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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Jeff81 on April 4, 2007, at 8:19:47
Hi,
I have been on Emsam for 3 weeks. I haven't noticed any affects yet. My problem is every couple of days a corner of the patch peals off and I don't think I am getting all the medicine. It is very frustrating because I am so depressed and want it to kick in. I am thinking about switching to selegiline pills instead. What is the difference (besides the way the medicine gets into your body)? Is Emsam safer? Is it better for your liver? Are they equally effective? I am scared that the selegiline pills are bad for me. I would appreciate if anyone can shed some light on this.
Thanks,
Jeff
Posted by saturn on April 4, 2007, at 10:05:43
In reply to Switching from Emsam patch to Selegiline pills, posted by Jeff81 on April 4, 2007, at 8:19:47
There are supposed to be no dietary restrictions with the 6 mg Emsam patch. (There ARE however, restrictions at the 9 mg and 12 mg doses).
With oral selegeline there would be a risk of hypertensive crisis at any dose--and therefore you would have dietary restrictions.
Posted by Phillipa on April 4, 2007, at 11:59:18
In reply to Re: Switching from Emsam patch to Selegiline pills » Jeff81, posted by saturn on April 4, 2007, at 10:05:43
It doesn't bypass the liver either does it? love Phillipa
Posted by Honore on April 4, 2007, at 13:21:16
In reply to Re: Switching from Emsam patch to Selegiline pills » saturn, posted by Phillipa on April 4, 2007, at 11:59:18
Emsam is much more effective than selegiline at the same dose. Also it's hard to get enough oral selegiline for an AD response, from what I've heard.
Certainly the potential for hypertensive crisis is much greater on oral s. because you have to take a much greater amount and it goes through the liver and intestine.
Emsam goes directly into the bloodstream. Racer recently wrote a detailed post in a thread describing the biological differences in delivery and effects.
Honore
Posted by saturn on April 4, 2007, at 13:33:37
In reply to Re: Switching from Emsam patch to Selegiline pills » saturn, posted by Phillipa on April 4, 2007, at 11:59:18
> It doesn't bypass the liver either does it? love Phillipa
Emsam goes *less* through the liver than oral selegeline in that it lacks first-pass metabolism--meaning it does not go through the liver *first*, before getting into the blood and eventually brain. But it will eventually go through the liver, just at a much lower dose.
For this reason, you can hypothetically get a desired response at a lower dose than orally, and therefore with potentially less side effects.
Posted by stargazer on April 4, 2007, at 18:20:30
In reply to Switching from Emsam patch to Selegiline pills, posted by Jeff81 on April 4, 2007, at 8:19:47
Is your pdoc in agreement to switch from the patch to pills? I don't think the seligilene pills are used much for depression. You would be better off to go up in your dose, from 6 to 9mg.
I increased my dose first but then added abilify which has helped with my depression.If not, then can you use another MAO-I like Nardil? That would be my next choice after Emsam which I am currently taking.
Did you fail on many other meds before trying Emsam, like the Serotonin meds?
Stargazer
Posted by Phillipa on April 4, 2007, at 19:30:58
In reply to Re: Switching from Emsam patch to Selegiline pills » Phillipa, posted by saturn on April 4, 2007, at 13:33:37
Thanks saturn I appreciate you explaining it to me. Love Phillipa/ Jan
Posted by Jeff81 on April 4, 2007, at 21:47:49
In reply to Re: Switching from Emsam patch to Selegiline/Jeff, posted by stargazer on April 4, 2007, at 18:20:30
> Is your pdoc in agreement to switch from the patch to pills? I don't think the seligilene pills are used much for depression. You would be better off to go up in your dose, from 6 to 9mg.
> I increased my dose first but then added abilify which has helped with my depression.
>
> If not, then can you use another MAO-I like Nardil? That would be my next choice after Emsam which I am currently taking.
>
> Did you fail on many other meds before trying Emsam, like the Serotonin meds?
>
> StargazerStargazer, I did not discuss switching from the patch to the pills with my doctor. I haven't felt anything good yet but my problem is the patch is not going on me right, sometimes they peel off a little ,which means I am not getting all my meds. I am obssessing that I don't have the patch on right to I was thinking about the pills.
