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Selegiline

Also indexed as: Carbex®, Eldepryl®

Selegiline is used together with levodopa and carbidopa to treat symptoms of Parkinson’s disease.

Interactions with Dietary Supplements

L-Tryptophan and 5-HTP
Both L-tryptophan and 5-HTP have been used to treat depression. One controlled study showed that taking selegiline at the same time as 5-HTP enhanced the antidepressant effect when compared with 5-HTP alone.1 Further research is needed to determine whether taking selegiline and 5-HTP together might result in unwanted side effects.

Interactions with Herbs

Ephedra (Ephedra sinica)
Ephedrine is an active ingredient found in ephedra, an herb used in cold remedies and herbal weight loss products. One individual taking selegiline together with ephedrine experienced a serious side effect known as hypertensive crisis, in which blood pressure can reach dangerous levels.2 Though no studies have investigated whether the herb ephedra might result in similar effects, the current evidence suggests that people taking selegiline should avoid all products that contain ephedra.

Interactions with Foods and Other Compounds

Food
Taking selegiline with food dramatically increases the absorption of the drug.3 Problems might occur when individuals switch from taking selegiline with food to taking it on an empty stomach and vice versa. Therefore, people should consistently take selegiline with a meal to enhance the effects of the drug and to avoid problems.

Tyramine-containing Foods
Rarely, people taking selegiline might experience a rapid rise in blood pressure and a severe throbbing headache when the drug is taken with foods that contain tyramine, such as cheese (especially aged); sour cream; yogurt; alcoholic beverages; meat, fish, and poultry; a variety of fruits and vegetables, including avocados, figs, and eggplant; fava beans; some soups; and chocolate.4 One study showed that taking 30 mg of selegiline each day greatly increases tyramine sensitivity.5 It has therefore been suggested that people taking 30 mg or more of selegiline per day should consume a tyramine-free diet.

Summary of Interactions for Selegiline

Depletion or interference None known
Adverse interaction Ephedra
Tyramine
Side effect reduction/prevention None known
Supportive interaction 5-HTP
Food
L-Tryptophan
Reduced drug absorption/bioavailability None known

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

1. Mendlewicz J, Youdim MB. Antidepressant potentiation of 5-hydroxytryptophan by L-deprenil in affective illness. J Affect Disord 1980;2:137–46.

2. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1025–7.

3. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1025–7.

4. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1025–7.

5. Prasad A, Glover V, Goodwin BL, et al. Enhanced pressor sensitivity to oral tyramine challenge following high dose selegiline treatment. Psychopharmacology (Berl) 1998;95:540–3.