Diethylpropion: (Contraindicated) The product label for diethylpropion contraindicates use with monoamine oxidase inhibitors (MAOIs) due to the risk of hypertensive crisis. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. If a hypertensive crisis occurs, selegiline should be discontinued and therapy to lower blood pressure should be instituted immediately. Concurrent use may result in additive CNS depression. Duloxetine: (Contraindicated) Serotonin norepinephrine reuptake inhibitors (SNRIs) are contraindicated for use with selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor). Food sources considered to be high in tyramine and that may interact with MAO inhibitors in general include Stilton aged cheese, concentrated yeast extracts (e.g., Marmite), aged meats, and sauerkraut. Patients should also be instructed to contact their healthcare provider if they experience severe headache, shortness of breath, palpitations, diaphoresis, chest pain or other symptoms suggestive of a significant hypertensive reaction or hypertensive crisis. In vitro studies have shown that transdermal selegiline exhibits antidepressant properties only at doses that inhibit both MAO-A and MAO-B activity in brain. Selegiline is a selective monoamine oxidase inhibitor type B; however, the selectivity of the drug decreases with increasing doses. Tryptophan is a serotonin precursor. Guaifenesin; Phenylephrine: (Contraindicated) The product label for phenylephrine contraindicates use with monoamine oxidase inhibitors (MAOIs) due to the risk of hypertensive crisis. Concurrent use may also represent duplicative therapy. Throughout lactation and post-weaning periods, decreases in pup weight, retarded pup physical development, and retarded pup neurobehavioral and sexual development were seen at all doses up to 60 times the MRHD. Concomitant use increases the risk for serotonin syndrome. Selegiline is a selective monoamine oxidase inhibitor type B; however, the selectivity of the drug decreases with increasing doses. Concomitant use increases the risk for serotonin syndrome. Carbinoxamine; Pseudoephedrine: (Contraindicated) The product label for pseudoephedrine contraindicates use with monoamine oxidase inhibitors (MAOIs) due to the risk of hypertensive crisis. Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Moderate) Consider a selegiline dose reduction to minimize the risk for selegiline-related adverse reactions during concomitant ethinyl estradiol use. Carbex:- Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees FEldepryl:- Store at controlled room temperature (between 68 and 77 degrees F)EMSAM:- Do not store outside of the sealed pouch- Store at controlled room temperature (between 68 and 77 degrees F)Zelapar:- Product should be used within 3 months after opening- Store at 77 degrees F; excursions permitted to 59-86 degrees F- Store in original container. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. Solriamfetol: (Contraindicated) The concurrent use of noradrenergic drugs, such as solriamfetol, and monoamine oxidase inhibitors (MAOIs), such as selegiline, or use of solriamfetol within 14 days of MAOI therapy is contraindicated due to the increased risk for hypertensive crisis. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with codeine. Pseudoephedrine should generally not be used concurrently with MAOIs or within 14 days before or after their use. (Major) Avoid use if possible. Concurrent use may result in additive CNS depression. Aspirin, ASA; Butalbital; Caffeine; Codeine: (Contraindicated) Codeine is contraindicated for use with selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor), due to the risk of serotonin syndrome or opioid toxicity, including respiratory depression. Concurrent use may result in additive CNS depression. Although barbiturates are CYP3A4 inducers and selegiline is a CYP3A4 substrate, adequate studies have not been conducted to evaluate their effect, if any, on the effectiveness of selegiline. If serotonin syndrome occurs, discontinue therapy. A washout period of at least 14 days should elapse between the start of dextromethorphan after discontinuation of selegiline. Ephedrine; Guaifenesin: (Moderate) Monitor blood pressure for hypertension during concomitant use of selegiline and sympathomimetics such as ephedrine. (Moderate) Monitor for excessive sedation and somnolence during coadministration of selegiline and brompheniramine. Caregivers should be advised to closely observe the patient on a daily basis and to communicate immediately with the prescriber the emergence of agitation, irritability, unusual changes in behavior, or emergence of suicidality. Bretylium: (Minor) Selegiline, a monoamine oxidase type B inhibitor, might potentiate the effects of the early release of catecholamines from nerve endings produced by bretylium, such as transient hypertension and increased frequency of arrhythmias. