Availability of Emsam (Selegiline)
Yes, Emsam (selegiline transdermal system) is still available as a prescription medication for the treatment of major depressive disorder.
Background on Emsam
- Emsam is a monoamine oxidase inhibitor (MAOI) that is uniquely delivered through a transdermal patch system, making it the only MAOI available in a transdermal formulation 1, 2
- It was developed to overcome some of the limitations of oral MAOIs while maintaining their therapeutic efficacy in depression 1
- Selegiline is also available in oral form for Parkinson's disease treatment, but the transdermal system (Emsam) was specifically developed for depression 3
Clinical Uses of Emsam
- Emsam is FDA-approved for the treatment of major depressive disorder (MDD) 1, 4
- At the lowest therapeutic dose of 6 mg/24 hours, Emsam does not require dietary restrictions that are typically necessary with other MAOIs 1, 5
- Higher doses (9 mg/24 hours and 12 mg/24 hours) are also available but may require dietary tyramine restrictions 4
- Emsam may be particularly useful for patients with atypical depression features or those who have failed other antidepressants 1, 5
Advantages of Emsam Over Oral MAOIs
- Transdermal delivery bypasses first-pass hepatic metabolism, reducing the risk of tyramine-induced hypertensive crisis ("cheese reaction") at the 6 mg/24 hour dose 1, 2
- Provides more consistent blood levels of medication compared to oral administration 2
- May have fewer gastrointestinal side effects than oral antidepressants 5
- Useful for patients who have difficulty swallowing pills or adhering to multiple daily dosing regimens 5
Important Considerations and Precautions
- Despite its improved safety profile, Emsam still carries contraindications with certain medications including other MAOIs, SSRIs, SNRIs, TCAs, opioids (especially meperidine), and some cough/cold medications due to risk of serotonin syndrome 6, 7
- When switching to or from Emsam, adequate washout periods (typically 2 weeks, 5 weeks for fluoxetine) are essential to avoid serious drug interactions 6
- Common side effects include application site reactions, insomnia, and occasionally orthostatic hypotension 4, 7
- Patients should be educated about avoiding over-the-counter medications without consulting their healthcare provider 6
Factors Affecting Clinical Utilization
- Despite its advantages, Emsam has been underutilized in clinical practice 5
- Contributing factors include concerns about potential side effects, high cost, limited insurance coverage, and minimal marketing efforts 5
- Clinical evidence supports its efficacy and safety, particularly at the 6 mg/24 hour dose which does not require dietary restrictions 1, 5
Emsam represents an important treatment option for depression that combines the efficacy of MAOIs with improved safety and convenience through its transdermal delivery system.