Emsam (Selegiline) – Transdermal: Uses, Side Effects, Dosages
What Is Emsam?
Emsam (selegiline) is a prescription drug used to treat adults 18 and older with diagnosed depression, also known as major depressive disorder (MDD). It is available as a transdermal patch that is worn on the skin.
Emsam is in a drug class called monoamine oxidase inhibitors, or MAOIs. The way it works is not fully understood, but it is thought to work by acting on dopamine, serotonin, and norepinephrine in the central nervous system.
Dopamine, serotonin, and norepinephrine are known as monoamine transmitters, a type of chemical messenger in the brain. Emsam keeps these hormones properly balanced.
Generic Name: Selegiline
Brand Name(s): Emsam
Drug Availability: Prescription
Therapeutic Classification: Antidepressant
Available Generically: No
Controlled Substance: No
Administration Route: Transdermal (through the skin)
Active Ingredient: Selegiline hydrochloride
Dosage Form(s): Patch
What Is Emsam Used For?
The Food and Drug Administration (FDA) approved Emsam to treat depression. Selegiline is in a class of medications called monoamine oxidase (MAO) inhibitors. It works by increasing the amounts of certain natural substances that are needed to maintain mental balance.
Transdermal patches, as a method of administration, is a medicated adhesive patch that is placed on the skin to deliver a specific dose of medication through the skin and directly into the bloodstream.
How to Use Emsam
If you are prescribed Emsam:
- Read the prescription label, information leaflet, and medication guide that comes with your prescription.
- Consult your healthcare provider if you have any questions.
- Use Emsam exactly as directed by your healthcare provider.
- Apply the Emsam patch to clean, dry, hairless skin. You can apply Emsam to the chest, back, thigh, or outer part of the upper arm. Press the patch firmly into place.
- You can leave the Emsam patch on while you shower or swim.
- After 24 hours, remove the patch and place a new one on a different area of the body. Every time you change your patch, remember to remove the old patch and put the new patch in a different area. Never wear more than one patch at a time. Doing so will not make the medication work better. The patch should be changed once daily at the same time each day. Choose a time that is convenient for you.
- Wash your hands after handling a patch.
- If the patch falls off, try to put it back in place. If it does not stay on, put on a new patch and leave it on for the rest of your wearing time. Do not change your schedule.
- Do not cut the Emsam patch.
- While wearing the Emsam patch, do not expose it to sunlight, or other heat sources like a heating pad or sauna.
- Avoid alcohol while taking Emsam. Do not drive or operate machinery until you know how Emsam affects you.
- Talk to your healthcare provider about dietary changes while on Emsam.
- If you are scheduled for any type of surgery, let the surgeon know ahead of time that you are using Emsam. You may be advised to stop using Emsam for a period of time before the surgery. Do not stop using Emsam unless your healthcare provider advises you to do so.
Ask your healthcare provider if you have any questions or concerns about Emsam.
Storage and Disposal
Store Emsam patches at room temperature. Keep away from direct light, heat, and moisture. Keep each patch in the foil pouch until it is time to apply one. Keep all Emsam patches (used and unused) out of the reach of children and pets. The amount of medication in a used skin patch can cause death to a child or pet who accidentally chews on the patch. If this happens, get emergency medical help.
When changing your patch, fold the used Emsam patch in half, pressing it together firmly so that the sticky side sticks to itself. Immediately discard the folded patch in a container with a lid so that children and pets cannot get to it. If you have unused Emsam patches that are no longer needed, safely discard the patches. To do so, remove each leftover patch from the pouch and the release liner. Next, fold the patches in half, placing the sticky sides together, and immediately throw them away in a container with a lid.
How Long Does Emsam Take to Work?
You may start to notice an improvement in depression symptoms within a few weeks of starting Emsam. It may take some additional time for you and your healthcare provider to figure out the ideal dose.
Keep in contact with your healthcare provider so they can make adjustments to the dosage as needed. It may take up to six or eight weeks to feel the medication’s full benefit.
What Are the Side Effects of Emsam?
This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.
Like other medications, Emsam can cause side effects. Tell your healthcare provider about any side effects you experience while taking this medication.
Common Side Effects
The most common side effects of Emsam include:
Severe Side Effects
Emsam has a black box warning. A black box warning is the strongest warning required by the FDA. All antidepressants can increase the risk of having suicidal thoughts (thinking about ending one’s life) or suicidal behaviors (taking an action that could cause death) – this was seen in studies of children and young adults.
Regardless of age, anyone who is taking an antidepressant, such as Emsam, should be closely monitored for changes in mood and behavior, and/or suicidal thoughts and behaviors.
Emsam is discouraged in children less than 12 years old. Using Emsam in a child under 12 years old can increase the risk of a hypertensive crisis. A hypertensive crisis is a sudden and severe increase in blood pressure. Emsam is also not recommended for use in adolescents ages 12 to 17 years old, and should only be used in adults.
Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:
- Hypersensitivity reaction or anaphylaxis: Symptoms can include rash, hives, swelling around the lips, tongue, and face, difficulty breathing, and require emergency medical attention.
- Hypertensive crisis: Symptoms may include a sudden and severe headache, confusion, vision problems, chest pain, pounding in the neck/ears, sweating, vomiting, stiff neck, fast or slow heartbeat, or dilated pupils (when the black center of the eye becomes larger than usual).
- Orthostatic hypotension: Notify your healthcare provider of any dizziness, unsteadiness, (especially when standing up), falls, or fainting. Stand up slowly and carefully.
