Emsam

Emsam is used to treat adult patients with depression, also known as major depressive disorder (MDD).

Product dosage: 5mg
Package (num)	Per pill	Price	Buy
60	$1.10	$66.00 (0%)	🛒 Add to cart
90	$1.06	$99.00 $95.00 (4%)	🛒 Add to cart
120	$1.02	$132.00 $123.00 (7%)	🛒 Add to cart
180	$0.99	$198.00 $178.00 (10%)	🛒 Add to cart
270	$0.97	$297.00 $262.00 (12%)	🛒 Add to cart
360	$0.96 Best per pill	$396.00 $345.00 (13%)	🛒 Add to cart
Synonyms Apo-seleg Apo-selegiline Apo-selin

Similar products

Eldepryl

Price from 46.00 USD

View

EMSAM (selegiline transdermal system) represents a significant advancement in the treatment of Major Depressive Disorder (MDD), offering a unique mechanism of action through a convenient patch delivery system. As the first and only monoamine oxidase inhibitor (MAOI) available in a transdermal form, it bypasses many of the historical dietary restrictions associated with oral MAOIs at its lower doses, providing a powerful option for patients who have not found success with first-line antidepressants. Its targeted delivery allows for sustained, steady-state plasma concentrations, minimizing peak-to-trough fluctuations and potentially reducing certain side effects. This profile provides a comprehensive, expert-level overview of EMSAM for healthcare professionals.

Features

• Active Ingredient: Selegiline, a monoamine oxidase inhibitor (MAOI).
• Delivery System: A transdermal patch for continuous 24-hour delivery.
• Available Strengths: 6 mg/24 hr, 9 mg/24 hr, and 12 mg/24 hr.
• Mechanism of Action: Irreversible inhibition of monoamine oxidase type A (MAO-A) and monoamine oxidase type B (MAO-B), increasing the levels of key neurotransmitters in the brain, including serotonin, norepinephrine, and dopamine.
• Dosing Schedule: Single daily application.

Benefits

• Bypasses First-Pass Metabolism: Transdermal delivery avoids the extensive hepatic metabolism that produces amphetamine metabolites, leading to a cleaner pharmacokinetic profile compared to oral selegiline.
• Dietary Flexibility at Lower Doses: At the 6 mg/24 hr dose, the tyramine restriction commonly associated with MAOIs is not required for most patients, as the transdermal system minimizes inhibition of MAO-A in the gut.
• Steady-State Drug Delivery: Provides consistent plasma levels over 24 hours, avoiding the peaks and troughs associated with oral dosing, which may contribute to improved tolerability.
• Proven Efficacy: Demonstrated significant improvement in depressive symptoms compared to placebo in controlled clinical trials for adult patients with MDD.
• Alternative for Treatment-Resistant Depression: Offers a valuable therapeutic option for patients who have not responded adequately to other antidepressant classes, such as SSRIs or SNRIs.
• Simple Once-Daily Dosing: The patch application may improve adherence compared to multiple daily oral regimens.

Common use

EMSAM is indicated for the treatment of Major Depressive Disorder (MDD) in adults. It is typically considered after first-line treatments like selective serotonin reuptake inhibitors (SSRIs) have proven ineffective or intolerable, though it may be used as a first-line agent based on clinical judgment. It is particularly relevant for patients who may benefit from its unique mechanism of action impacting multiple neurotransmitter systems (serotonin, norepinephrine, and dopamine).

Dosage and direction

• Initial Dose: The recommended starting dose is 6 mg/24 hr applied once daily.
• Dose Titration: Depending on clinical response and tolerability, the dose may be increased in 3 mg/24 hr increments at intervals of no less than 2 weeks up to a maximum dose of 12 mg/24 hr.
• Application Instructions:
  • Apply to dry, intact skin on the upper torso (below the neck and above the waist), upper thigh, or the outer surface of the upper arm.
  • Do not apply to irritated skin or where cuts are present.
  • Rotate the application site with each new patch; do not apply a new patch to the same site for at least 2 weeks.
  • Press firmly into place for at least 30 seconds, ensuring complete contact, especially around the edges.
  • The patch should be worn for 24 hours; after removal, a new patch should be applied to a different site.
• Missed Dose: If a patch is applied late or forgotten, apply a new patch as soon as possible and then continue on the original daily application schedule. Do not apply two patches at one time.

Precautions

• Hypertensive Crisis: Although the risk is reduced with the transdermal system, the potential for a hypertensive crisis exists, especially at the 9 mg/24 hr and 12 mg/24 hr doses. Patients must be advised to avoid foods high in tyramine and certain medications.
• Serotonin Syndrome: There is a risk of serotonin syndrome, particularly when EMSAM is used concomitantly with other serotonergic drugs (e.g., other antidepressants, tramadol, triptans) or drugs that impair serotonin metabolism.
• Activation of Mania/Hypomania: As with all antidepressants, EMSAM may induce a manic or hypomanic episode in patients with bipolar disorder. It should be used with caution in such patients, typically in conjunction with a mood stabilizer.
• Suicidality: All patients being treated with antidepressants for MDD should be monitored closely for clinical worsening, suicidality, and unusual changes in behavior, especially at the beginning of therapy and during dose adjustments.
• Orthostatic Hypotension: MAOIs can cause orthostatic hypotension. Patients should be cautioned about rising quickly from a sitting or lying position.
• Application Site Reactions: Skin reactions (e.g., erythema, irritation, rash) are common. If a reaction is associated with increased swelling, itching, or fluid accumulation, or if it persists for more than a few days after removal, medical attention should be sought.

