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Skeletal formula of selegiline
Skeletal formula of selegiline

Emsam (selegiline transdermal system) is a transdermal patch using the monoamine oxidase inhibitor (MAOI) selegiline. The skeletal formula of an Organic compound is a shorthand representation of its molecular structure. A transdermal patch or skin patch is a Medicated Adhesive patch that is placed on the Skin to deliver a specific Dose of medication Monoamine oxidase inhibitors ( MAOIs) are a class of powerful antidepressant drugs prescribed for the treatment of depression. Selegiline (l-deprenyl Eldepryl Zelapar or Anipryl Veterinary) is a drug used for the treatment of early-stage Parkinson's disease, Depression Selegiline, in small doses, is most commonly used in the treatment of Parkinson's disease. Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the Central nervous system that often impairs the sufferer's It is also effective in higher doses for the treatment of major depressive disorder. [1] On February 28, 2006 the FDA approved EMSAM for the treatment of clinical depression. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression [2] [3] [4]

Contents

Inception & Development

Emsam's development was spearheaded by J. Alexander, M. D. [5], Director of the Clinical Psychopharmacology Research Program at McLean Hospital in Belmont MA, in conjunction with Harvard Medical School. McLean Hospital (pronounced 'Mc-Lane' is a Psychiatric hospital in Belmont, Massachusetts. Harvard Medical School ( HMS) is one of the graduate schools of Harvard University and currently the #1 medical school in America as ranked by U [4] [6] [7] [8] Currently, it is the only MAOI on the market used in the treatment of depression that is absorbed through the skin into the blood stream and thereby to the central nervous system. Monoamine oxidase inhibitors ( MAOIs) are a class of powerful antidepressant drugs prescribed for the treatment of depression. In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges.

The patch "is a matrix containing three layers consisting of a backing, an. . . adhesive drug layer, and a release liner that is placed against the skin. "[1] The primary advantage of delivering selegiline in this manner is to bypass the gastrointestinal tract and liver, specifically the small intestine, thereby limiting the chance of hypertensive crisis (very high spike in blood pressure possibly leading to stroke). [1] [9] [10]

"Despite long-standing concerns over hypertensive reactions,. . . (MAOIs) have grown in popularity. . . (and) the risk of hypertensive episodes is less than 1%. "[11]

Food Intake Restrictions

The dietary problem was first discovered by a neurologist whose wife was taking an MAO inhibitor. After eating hard cheese, which is rich in tyramine, she would get severe headaches; thus, her husband's discovery of these spikes in blood pressure. In organic Chemistry tyramine (4-hydroxy- Phenethylamine, para-tyramine p-tyramine is a Monoamine compound derived from the For this reason, the crisis is still called the "cheese syndrome", even though other foods can cause the same problem. This is a list of foods containing tyramine. Tyramine is an amine which causes elevated blood pressure and Tachycardia by displacing norepinephrine from storage vesicles

When an MAOI is taken orally, and an individual ingests such tyramine rich foods, the body can not properly regulate the additional tyramine. In organic Chemistry tyramine (4-hydroxy- Phenethylamine, para-tyramine p-tyramine is a Monoamine compound derived from the Therefore, dietary modifications are necessary. Foods containing considerable amounts of tyramine include: air dried, aged and fermented meats, sausages and salamis; pickled herring; any spoiled or improperly stored meat, poultry and fish; spoiled or improperly stored animal livers; broad bean pods (fava beans); all tap beers, and other beers that have not been pasteurized; concentrated yeast extract (such as Marmite); most soybean products (including soy sauce and tofu); aged cheeses (not processed cheese); sauerkraut; and over-the-counter supplements containing tyramine. Herring are small Oily fish of the genus Clupea found in the shallow temperate waters of the North Atlantic, the Baltic Sea, the North Vicia faba, the broad bean, fava bean, faba bean, horse bean, field bean, tic bean is a species of Draught beer (also known as draft beer or tap beer) has several related though slightly different understandings Marmite (/ˈmɑːmaɪt/ is the name given to two similar food spreads a British version produced in the United Kingdom and South Africa and the other in New Soy sauce ( US) soya sauce ( Commonwealth) shoyu ( Japan) or sillao ( Peru) is a fermented Sauce Tofu, also (the Japanese Romaji spelling doufu (the Chinese Pinyin spelling often used in Chinese recipes or bean curd (the literal Processed cheese, process cheese, prepared cheese, or cheese food is a food product made from regular Cheese and sometimes other unfermented Sauerkraut ( English:, German:, Yiddish: ˈzɔi̯əʀˌkʀɔi̯t is finely shredded Cabbage that has been fermented by various In organic Chemistry tyramine (4-hydroxy- Phenethylamine, para-tyramine p-tyramine is a Monoamine compound derived from the [7] [12] [13][14][15]

