Selegiline Patch (Emsam): Uses, Food Limits and Warnings

What the selegiline patch is

The selegiline patch is a monoamine oxidase inhibitor (MAOI) that you wear on your skin rather than swallow. It is sold as Emsam. NIMH says older antidepressants such as MAOIs are associated with more side effects, while still suiting some people.

Selegiline also comes in forms taken by mouth, and MedlinePlus says those are used to help control symptoms of Parkinson's disease in people taking levodopa and carbidopa. Those are not the same as the patch, and this page covers only the patch.

What it is approved for, and off-label uses

The FDA label says the patch is for adults with major depressive disorder. Unlike the labels for some other MAOIs, this one does not limit it to people who have tried other antidepressants. The label calls for screening for bipolar disorder before treatment.

It is contraindicated in children under 12 because of the risk of a hypertensive crisis, and the label does not recommend it for ages 12 to 17. MedlinePlus says only that it may be prescribed for other uses, without naming them, so this page does not list one.

How it is thought to work

The label says its antidepressant action is not fully understood, but is presumed to come from permanently blocking the enzyme monoamine oxidase. That strengthens the activity of chemical messengers in the brain. The label explains that selegiline favors one form of the enzyme, MAO-B, but loses that selectivity as levels rise. MAO-A, the form mostly found in the gut, helps protect you from tyramine in food, which is why food limits can apply at higher strengths.

What using it can be like

MedlinePlus says your condition may begin to improve after a week or longer. Keep using it even if you feel well, and do not stop without talking to your prescriber.

Using a patch has its own routine. The label says to apply it to dry, intact skin on the upper torso, upper thigh or outer upper arm, choosing a new spot each time and avoiding skin that is hairy, oily, irritated, broken, scarred or calloused. Wear only one patch at a time, do not cut it, and fold a used patch before putting it safely out of reach of children and pets.

Keep heat away from the patch. The label says to avoid heating pads, electric blankets, heat lamps, saunas, hot tubs, heated water beds and long direct sunlight, since heat might raise how much medicine you absorb.

• Food limits depend on patch strength. The label says no modified diet is required at the lowest strength, and that higher strengths require one.
• At higher strengths, the limits apply from the first day and continue for 2 weeks after lowering the strength or finishing treatment.
• MedlinePlus describes foods high in tyramine as meat, poultry, fish or cheese that is smoked, aged, poorly stored or spoiled, certain fruits, vegetables and beans, alcoholic drinks, and fermented yeast products. Your prescriber or dietitian can give you the full list.
• The label says to avoid tyramine supplements, and that alcohol is not recommended.

Side effects and warnings

Boxed warning: antidepressants increased the risk of suicidal thoughts and behaviors in children and young adults in short-term studies. All patients should be closely watched for worsening mood and for these thoughts. The patch is contraindicated under age 12. If you are thinking about suicide or are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services. See our crisis resources as well.

The label names application site reactions as the main side effect, along with headache, trouble sleeping, diarrhea, dry mouth, indigestion, rash, sore throat and sinus infection. MedlinePlus also lists weight loss.

The label warns of a hypertensive crisis, a sudden dangerous rise in blood pressure that in some cases may be fatal, with tyramine-rich foods. Signs include a headache spreading from the back of the head, pounding heartbeat, stiff or sore neck, nausea, vomiting, sweating, wide pupils, light sensitivity and chest pain. Call 911 if these occur.

Dangerous drug combinations: it is contraindicated with SSRIs, SNRIs, clomipramine, imipramine, meperidine, tramadol, methadone, pentazocine and dextromethorphan because of serotonin syndrome, and with carbamazepine because of possible hypertensive crisis. It is also contraindicated with pheochromocytoma, a rare gland tumor. The label says at least 2 weeks must pass after the patch before beginning any of these, and at least 5 weeks after fluoxetine before beginning the patch. Blood pressure should be monitored if used with buspirone, amphetamines, or cold and weight products containing decongestants.

It may also bring on mania or hypomania in people with bipolar disorder. Tell your prescriber if you are pregnant, planning a pregnancy or breastfeeding.

Can it be managed online in Pennsylvania and New York

The patch is used at home, its label says it is not a controlled substance, and the label does not limit it to a certified healthcare setting. A video visit can go over your medicines, your skin and your mood. It cannot measure blood pressure, so ask how that would be handled if your situation calls for it. An emergency reaction needs 911, not a video visit.

A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine (DO) with more than three decades of practice, offers online depression treatment and medication management by secure video for people physically located in Pennsylvania or New York during each visit. Our therapists do not prescribe.

Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help, through our medication contact form.