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. After stopping treatment with an SNRI, a time period equal to 4 to 5 half-lives of the SNRI or any active metabolite should elapse before starting therapy with selegiline. Pseudoephedrine should generally not be used concurrently with MAOIs or within 14 days before or after their use. Atropine; Difenoxin: (Major) Avoid concomitant use of selegiline and diphenoxylate or difenoxin due to the theoretical risk of hypertensive crisis. Acetaminophen; Dextromethorphan; Doxylamine: (Contraindicated) Dextromethorphan products are contraindicated in patients taking selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor) or in patients who have taken an selegiline within the last 14 days, due to the risk of serious and possibly fatal drug interactions, including serotonin syndrome. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Selegiline is a CYP3A substrate and phenytoin is a strong CYP3A inducer. Phendimetrazine: (Contraindicated) The product label for phendimetrazine contraindicates use with monoamine oxidase inhibitors (MAOIs) due to the risk of hypertensive crisis. Because a pooled analysis found that maternal use of sertraline, along with nortriptyline and paroxetine, usually produced undetectable or low drug concentrations in infant serum, these agents may be preferable to other antidepressants when initiating antidepressant therapy in a breast-feeding mother. Carbinoxamine: (Moderate) Monitor for excessive sedation and somnolence during coadministration of selegiline and carbinoxamine. Benzhydrocodone; Acetaminophen: (Major) The use of benzhydrocodone is not recommended in patients who have received a monoamine oxidase inhibitor (MAOI) within the previous 14 days or are currently taking an MAOI due to a risk for serotonin syndrome or opioid toxicity, including respiratory depression. In some cases, excessive drowsiness has resulted in auto accidents or other harmful events in the course of daily living. Because selegiline is a selective MAO-B inhibitor at manufacturer recommended doses, serious reactions with agents affecting catecholamine release are less likely than with non-selective MAOIs. Uncontrolled hypertension has been reported when taking the recommended dose of oral selegiline and a sympathomimetic medication. Monitor for serotonergic side effects during therapy transitions. (Contraindicated) The product label for phenylephrine contraindicates use with monoamine oxidase inhibitors (MAOIs) due to the risk of hypertensive crisis. Serotonin syndrome has occurred in patients receiving selective MAO-B inhibitors and serotonin-augmenting antidepressants simultaneously. Advise patients to regularly monitor for skin changes and to promptly report these changes to their provider. Patients should read nonprescription product labels carefully. MAOIs can affect the metabolism and uptake of circulating amines. Pseudoephedrine: (Contraindicated) The product label for pseudoephedrine contraindicates use with monoamine oxidase inhibitors (MAOIs) due to the risk of hypertensive crisis. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with an SNRI. Dose reductions of levodopa may be needed if dopaminergic side effects, including dyskinesia and hallucinations emerge. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. Although barbiturates are CYP3A4 inducers and selegiline is a CYP3A4 substrate, adequate studies have not been conducted to evaluate their effect, if any, on the effectiveness of selegiline. Do not swallow the ODT tablet.The patient should avoid ingesting food or liquids for 5 minutes before and after taking selegiline ODT.Do not administer doses greater than 2.5 mg/day because of the risk of hypertensive crisis. Transdermal administration avoids first-pass metabolism and results in much higher bioavailability compared to the oral dose form (74% vs. 4%). Concomitant use may increase selegiline exposure. Patients should read nonprescription product labels carefully. Methylphenidate Derivatives: (Contraindicated) The product labels for methylphenidate and its derivatives contraindicate use with monoamine oxidase inhibitors (MAOIs), including selegiline, due to the risk of hypertensive crisis. 