Emsam Advantages

Due mainly to the availability of the newer SSRIs and SNRIs, which are viewed to have more medically benign side effects in the treatment of depression, psychopharmacologists and psychiatrists have avoided prescribing MAOIs[1][11] [16] [17] because of the possibility of hypertensive crisis. Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders A psychiatrist (also archaically called an alienist) is a Physician who specializes in Psychiatry and is certified in treating Mental disorders With Emsam, taken at the lowest dose of 6 mg every 24 hours, no dietary modifications are required by the FDA[2]

In addition to the lack of dietary restrictions at the 6mg/24h dose, Emsam offers[10] another benefit. It is a continuous delivery system, keeping the medication at a steady level in the body over time, although there is no evidence that this makes a difference in terms of the efficacy or side effects of this medication. [18] Generally, oral medication can not keep a steady dose in the blood stream.

Emsam is also valuable in the treatment of depression that is not alleviated by the more commonly used selective serotonin reuptake inhibitors (SSRIs), dual serotonin and norepinephrine reupatake inhibitors (SNRIs) and tricyclic antidepressants (TCAs).

Somewhat surprisingly, clinical trials done with MAOIs do not find that they are more effective than other antidepressants when they are tested in large groups of people. However, for certain individuals, especially individuals who have not done well on other antidepressants, an MAOI may be best. MAOIs are thought to be particularly effective in what has been called "atypical" depression. Atypical depressions are characterized by an increased need for sleep, increased appetite, and increased severity of depressive symptoms towards the end of the day.

Usage

The patch is changed once daily. There may be a reaction to the adhesive on the skin at the site of application. Glue or adhesive is a compound that adheres or bonds two items together [19] Patients are encouraged to use an adhesive remover: usually mineral oil, Vaseline or an over-the-counter product such as dermatology recommended TRIAD brand adhesive tape remover pads. Mineral oil or liquid Petroleum is a By-product in the Distillation of Petroleum to produce Gasoline and other petroleum Vaseline (Vasenol in Portugal Brazil Italy and Spain is a brand of Petroleum jelly based products owned by Anglo-Dutch company Unilever. A new patch is placed on a different site. The combination of adhesive remover, and placing each patch on a new area of skin, is to discourage any dermatological reason for discontinuance of the patch.

Using rubbing alcohol or hydrogen peroxide to clean the skin of oils and dirt before applying a patch can increase the likelihood of proper attachment for the duration of each 24 hour period. Rubbing alcohol USP / BP is a liquid prepared and used primarily for Topical application Hydrogen peroxide (H2O2 is a very pale blue liquid which appears colorless in a dilute solution slightly more Viscous than water Immediately after applying a patch it can be helpful to use the pressure and body heat of the palm of the hand to enhance proper adhesive contact.

All of the dietary restrictions are currently required by the FDA, as a precaution, at the higher 9 mg/24h and 12 mg/24h doses of Emsam. [20]

Medication Interactions

Over-the-counter items that can not be used while on Emsam include: St. John's Wort; products containing dextromethorphan such as cough and cold preparations; decongestant medicines; and diet pills or herbal weight loss products. St John's wort (pronounced) used alone refers to the species Hypericum perforatum, also known as Tipton's Weed or Klamath weed, but with qualifiers is Dextromethorphan ( DXM or DM) is an Antitussive (cough suppressant drug found in many over-the-counter cold and Cough medicines A decongestant is a broad class of Medications used to relieve Nasal congestion. Caffeine and chocolate can only be consumed in small amounts. Caffeine is a bitter white crystalline Xanthine Alkaloid that acts as a Psychoactive Stimulant Drug and a mild Diuretic Chocolate ( pronounced or /-ˈələt/ comprises a number of raw and processed foods that are produced from the seed of the tropical Cacao tree

There are prescription medications that can not be taken while using Emsam, and for 2 weeks after stopping Emsam. [4] Some medications must not be taken for 1 week (or more) before an individual can start using Emsam.

Medications that can not be taken because they can cause serotonin syndrome [21] include: (SSRIs), (SNRIs), (TCAs), other MAOIs, mirtazapine, bupropion, meperidine, analgesics such as tramadol, methadone, propoxyphene, cyclobezaprine and oral selegiline. Serotonin syndrome is a potentially life-threatening adverse drug reaction that may occur following therapeutic drug use inadvertent interactions between drugs or the recreational [4] The use of Emsam is contraindicated for use with sympathomimetic amines, including amphetamines as well as cold products and weight-reducing preparations that contain vasoconstrictors (e. g. , pseudoephedrine, phenylephrine, phenylpropanolamine, and ephedrine). Carbamazepine and oxcarbazepine are also contraindicated. [4]

Patients taking Emsam should not undergo elective surgery requiring general anesthesia or be given local anesthesia containing sympathomimetic vasoconstrictors. [4]

Emsam Name Origin, Manufacturer & Distributor

The acronym Emsam is derived from the names Emily and Samuel. They are the children of Mel Sharoky, M. D. , CEO of Emsam's manufacturer, Somerset Pharmaceuticals, Inc. ,[22] The prescription medication is distributed by Bristol-Myers Squibb out of Princeton NJ

External links

Using EMSAM in Lower Doses May Avoid Concerns About Drug Interactions"". Medicine Net. com.  