I have tried many AD meds. None have helped me that much but with that being said SSRI;s worked the best for me so far. Effexor and Anafranal where terrable.
I am a little nervous about Nardil. Is it a lot different then Emsam? If MAO's don't work I will probably go to Lexapro but I want to give MAOI's a fair shot.
Posted by notfred on April 4, 2007, at 21:55:57
In reply to Re: Switching from Emsam patch to Selegiline pills » Jeff81, posted by saturn on April 4, 2007, at 10:05:43
>
> With oral selegeline there would be a risk of hypertensive crisis at any dose--and therefore you would have dietary restrictions.
Nope, not at lower doses. Years of Parkinsons patients have demonstrated this. Just like Emsam;
& also selective at lower doses:http://www.rxlist.com/cgi/generic/zelapar_cp.htm
"it seems prudent to assume that ZELAPARÃ? can ordinarily only be used safely without dietary restrictions at doses where it presumably selectively inhibits MAO-B (e.g., 2.5 mg/day). Safe use of ZELAPARÃ? at doses above 2.5 mg daily without dietary tyramine restrictions has not been established."
Posted by rvanson on April 6, 2007, at 11:37:38
In reply to Switching from Emsam patch to Selegiline pills, posted by Jeff81 on April 4, 2007, at 8:19:47
> Hi,
>
> I have been on Emsam for 3 weeks. I haven't noticed any affects yet. My problem is every couple of days a corner of the patch peals off and I don't think I am getting all the medicine. It is very frustrating because I am so depressed and want it to kick in. I am thinking about switching to selegiline pills instead. What is the difference (besides the way the medicine gets into your body)? Is Emsam safer? Is it better for your liver? Are they equally effective? I am scared that the selegiline pills are bad for me. I would appreciate if anyone can shed some light on this.
>
> Thanks,
> JeffI did not fare well on segeline.
If you are subject to drug testing at work make sure your Pdoc writes you a note that he has Rx'ed it for you as it will show up as a false Meth positive on a standard drug test.
I carried a copy of the pharmacy printout in my wallet, as I am rotinely drug tested at my safety senitive work, and that way I could shove it in their faces without having to call the Pdoc. :-)
You do not have to tell them what you are taking if for, i.e. depression. If they ask tell them NO and if they fire you for not disclosing get an attorney as you will win under ADA rules.
Posted by Jeff81 on April 6, 2007, at 16:18:45
In reply to Re: Switching from Emsam patch to Selegiline pills, posted by rvanson on April 6, 2007, at 11:37:38
Hi Guys,
Thank you for your replies. It is comforting to talk to people who know what I go through. If the Emsam patch doesn't work for me (bc it falls off) what is a good MAOI to take. I want to give MAOI's a fair shot before I go back to SSRI's. I don't know much about this class but I heard the other MAOI's are more hardcore. Do they have more side effects? Any information would be appreciated.
Thanks,
Jeff
Posted by UgottaHaveHope on April 6, 2007, at 19:00:09
In reply to If Emsam doesn't work then what is the next MAO?, posted by Jeff81 on April 6, 2007, at 16:18:45
Your next options would be:
1. Nardil or Parnate
2. Nardil or Parnate with a TCA
3. Ultram alone
Posted by gigantor on August 22, 2013, at 23:14:45
In reply to Re: Switching from Emsam patch to Selegiline pills, posted by notfred on April 4, 2007, at 21:55:57
To clarify, does that mean a 6mg Emsam patch (with little to no restrictions) is the same as 6mg Zelapar lozenges (as far as diet AND dosing) just different delivery methods?
Posted by damnthislife on August 23, 2013, at 7:50:49
In reply to Re: Switching from Emsam patch to Selegiline pills, posted by gigantor on August 22, 2013, at 23:14:45
Gigantor,
I misunderstood your post in your other thread. No, the 6mg patch of Emsam contains I believe 20mgs of Selegiline. So taking 6mgs of oral Selegiline will be a reduced dose.
This is the end of the thread.
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