Contraindications

EMSAM is contraindicated in patients with:

• Pheochromocytoma (due to risk of hypertensive crisis).
• Concomitant use with other MAOIs (or within 2 weeks of discontinuing another MAOI).
• Concomitant use with selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), clomipramine, imipramine, tramadol, meperidine, methadone, propoxyphene, dextromethorphan, St. John’s Wort, or cyclobenzaprine (or within 2 weeks of discontinuing EMSAM).
• Concomitant use with sympathomimetic amines (e.g., amphetamines, cold products containing phenylephrine or pseudoephedrine).
• Concomitant use with bupropion, buspirone, or carbamazepine.
• A history of hypersensitivity to selegiline or any component of the transdermal system.

Possible side effect

Common side effects (incidence ≥5% and greater than placebo) include:

• Application site reactions (redness, irritation, rash, itching)
• Insomnia
• Dry mouth
• Dyspepsia
• Diarrhea
• Pharyngitis
• Headache
• Dizziness

Less common but serious side effects require immediate medical attention and include:

• Symptoms of hypertensive crisis (e.g., sudden, severe headache, nausea, vomiting, sweating, dilated pupils, tachycardia, chest pain)
• Symptoms of serotonin syndrome (e.g., agitation, hallucinations, coma, tachycardia, labile blood pressure, hyperthermia, incoordination, nausea, vomiting, diarrhea)
• Symptoms of mania (e.g., greatly increased energy, severe trouble sleeping, racing thoughts, reckless behavior)
• Significant orthostatic hypotension or syncope
• Severe skin reactions at the application site

Drug interaction

EMSAM has numerous and potentially serious drug interactions due to its potent MAO inhibition.

• Absolutely Contraindicated: Other MAOIs, SSRIs, SNRIs, tricyclic antidepressants (especially clomipramine and imipramine), tramadol, meperidine, methadone, dextromethorphan, St. John’s Wort, sympathomimetics (e.g., pseudoephedrine, amphetamines), bupropion, buspirone.
• Use with Extreme Caution: Other antidepressants (require a sufficient washout period), triptans, antipsychotics, antihypertensives (may potentiate hypotension), general anesthetics.
• Tyramine-Rich Foods: At the 6 mg/24 hr dose, dietary modification is generally not required. At the 9 mg/24 hr and 12 mg/24 hr doses, patients must adhere to a tyramine-restricted diet (avoiding aged cheeses, cured meats, fermented products, tap beers, overripe fruits, etc.) to prevent hypertensive crisis.

Missed dose

If a dose is missed, the patient should apply the EMSAM patch as soon as they remember. However, if it is almost time for the next application, the missed patch should be skipped, and the regular dosing schedule resumed. Under no circumstances should two patches be worn simultaneously to make up for a missed dose. This could lead to a dangerous overdose.

Overdose

Overdose with MAOIs like EMSAM is serious and potentially fatal. Symptoms may be severe and delayed (up to 12 hours post-ingestion) and can include:

• Drowsiness, dizziness, faintness, irritability, hyperactivity, agitation, severe headache.
• Hallucinations, trismus, opisthotonos, seizures, coma.
• Hypertension or hypotension, tachycardia, bradycardia, cardiovascular collapse.
• Hyperpyrexia, diaphoresis, cool clammy skin.
• Respiratory depression and failure. Management is symptomatic and supportive. There is no specific antidote. Immediate hospitalization and intensive supportive care with continuous monitoring of vital signs and symptomatic treatment are required. Treatment of hypertensive crisis may include the use of rapidly acting alpha-adrenergic blocking agents (e.g., phentolamine).

Storage

• Store at room temperature, 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F).
• Keep the sealed pouch in the carton until immediately before use to protect from light and moisture.
• Keep out of reach of children and pets.
• Used patches should be folded so the adhesive side sticks to itself and disposed of safely, out of reach of children and others, as the patch still contains active medication.

Disclaimer

This information is intended for educational purposes and for use by healthcare professionals. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The content is provided on an “as is” basis and the author makes no representations or warranties concerning its accuracy or completeness.

Reviews

• Clinical Perspective: “EMSAM fills a crucial niche in our psychopharmacology arsenal. Its transdermal delivery mitigates the classic ‘cheese reaction’ concern at the starting dose, making a powerful MAOI more accessible. I’ve found it particularly effective in patients with atypical depression and significant anergia who have failed multiple SSRIs. The main challenges are navigating its complex drug interaction profile and managing application site reactions.” – Board-Certified Psychiatrist
• Patient Experience (Compiled from clinical reports): Many patients report a different quality of improvement compared to SSRIs, often describing increased energy, motivation, and a return of positive affect without emotional blunting. The once-daily patch is frequently cited as convenient. The most common complaint is localized skin irritation, which can sometimes lead to discontinuation. Patients on higher doses emphasize the importance of strict dietary adherence.