Selegiline Cream Formulations for Depression
No, there are no cream or topical formulations of selegiline available for the treatment of depression—selegiline is only available as a transdermal patch system (Emsam) or oral formulations for depression treatment.
Available Selegiline Formulations
The selegiline transdermal system (STS/Emsam) is the only FDA-approved transdermal delivery method for selegiline in treating major depressive disorder, available in 6 mg/24 hours, 9 mg/24 hours, and 12 mg/24 hours patch strengths 1, 2.
- Transdermal patches are specifically designed to bypass hepatic first-pass metabolism, allowing sufficient brain levels of selegiline while avoiding significant gastrointestinal and hepatic MAO-A inhibition 1, 2.
- Oral selegiline formulations exist but are primarily approved for Parkinson's disease and lose selectivity at higher antidepressant doses, increasing tyramine interaction risks 2.
Why Cream Formulations Don't Exist
The transdermal patch technology is essential for selegiline's antidepressant efficacy and safety profile:
- Sustained plasma concentrations are achieved through the patch delivery system, which cannot be replicated with cream formulations 2.
- Targeted CNS delivery with minimal peripheral MAO-A inhibition requires the controlled-release mechanism of patches 2.
- The 6 mg/24 hour dose provides effective antidepressant action without dietary tyramine restrictions specifically because of the transdermal delivery system 1, 3.
Clinical Implications for Your Patient on 12 mg Emsam
Important caveat: At the 12 mg/24 hour dose, dietary tyramine restrictions are recommended, unlike the 6 mg dose 1, 3.
- Patients on 12 mg patches who experience application site reactions (the most common side effect) should not attempt to substitute with creams, as no equivalent formulation exists 3, 4.
- If skin reactions are problematic, consider rotating patch application sites or discussing dose reduction to 9 mg or 6 mg with the prescribing physician 4.
- Application site reactions occur more frequently with STS compared to oral MAOIs, but STS has significantly fewer cardiovascular and gastrointestinal side effects 4.
Alternative Considerations
If the question stems from concerns about patch tolerability:
- Oral MAOIs (phenelzine, tranylcypromine) are alternatives but require strict dietary restrictions at all doses and have more side effects than STS 4, 2.
- Switching to oral selegiline is not recommended for depression treatment, as it loses MAO-B selectivity at antidepressant doses and increases tyramine interaction risk 2.