Emsam vs. sublingual selegiline » Jost, posted by Iansf on May 25, 2006, at 23:03:02
> So the question is, is 6mg of sublingually delivered selegiline equivalent to 6mg of selegiline delivered via a skin patch?
Dont know for sure, but I guess taking 1 mg under the tounge every 4 hours six times within 24h will come quite close to the 6mg/24hours patch.....
keep in mind if you take the 6mg all at once will cause a peak in you blood the patch mostl likely will not produce.....
take care
rod
Posted by sparkinark on May 26, 2006, at 10:10:14
In reply to Emsam vs. sublingual selegiline, posted by Iansf on May 24, 2006, at 16:22:26
I believe the term would be transdermally. Sublingual refers to speech.
Posted by SFY on May 26, 2006, at 11:02:19
In reply to Re: Emsam vs. sublingual selegiline, posted by sparkinark on May 26, 2006, at 10:10:14
> I believe the term would be transdermally. Sublingual refers to speech.
No, in the case of meds, sublingual means to be taken under the tongue. There are three ways to deliver selegiline: orally by pill, transdermally via patch, or sublingually via liquid or fast-dissolving pill.
Posted by Iansf on May 26, 2006, at 11:21:45
In reply to Re: Emsam vs. sublingual selegiline » Iansf, posted by rod on May 26, 2006, at 9:08:13
> > So the question is, is 6mg of sublingually delivered selegiline equivalent to 6mg of selegiline delivered via a skin patch?
>
> Dont know for sure, but I guess taking 1 mg under the tounge every 4 hours six times within 24h will come quite close to the 6mg/24hours patch.....
>
> take care
> rodThough I'm not sure, I think that could be considerably cheaper than Emsam. I'm going to have to check into this.
Posted by Declan on May 26, 2006, at 19:03:26
In reply to Re: Emsam vs. sublingual selegiline » Jost, posted by Iansf on May 25, 2006, at 23:03:02
The limiting factor with me and sublingual selegeline and deprenyl was always the insomnia they aggravated. (I always took them sublingual)
Any dose above 1mg/d clearly did that. So I guess the patch wouldn't work for me. The dietary thing is no bother though.
Posted by Jakeman on May 27, 2006, at 14:00:34
In reply to Re: Emsam vs. sublingual selegiline » Iansf, posted by Declan on May 26, 2006, at 19:03:26
It's my understanding that with the patch there is less exposure to the amphetamine metabolites that are produced by selegeline. So it's my hope that insomnia may be less problematic with the patch. But I could be wrong.
Jake
> The limiting factor with me and sublingual selegeline and deprenyl was always the insomnia they aggravated. (I always took them sublingual)
> Any dose above 1mg/d clearly did that. So I guess the patch wouldn't work for me. The dietary thing is no bother though.
Posted by Iansf on May 27, 2006, at 18:44:55
In reply to Re: Emsam vs. sublingual selegiline » Declan, posted by Jakeman on May 27, 2006, at 14:00:34
> It's my understanding that with the patch there is less exposure to the amphetamine metabolites that are produced by selegeline. So it's my hope that insomnia may be less problematic with the patch. But I could be wrong.
>
> Jake
>
>
Do you know why there might be less exposure to the amphetamine metabolites?
Posted by Jakeman on May 27, 2006, at 22:12:38
In reply to Re: Emsam vs. sublingual selegiline, posted by Iansf on May 27, 2006, at 18:44:55
> > It's my understanding that with the patch there is less exposure to the amphetamine metabolites that are produced by selegeline. So it's my hope that insomnia may be less problematic with the patch. But I could be wrong.
> >
> > Jake
> >
> >
> Do you know why there might be less exposure to the amphetamine metabolites?I was speaking in regard to the patch verus oral. Oral dosing has more first pass metabolism thus there's more exposure to the metabolites. I'm no expert, it's what I've gathered from reading the drug monograph at emsam.com
This is the end of the thread.
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