References

  1. ^ a b c d Patkar AA, Pae CU (May 2006). "Transdermal selegiline: the new generation of monoamine oxidase inhibitors". CNS Spectrum 11 (5). PMID 16641841.  
  2. ^ a b Cruzan, Suzanne (28 February 2006). "FDA Approves EMSAM (Selegiline) as First Drug Patch for Depression". U. S. Food and Drug Administration, FDA News P06-31.  
  3. ^ Andrew Bridges, Associated Press (March 01, 2006). "Skin Patch for Mood Disorders Approved". The Boston Globe.  
  4. ^ a b c d e f "FDA Approves EMSAM(R) (selegiline Transdermal System), The First Transdermal Patch For The Treatment Of Major Depressive Disorder" (06 Mar 2006). Medical News Today.  
  5. ^ Alexander J. Bodkin, M.D.. Retrieved on 2007-09-08. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 70 - Roman forces under Titus sack Jerusalem. 1264 - The Statute of Kalisz
  6. ^ Frampton JE, Plosker GL (2007). "Selegiline transdermal system: in the treatment of major depressive disorder". Drugs 67 (2): 257–67, discussion 266-7. PMID 17284087.  
  7. ^ a b Tong TG, Saklad SR (1994). "What foods you should avoid on MAOIs (MAO-I's Dietary Restrictions)".  
  8. ^ William J. Cromie (2002-11-07). See also 2002 (disambiguation Year 2002 ( MMII) was a Common year starting on Tuesday of the Gregorian calendar. Events 1492 - The Ensisheim Meteorite the oldest Meteorite with a known date of impact strikes the Earth around noon in a Wheat Bodkin is Patching up Depression. Retrieved on 2007-09-08. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 70 - Roman forces under Titus sack Jerusalem. 1264 - The Statute of Kalisz
  9. ^ Hypertensive Crisis. Retrieved on 2007-09-15. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 668 - Eastern Roman Emperor Constans II is assassinated in his bath at Syracuse Italy.
  10. ^ a b Rapaport MH (2007). "Dietary restrictions and drug interactions with monoamine oxidase inhibitors: the state of the art". Journal of Clinical Psychiatry 68 (8). PMID 17640157.  
  11. ^ a b Lavin MR, Mendelowitz A, Kronig MH (August 1, 1993). "Spontaneous hypertensive reactions with monoamine oxidase inhibitors". Biological Pysychiatry 34 (3). PMID 8399806.  
  12. ^ "Continuous Delivery for Once-Daily Application" (June 2007). Bristol-Myers Squibb.  
  13. ^ Walker SE, Shulman KI, Tailor SA, Gardner D (1996 October). "Tyramine content of previously restricted foods in monoamine oxidase inhibitor diets". Journal of Clinical Psychopharmacoly 16 (5): 383–8. PMID 8889911.  
  14. ^ Feinberg SS, Holzer B (June 1997). "Feinberg SS, Holzer B". Journal of Clinical Psychopharmacology 17 (3). PMID 9169971.  
  15. ^ Wing YK, Chen CN (June 1997). "Wing YK, Chen CN". Journal of Clinical Psychopharmacology 17 (3). PMID 9169972.  
  16. ^ Fiedorowicz JG, Swartz KL (July 2004). "The role of monoamine oxidase inhibitors in current psychiatric practice". Journal of Psychiatric Practice 10 (4). PMID 15552546.  
  17. ^ Krishnan KR (2007). "Revisiting monoamine oxidase inhibitors". Journal of Clinical Psychiatry 68 (8). PMID 17640156.  
  18. ^ Patkar AA, Pae CU, Zarzar M (June 2007). "Transdermal selegiline" 43 (6). PMID 17612708.  
  19. ^ Frampton JE, Plosker GL (2007). "Selegiline transdermal system: in the treatment of major depressive disorder". Drugs 67 (12). PMID 17284087.  
  20. ^ Feiger AD, Rickels K, Rynn MA, Zimbroff DL, Robinson DS (September 2006). "Selegiline transdermal system for the treatment of major depressive disorder: an 8-week, double-blind, placebo-controlled, flexible-dose titration trial". Journal of Clinical Psychiatry 67 (9). PMID 17017821.  
  21. ^ Serotonin Syndrome. Retrieved on 2007-09-15. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 668 - Eastern Roman Emperor Constans II is assassinated in his bath at Syracuse Italy.
  22. ^ Somerset Pharmaceuticals, Inc. Tampa FL 33607 USA
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