1 Some reports have shown that oral selegiline treatment can also be effective in treating depression. Concomitant use may increase the risk for serotonin syndrome or additive CNS depression. Patients should be advised to avoid exposing the patch application site to external sources of direct heat, such as a heating pad or electric blanket, or any external ambient temperature increase from heat lamps, saunas, hot tubs, heated water beds, and prolonged direct sunlight (UV) exposure. Pseudoephedrine should generally not be used concurrently with MAOIs or within 14 days before or after their use. (Moderate) Monitor for unusual drowsiness and sedation during coadministration of cetirizine and selegiline due to the risk for additive CNS depression. During non-emergent use of methylene blue, it is advisable to discontinue the MAOI at least 2 weeks prior to methylene blue treatment, but also taking into consideration the half-life of selegiline. Chlophedianol; Dexchlorpheniramine; Pseudoephedrine: (Contraindicated) The product label for pseudoephedrine contraindicates use with monoamine oxidase inhibitors (MAOIs) due to the risk of hypertensive crisis. Diethylpropion should generally not be used concurrently with MAOIs or within 14 days before or after their use. Dexbrompheniramine; Pseudoephedrine: (Contraindicated) The product label for pseudoephedrine contraindicates use with monoamine oxidase inhibitors (MAOIs) due to the risk of hypertensive crisis. Although adequate studies have not been conducted, concurrent use may decrease selegiline exposure. If serotonin syndrome occurs, discontinue therapy. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. Rizatriptan: (Moderate) Monitor for signs and symptoms of serotonin syndrome, particularly during treatment initiation and dosage increase, during concomitant rizatriptan and selegiline use. Methylene Blue: (Major) Concurrent use of intravenous (IV) methylene blue and MAOIs such as selegiline should generally be avoided due to the potential for serotonin syndrome. Prochlorperazine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of phenothiazines and selegiline due to the risk for additive CNS depression. After stopping treatment with bupropion, a time period equal to 4 to 5 half-lives of bupropion or any active metabolite should elapse before starting therapy with selegiline. Codeine; Guaifenesin; Pseudoephedrine: (Contraindicated) Codeine is contraindicated for use with selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor), due to the risk of serotonin syndrome or opioid toxicity, including respiratory depression. Following hepatic metabolism, selegiline is excreted primarily in the urine as metabolites (mainly as L-methamphetamine and L-amphetamine) and as a small amount in the feces. Phendimetrazine should generally not be used concurrently with MAOIs or within 14 days before or after their use. A washout period of at least 14 days should elapse between the start of dextromethorphan after discontinuation of selegiline. Concurrent use may result in additive CNS depression. Serotonin syndrome has occurred in patients receiving selective MAO-B inhibitors and serotonin-augmenting antidepressants simultaneously. If urgent use of an opioid is necessary, use test doses and frequent titration of small doses of alternate opioids to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression. Serotonin syndrome has occurred in patients receiving selective MAO-B inhibitors and sertonoergic antidepressants simultaneously. Dopamine antagonists, such as atypical antipsychotics, may diminish the effectiveness of selegiline. Doxepin: (Contraindicated) Tricyclic antidepressants (TCAs) are contraindicated for use with selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor). At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with sibutramine. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with codeine. Concurrent use may result in additive CNS depression. Chlordiazepoxide: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and selegiline due to the risk for additive CNS depression. Amphetamines should not be used concurrently with MAOIs or within 14 days before or after their use. (Moderate) Monitor for unusual drowsiness and sedation during coadministration of phenothiazines and selegiline due to the risk for additive CNS depression. Carbinoxamine; Dextromethorphan; Pseudoephedrine: (Contraindicated) Dextromethorphan products are contraindicated in patients taking selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor) or in patients who have taken an selegiline within the last 14 days, due to the risk of serious and possibly fatal drug interactions, including serotonin syndrome. All patients should be monitored for symptom worsening or suicidality, especially at treatment initiation or after dose changes. The need for an antidepressant in children, adolescents, or young adults for any use must be weighed against the risk of suicidality; it is unknown if this risk extends to long-term use. Selegiline is selective for MAO-B at recommended doses (2.5 to 12 mg/day). The elderly population with Parkinson's disease, already at risk for falls, may be at greater risk with the use of selegiline; therefore, caution is warranted. Dihydrocodeine is closely related to codeine and is usually considered contraindicated for use with selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor), due to the risk of serotonin syndrome or opioid toxicity, including respiratory depression. Ensure that the transdermal system is flat against the skin and is sticking securely. Because of the long half-life of fluoxetine and its active metabolite, at least 5 weeks should elapse between discontinuation of fluoxetine and initiation of treatment with selegiline. