Emsam TD

Selegiline is an antidepressant (monoamine oxidase inhibitor) that treats depression by restoring the balance of certain natural substances (neurotransmitters) in the brain. Selegiline can improve your mood and feelings of well-being. This medication is a patch for use on the skin.
This medication is not recommended for use in children younger than 12 years due to an increased risk of serious side effects.

How to use Emsam TD
Read the Medication Guide available from your pharmacist before you start using selegiline and each time you get a refill. If you have any questions, consult your doctor or pharmacist.
Follow the package instructions for using this medication. Make sure you understand how to apply a new patch and dispose of the used product. Do not cut the patch into smaller sizes. Do not use the patch if it appears broken, cut or damaged. If you have any questions, consult your doctor or pharmacist.
Before applying the patch, wash the area you will be using for the patch gently and thoroughly with soap and water. Rinse and dry with a clean dry towel. Do not apply the patch to hairy/oily/red/cut/irritated/broken or scarred/calloused skin. Remove the patch from the foil pouch and apply as directed by the manufacturer. Apply one patch to an area of clean dry skin on the upper body (torso), upper thigh, or on the outside of the upper arm where it will not be rubbed by tight clothing. Change the patch daily at about the same time each day. Apply the patch to a different area on your body each time to avoid irritation. If your patch falls off, apply a new patch to a new area and continue on your same schedule.
Be sure to remove the old patch, fold it in half so it sticks to itself, and throw it away out of the reach of children and pets. Do not touch the sticky side with your fingers. Wash your hands with soap and water after handling the patch.
To reduce your risk of side effects, your doctor may start you at a low dose and gradually increase your dose. Usually, your daily dose will not be more than 12 milligrams. Once your condition improves and you are better for a while, your doctor may work with you to reduce your regular dose. Follow your doctor\'s instructions carefully. Do not apply more patches or leave the patch on for longer than prescribed. Your condition will not improve any faster and your risk of side effects will increase.
Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time each day. It may take several weeks for the full benefits of this medication to be noticed. Do not stop using this medication without consulting your doctor.
Inform your doctor if your condition persists or worsens.

