What is the most important information I should know about selegiline?

There are many other medicines that can cause serious medical problems if you take them together with selegiline. Tell your doctor about all other prescription and over-the-counter medications you use, including vitamins, minerals, and herbal products.

While taking selegiline, do not drink alcohol or eat foods that are high in tyramine, listed in the "What should I avoid while using selegiline?" section of this leaflet. Eating tyramine while you are using selegiline can raise your blood pressure to dangerous levels and cause life-threatening symptoms.

You should become very familiar with the list of foods to avoid while you are using selegiline.

Do not stop taking selegiline suddenly or you may have harmful side effects. Keep taking the medicine as prescribed. Talk with your doctor before stopping the medication.

You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medication. Talk with your doctor if you believe you have any intense or unusual urges while taking selegiline.

What is selegiline?

Selegiline prevents the breakdown of a chemical in your brain called dopamine (DO pa meen). Low levels of this chemical are associated with Parkinson's disease.

Selegiline is used together with other medicines to treat symptoms of Parkinson's disease.

Selegiline may also be used for other purposes not listed in this medication guide.

What should I discuss with my healthcare provider before using selegiline?

Do not use this medication if you are allergic to selegiline, or if you have used any of the following drugs within the past 14 days:

• cough or cold medicine that contains dextromethorphan;
• meperidine (Demerol), propoxyphene (Darvon, Darvocet), or tramadol (Ultram, Ultracet);
• methadone (Dolophine, Methadose); or
• other MAO inhibitors such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or transdermal selegiline (Emsam).

After you stop taking selegiline, you must wait at least 14 days before taking any of the medications listed above.

Before using this medicine, tell your doctor if you have kidney disease, liver disease, heart disease, high or low blood pressure, or a seizure disorder. If you have any of these conditions, you may need a dose adjustment or special tests to safely take selegiline.

You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking selegiline. It is not known whether the medicine actually causes this effect. Talk with your doctor if you believe you have any intense or unusual urges while taking selegiline.

FDA pregnancy category C. It is not known whether this medication is harmful to an unborn baby. Before you take selegiline, tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether selegiline passes into breast milk or if it could harm a nursing baby. Do not take selegiline without telling your doctor if you are breast-feeding a baby.

The selegiline disintegrating tablets may contain phenylalanine. Talk to your doctor before using this form of selegiline if you have phenylketonuria (PKU).

How should I take selegiline?

Take selegiline exactly as it was prescribed for you. Do not take the medication in larger amounts or for longer than recommended by your doctor. Larger doses will not have any greater effect, but serious side effects could result. Follow the directions on your prescription label.

While you are using selegiline and for 14 days after you stop, you must not eat foods listed in the "What should I avoid while using selegiline?" section of this leaflet. Eating these foods while you are using selegiline can raise your blood pressure to dangerous levels.

Foods that you MAY eat include:

• fresh meat, poultry, or fish (including lunch meat, hot dogs, breakfast sausage, and cooked sliced ham);
• any vegetables except broad bean pods (fava beans);
• processed cheese, mozzarella, ricotta, cottage cheese;
• pizza made with cheeses low in tyramine;
• soy milk, yogurt; or
• Brewer's or baker's yeast.

Selegiline capsules are usually taken twice a day, at breakfast and lunch. Follow your doctor's instructions.

The disintegrating tablet form of selegiline (Zelapar) should be taken once a day before breakfast and without any liquid.

To take selegiline orally disintegrating tablets (Zelapar):

• Keep the tablet in its blister pack until you are ready to take the medicine. Open the package and peel back the foil from the tablet blister. Do not push a tablet through the foil or you may damage the tablet.
• Using dry hands, remove the tablet and place it in your mouth. It will begin to dissolve right away.
• Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. Swallow several times as the tablet dissolves.
• Do not drink or eat anything for at least 5 minutes after taking a Zelapar orally disintegrating tablet.

Parkinson's disease is often treated with a combination of different drugs. To best treat your condition, use all of your medications as directed by your doctor. When you start taking selegiline, your doses of the other medications may need to change. Do not change your doses or medication schedule without advice from your doctor.

Do not stop taking selegiline suddenly or you may have harmful side effects. For best results, keep taking the medicine as prescribed.

Store this medicine at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include severe headache, hallucinations, vision problems, sweating, cool or clammy skin, fast or uneven heart rate, feeling light-headed, fainting, or seizure (convulsions).

What should I avoid while using selegiline?

You must NOT eat foods that are high in tyramine, including:

• air dried meats, aged or fermented meats, sausage or salami (including cacciatore and mortadella), pickled herring, and any spoiled or improperly stored beef, poultry, fish, or liver;
• beer from a tap, beer that has not been pasteurized;
• aged cheeses, including blue, boursault, brick, brie, camembert, cheddar, emmenthaler, gruyere, parmesan, romano, roquefort, stilton, and swiss;
• over-the-counter supplements or cough and cold medicines that contain tyramine;
• sauerkraut, soy beans, soy sauce, tofu, miso soup, bean curd, fava beans; or
• yeast extracts (such as Marmite).

Eating tyramine while you are taking selegiline can raise your blood pressure to dangerous levels which could cause life-threatening side effects.

You should become very familiar with the list of foods to avoid while you are taking selegiline.

Avoid drinking alcohol while taking selegiline.

Selegiline can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What are the possible side effects of selegiline?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop taking selegiline and call your doctor at once if you have any of these serious side effects:

• sudden and severe headache, confusion, blurred vision, problems with speech or balance, nausea, vomiting, chest pain, seizure (convulsions), and sudden numbness or weakness (especially on one side of the body);
• feeling light-headed, fainting;
• hallucinations;
• feeling restless, agitated, or irritable;
• twitching muscle movements; or
• painful or difficult urination.

Less serious side effects may include:

• dizziness, weakness;
• sleep problems (insomnia);
• runny or stuffy nose;
• back pain;
• constipation; or
• mouth sores or ulcers, pain with swallowing (while using Zelapar).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect selegiline?

Before taking selegiline, tell your doctor if you are using any of the following drugs:

• carbamazepine (Tegretol);
• diet pills or cold medicines that contain ephedrine, pseudoephedrine, or phenylephrine;
• nafcillin (Unipen);
• phenobarbital (Luminal, Solfoton);
• rifampin (Rifadin, Rifater, Rifamate, Rimactane); or
• an antidepressant such as amitriptyline (Elavil), amoxapine (Ascendin), bupropion (Wellbutrin, Zyban), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), imipramine (Tofranil), nortriptyline (Pamelor), paroxetine (Paxil), protriptyline (Vivactil), sertraline (Zoloft), venlafaxine (Effexor), or trimipramine (Surmontil).

This list is not complete and there are many other medicines that can cause serious medical problems if you take them together with selegiline. Do not take selegiline before telling your doctor about all other prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Keep a list with you of all the medicines you use and show this list to any doctor, dentist, or other healthcare provider who treats you.

Where can I get more information?

Your pharmacist can provide more information about selegiline.