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with an SSRI. Selegiline should not be used in patients with alcoholism. Patients should read nonprescription product labels carefully. Concurrent use of selegiline and procarbazine may increase the risk of hypertensive crisis or serotonin syndrome. Steady state is achieved after 8 days. Phenytoin: (Moderate) Monitor for a decrease in selegiline efficacy if coadministered with phenytoin. Because selegiline is a selective monoamine oxidase-B (MAO-B) inhibitor, an interaction may be less likely to occur than with other traditional MAOIs. After stopping treatment with maprotiline, a time period equal to 4 to 5 half-lives of maprotiline or any active metabolite should elapse before starting therapy with selegiline. Guaifenesin; Pseudoephedrine: (Contraindicated) The product label for pseudoephedrine contraindicates use with monoamine oxidase inhibitors (MAOIs) due to the risk of hypertensive crisis. Oral forms of selegiline should generally also be avoided in these patients, due to similar reasons. If serotonin syndrome occurs, discontinue therapy. The manufacturer of transdermal selegiline recommends avoiding ethanol ingestion and specifically recommends avoiding tyramine-rich alcoholic beverages such as all varieties of tap beer and beers that have not been pasteurized during use of the 9 mg/24 hour or 12 mg/24 hour patch and for 2 weeks after discontinuation or dose reduction to 6 mg/24 hour due to the risk for hypertensive crisis. Do not use scissors.Do not cut or trim the patch.To apply the patch, remove half of the release liner and discard it. Nalbuphine: (Major) Avoid concomitant use of nalbuphine in patients receiving selegiline or within 14 days of stopping treatment with selegiline due to the risk of serotonin syndrome or opioid toxicity, including respiratory depression. Concurrent use may result in additive CNS depression. If a hypertensive crisis occurs, selegiline should be discontinued and therapy to lower blood pressure should be instituted immediately. A washout period of at least 14 days should elapse between the start of dextromethorphan after discontinuation of selegiline. (Moderate) Monitor for excessive sedation and somnolence during coadministration of selegiline and brompheniramine. Although adequate studies to investigate the effect of CYP3A4-inducers on selegiline have not been performed, drugs that induce CYP3A4 (e.g., phenytoin, carbamazepine, nafcillin, phenobarbital, and rifampin) should be used with caution. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with mirtazapine. Belladonna; Opium: (Moderate) Concomitant use of opioid agonists with selegiline may cause excessive sedation, somnolence, and serotonin syndrome. Acetaminophen; Dextromethorphan: (Contraindicated) Dextromethorphan products are contraindicated in patients taking selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor) or in patients who have taken an selegiline within the last 14 days, due to the risk of serious and possibly fatal drug interactions, including serotonin syndrome. Inhibition of VMAT2 results in decreased uptake of monoamines into synaptic vesicles and depletion of monoamine stores. Concomitant use may increase selegiline exposure. Serotonin syndrome has occurred in patients receiving selective MAO-B inhibitors and such antidepressants simultaneously. It is also possible that dopamine antagonists, such as phenothiazines, could diminish the effectiveness of selegiline. In vitro studies have demonstrated that selegiline is not an inhibitor of CYP450 enzymes. Lithium: (Moderate) Monitor for signs and symptoms of serotonin syndrome, particularly during treatment initiation and dosage increase, during concomitant selegiline and lithium use. The use of these drugs together may produce substantial elevations in blood pressure. Because of the potential for serious adverse effects in a breast-fed infant, including hypertensive crisis, the manufacturer for the orally disintegrating tablets recommends against breast-feeding during treatment and for 7 days after the final dose. In addition, when beginning treatment with antihypertensives that initially increase the release of catecholamine stores, such as guanfacine, hypertensive crisis may occur. Chlophedianol; Dexbrompheniramine: (Moderate) Monitor for excessive sedation and somnolence during coadministration of selegiline and dexbrompheniramine. Although selegiline is a selective MAO-B inhibitor, there is a risk of hypertension or serotonin syndrome during concurrent use of other drugs with MAO inhibiting activity such as procarbazine, since the selectivity of selegiline decreases with increasing dosages. