Understanding Patient Confusion About Emsam "Creams"
Your patient is likely confusing Emsam (selegiline transdermal system), which is a patch, not a cream, with other topical medications or misunderstanding the transdermal delivery system entirely.
What Emsam Actually Is
Emsam is a transdermal patch system, not a cream or topical formulation. 1, 2 It delivers the monoamine oxidase inhibitor selegiline through the skin via an adhesive patch that is applied once daily. 3, 4
- The patch is designed to bypass hepatic first-pass metabolism, allowing therapeutic brain concentrations of selegiline while avoiding significant inhibition of gastrointestinal MAO-A activity 3
- This transdermal delivery distinguishes it from oral selegiline formulations used in Parkinson's disease 1
- Available doses are 6 mg/24 hours, 9 mg/24 hours, and 12 mg/24 hours 2, 4
Why the Confusion May Have Occurred
Patients may confuse the patch with topical creams for several reasons:
- The term "transdermal" may sound like a topical cream or ointment to patients unfamiliar with medical terminology 3
- Application site reactions are the most common adverse event with Emsam, which patients might associate with topical preparations 4, 5
- Patients may have seen or heard about compounded topical formulations mentioned in other contexts (though these are unrelated to Emsam) 6
Clinical Clarification for Your Patient
Explain that Emsam is specifically a patch system applied to intact skin on the upper torso, upper thigh, or outer upper arm. 3 The patch should be:
- Applied to dry, intact skin once every 24 hours 4
- Rotated to different application sites to minimize skin reactions 4
- Not confused with creams, ointments, or other topical formulations
Key Clinical Points About Emsam
At the 6 mg/24 hour dose, Emsam is the only MAOI approved for major depressive disorder that does not require dietary tyramine restrictions. 3, 4 This represents a significant safety advantage over oral MAOIs. 2
- Higher doses (9 mg/24 hours or 12 mg/24 hours) do require dietary tyramine restrictions 3, 4
- No hypertensive crises have been reported at any dose in clinical trials 2
- Application site reactions occur commonly but are typically mild to moderate 4, 5
- Sexual side effects and weight gain rates are similar to placebo 4
The transdermal route avoids swallowing issues and provides favorable pharmacokinetics with minimal systemic side effects compared to oral formulations. 5