See also Warning section.
Dizziness, drowsiness, redness/irritation at the application site, tiredness, weakness, problems sleeping, constipation, and dry mouth may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor immediately if any of these unlikely but serious side effects occur: fainting, mental/mood changes (e.g., agitation, confusion), muscle stiffness/twitching, changes in sexual ability/interest, shaking (tremor), shivering, swollen ankles/legs, unusual weight gain/loss, vision changes (e.g., double/blurred vision).
Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: severe stomach/abdominal pain, persistent nausea/vomiting, seizures, dark urine, yellowing eyes/skin.
This drug may rarely cause an attack of extremely high blood pressure (hypertensive crisis), which may be fatal. Many drug and food interactions can increase this risk (See also Drug Interaction section.) Stop using selegiline and seek immediate medical attention if any of these very serious side effects occur: frequent/severe headache, fast/slow/irregular/pounding heartbeat, chest pain, neck stiffness/soreness, severe nausea/vomiting, sweating/clammy skin (sometimes with fever), enlarged pupils, sudden sensitivity to light (photophobia).
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US -
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Before using selegiline, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: a certain kind of adrenal gland tumor (pheochromocytoma), cerebrovascular disease (e.g., stroke), heart problems (e.g., congestive heart failure, heart attack), high blood pressure, history of severe/frequent headaches.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal/family history of mental/mood disorders (e.g., bipolar disorder, depression, schizophrenia), family history of high blood pressure, heart disease (e.g., coronary artery disease, history of chest pain), liver problems, certain nervous system diseases (Parkinson\'s syndrome, seizures), overactive thyroid (hyperthyroidism).
This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Avoid alcoholic beverages.
To minimize dizziness and the risk of fainting, get up slowly when rising from a sitting or lying position.
Avoid exposing your skin to direct heat sources such as heating pads, electric blankets, heat lamps, saunas, hot tubs, heated water beds, or prolonged direct sunlight while wearing your selegiline patch. Heat sources may cause more drug to be released into your body, increasing the chance of side effects.
Before having surgery, tell your doctor or dentist you are on this medication. You may need to stop using this drug beforehand. Follow your doctor\'s instructions carefully.
If you have diabetes, selegiline may make it more difficult to control your blood sugar levels. Check your blood sugar levels regularly as directed by your doctor. Tell your doctor immediately if you have symptoms of high/low blood sugar such as increased thirst or urination, hunger, unexplained sweating. Your anti-diabetic medication or diet may need to be adjusted.
Caution is advised when using this drug in the elderly because they may be more sensitive to the effects of the drug, especially the effects on blood pressure.
This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.
It is not known if this medication passes into breast milk. Consult your doctor before breast-feeding.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor\'s approval.
Some products that may interact with selegiline include: antidepressants (including amitriptyline, bupropion, fluoxetine, SNRIs such as duloxetine/venlafaxine), other MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, tranylcypromine), appetite suppressants (such as diethylpropion, sibutramine), drugs for attention deficit disorder (such as atomoxetine, methylphenidate), buspirone, carbamazepine/oxcarbazepine, cyclobenzaprine, dextromethorphan, certain herbal products (such as ephedra/ma huang, St. John\'s wort), cold medications/nasal decongestants (such as phenylephrine, phenylpropanolamine, pseudoephedrine), certain narcotic medications (meperidine, methadone, propoxyphene), street drugs (such as MDMA/\"ecstasy\", LSD, mescaline), stimulants (such as amphetamines, ephedrine), supplements (such as tryptophan, tyramine), tramadol.
Tell your doctor or pharmacist if you are using any of these medications before, during, or within 2 weeks after treatment with selegiline. Tell your doctor or pharmacist if you have taken fluoxetine during at least 5 weeks before starting selegiline. Discuss with your doctor how much time to wait between starting or stopping any of these drugs and taking selegiline.
Check the labels on all your medicines (such as allergy, cough-and-cold products, diet pills) because they may contain dextromethorphan, decongestants, or stimulants. Ask your pharmacist about the safe use of those products.
Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: certain antihistamines (such as diphenhydramine), anti-seizure drugs (such as phenytoin), medicine for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, narcotic pain relievers (such as codeine, fentanyl), psychiatric medicines (such as chlorpromazine, lithium, risperidone, trazodone).
It is very important that you follow special dietary restrictions in order to limit the amount of tyramine in your diet if you are using the higher strength patches (9 or 12 milligrams). Avoid drinking large amounts of beverages containing caffeine (coffee, tea, colas) or eating large amounts of chocolate. Caffeine can increase the side effects of this medication. Foods and beverages high in tyramine should be avoided while you are using this medication and for at least 2 weeks after you stop using this medication.
Foods high in tyramine include: aged cheeses (cheddar, camembert, emmenthaler, brie, stilton blue, gruyere, gouda, brick, bleu, roquefort, boursault, parmesan, romano, provolone, liederdranz, colby, edam), aged/dried/fermented/salted/smoked/pickled/processed meats and fish (includes bacon, summer sausage, liverwurst, hot dogs, corned beef, pepperoni, salami, bologna, ham, mortadella, pickled or dried herring), banana peel, beef/chicken liver (stored, not fresh), bouillon cubes, commercial gravies, concentrated yeast extracts, fava beans, Italian green beans, broad beans, fermented bean curd, homemade yeast-leavened bread, kim chee (Korean fermented cabbage), orange pulp, overripe or spoiled fruits, packaged soups, red wine, sauerkraut, sherry, snow pea pods, sourdough bread, soy sauce, soybeans, soybean paste/miso, tofu, tap beer and ale, vermouth.
Moderate-to-low tyramine content foods include: alcohol-free beer, avocados, bananas, bottled beer and ale, chocolate and products made with chocolate, coffee, cola, cultured dairy products (e.g. buttermilk, yogurt, sour cream), distilled spirits, eggplant, canned figs, fish roe (caviar), green bean pods, pate, peanuts, port wine, raisins, raspberries, red plums, spinach, tomatoes, white wine.
Tell your doctor or pharmacist immediately if you notice symptoms of high blood pressure such as fast/slow heartbeat, vomiting, sweating, headache, chest pain, sudden vision changes, weakness on one side of the body, or slurred speech.
Contact your healthcare professionals (e.g., doctor, pharmacist, dietician) for more information, including recommendations for your diet.

This medication may be harmful if swallowed. If overdose or swallowing is suspected, remove the patch if possible. Contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly.

NOTES:
Do not share this medication with others.
Laboratory and/or medical tests (e.g., blood pressure) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

MISSED DOSE:
If you miss a dose, use it as soon as you remember unless it is close to the time for your next dose. In that case, skip the missed dose and resume your usual dosing schedule. Do not apply 2 doses to catch up.

STORAGE:
Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not open the foil pouch until you are ready to use the patch. Do not store in the bathroom. Keep all medicines away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed (See How to Use section).
MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA) or 1-800-668-1507 (Canada).
Information last revised June 2012. Copyright(c) 2012 First Databank, Inc.