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. Although barbiturates are CYP3A4 inducers and selegiline is a CYP3A4 substrate, adequate studies have not been conducted to evaluate their effect, if any, on the effectiveness of selegiline. Selegiline and two of its metabolites, methamphetamine and desmethylselegiline, have little or no potential to induce CYP1A2 and CYP3A4/5 under clinical conditions. Concomitant use may increase the risk for serotonin syndrome or additive CNS depression. Patients should be advised that they may develop symptomatic or asymptomatic hypotension while taking oral selegiline, particularly during treatment initiation. Serotonin-Receptor Antagonists: (Moderate) Monitor for signs and symptoms of serotonin syndrome, particularly during treatment initiation and dosage increase, during concomitant selegiline and serotonin-receptor antagonist use. Nabilone: (Major) Avoid coadministration of selegiline with nabilone due to the risk of additive CNS depression. MAOIs are rarely used due to their potential interactions (i.e., hypertensive crisis) with tyramine- or tryptophan-containing foods (e.g., cheese, wine) or other medications, and their profound effect on blood pressure. Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Contraindicated) Dextromethorphan products are contraindicated in patients taking selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor) or in patients who have taken an selegiline within the last 14 days, due to the risk of serious and possibly fatal drug interactions, including serotonin syndrome. Pseudoephedrine should generally not be used concurrently with MAOIs or within 14 days before or after their use. Uncontrolled hypertension has been reported when taking the recommended dose of oral selegiline and a sympathomimetic medication. It is not known if a reduction in dosage will subsequently reduce or eliminate excessive somnolence or sudden episodes of sleep. Serotonin syndrome has been reported when another oxazolidinone-class antibacterial has been administered with certain serotonergic agents. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. Brompheniramine; Dextromethorphan; Phenylephrine: (Contraindicated) Dextromethorphan products are contraindicated in patients taking selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor) or in patients who have taken an selegiline within the last 14 days, due to the risk of serious and possibly fatal drug interactions, including serotonin syndrome. Uncontrolled hypertension has been reported when taking the recommended dose of oral selegiline and a sympathomimetic medication. Monitor for serotonergic side effects during therapy transitions. In the postmarketing period, potentially life-threatening serotonin syndrome has been reported in patients treated with selected serotonergic agents concomitantly with selegiline. Hydrocodone; Ibuprofen: (Major) Avoid concomitant use of hydrocodone in patients receiving selegiline or within 14 days of stopping treatment with selegiline due to the risk of serotonin syndrome or opioid toxicity, including respiratory depression. Asenapine: (Moderate) Monitor for loss of selegiline efficacy, signs and symptoms of serotonin syndrome, particularly during treatment initiation and dosage increase, and unusual drowsiness and sedation during concomitant atypical antipsychotic and selegiline use. A washout period of at least 14 days should elapse between the start of dextromethorphan after discontinuation of selegiline. Concurrent use may result in additive CNS depression. Concurrent use may result in additive CNS depression. Sodium Oxybate: (Moderate) Monitor for excessive sedation and somnolence during coadministration of selegiline and sodium oxybate. Dextromethorphan: (Contraindicated) Dextromethorphan products are contraindicated in patients taking selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor) or in patients who have taken an selegiline within the last 14 days, due to the risk of serious and possibly fatal drug interactions, including serotonin syndrome. Acetaminophen; Guaifenesin; Phenylephrine: (Contraindicated) The product label for phenylephrine contraindicates use with monoamine oxidase inhibitors (MAOIs) due to the risk of hypertensive crisis. Ozanimod: (Contraindicated) Coadministration of ozanimod with monoamine oxidase (MAO) inhibitors, like selegiline, is contraindicated. If serotonin syndrome occurs, discontinue therapy. Amphetamines should not be used concurrently with MAOIs or within 14 days before or after their use. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. 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