- Heart attack
- Serotonin syndrome: Serotonin syndrome is a life-threatening emergency situation caused by a buildup of the substance serotonin. Remove the patch and get emergency medical help if you have symptoms such as agitation, hallucinations (when you see, hear, touch, taste, or smell something that is not there), fever, sweating, shivering, rapid heart rate, stiff muscles, twitching, incoordination, nausea, vomiting, or diarrhea.
- Mania and hypomania: Mania is when you feel very happy, excited, and full of energy. Hypomania is a milder form of mania. Symptoms may include racing thoughts, increased energy, unusual risk-taking behavior, extreme happiness, and/or being irritable or talkative.
- Worsening of psychosis: Report any symptoms of hallucinations, confusion, or delusions (believing things that are not true).
- Worsening of depression/suicidal thoughts or behaviors: Symptoms may include mood or behavior changes, anxiety, panic attacks, difficulty sleeping, or if you feel impulsive, irritable, agitated, angry, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about hurting or killing yourself.
- Withdrawal symptoms (if the drug is stopped abruptly): When it is time to stop taking Emsam, your healthcare provider will tell you how to slowly and safely taper off the medication.
Report Side Effects
Emsam may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your healthcare provider may send a report to the FDA MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
Dosage: How Much Emsam Should I Take?
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The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For transdermal dosage form (skin patch):
- For depression:
- Adults—At first, one 6-milligram (mg) patch once a day. Your doctor may increase your dose if needed.
- Children 12 years of age and older—Use and dose must be determined by your doctor.
- Children younger than 12 years of age—Use is not recommended.
- For depression:
Users should be aware of the following before starting Emsam:
Older adults: You may need to use caution when using Emsam if you are 65 or older, especially if you have other medical conditions or take other medications. The recommended dose for adults ages 65 and older is 6 milligrams per 24 hours.
Pediatric/adolescents: Emsam should not be used in children less than 12 years old because of an increased risk of hypertensive emergency. Also, Emsam is not approved for use in adolescents 12 to 17 years old. It is only approved for use in adults.
Dietary modifications: Emsam can cause a hypertensive crisis if taken with foods or drinks that are high in tyramine (see food interactions section for a list). If you use the 6 milligrams per 24 hours patch, you can generally continue your normal diet. However, if you use the 9 milligrams per 24 hours or 12 milligrams per 24 hours patch, you will be advised to avoid foods and drinks that are high in tyramine. Consult your healthcare provider for more information.
People with liver problems: People with mild or moderate liver problems can use Emsam.
There is no data on Emsam use in people with severe liver problems.
People with kidney problems: People with mild, moderate, or severe kidney problems can use Emsam. However, Emsam has not been studied in people with end-stage renal (kidney) disease.
Pregnant people: Emsam should not be used during pregnancy because it could harm the unborn baby. If you already use Emsam and find out that you are pregnant, consult your healthcare provider right away.
Nursing mothers: People should not breastfeed while taking Emsam and for at least seven days after the final dose of Emsam.
If you miss a patch change, remove the old patch and apply a new patch as soon as you remember. However, if it is almost time for your next dose, skip the missed dose. Do not use extra patches.
Overdose: What Happens If I Use Too Much Emsam?
When using Emsam, be aware of the following symptoms indicative of a potential overdose:
- Cold or clammy skin
- Fast or irregular heart rate
- Trouble breathing
- Feeling agitated or irritable
- Twisting muscle movements
- Unusual arching in your back or neck,
What Happens If I Overdose on Emsam?
If you think you or someone else may have overdosed on Emsam, call a healthcare provider or the Poison Control Center (800-222-1222). If someone collapses or isn’t breathing after taking Emsam, call 911 immediately.
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It is very important that your doctor check your or your child’s progress at regular visits to make sure this medicine is working properly and to check for unwanted effects.
You should not use this medicine if you or your child are taking carbamazepine (Tegretol®), other medicines to treat depression (eg, clomipramine, duloxetine, fluoxetine, imipramine, paroxetine, sertraline, venlafaxine, Celexa®, Cymbalta®, Effexor®, Lexapro®, Paxil®, Prozac®, Zoloft®), certain pain medicines (eg, meperidine, methadone, pentazocine, propoxyphene, tramadol, Darvon®, Demerol®, Dolophine®, Ultram®), or cough medicines (eg, dextromethorphan, Benylin®). Do not use this medicine if you also take selegiline capsules or tablets.
Selegiline skin patch may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. If you, your child, or your caregiver notice any of these side effects, tell your doctor or your child’s doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.
When selegiline skin patch is used at low doses, there are no restrictions on the food or beverages that you can eat or drink. However, the chance exists that dangerous reactions, such as sudden high blood pressure, may occur if higher doses are used with certain foods or beverages. These foods or beverages include foods that have a high tyramine content (most common in foods that are aged or fermented to increase their flavor), such as cheeses, fava or broad bean pods, yeast or meat extracts, smoked or pickled meat, poultry, or fish, fermented sausage (bologna, pepperoni, salami, summer sausage) or other fermented meat, sauerkraut, any spoiled or improperly stored meat, poultry, fish, or animal livers, or any overripe fruit. These may also include alcoholic beverages or alcohol-free or reduced-alcohol beer and wine. Also, for at least 2 weeks after you stop using this medicine, these foods or beverages may continue to react with selegiline transdermal. If a list of these foods and beverages is not given to you, ask your doctor to provide one.
Selegiline may cause a serious condition called serotonin syndrome when used together with certain MAO inhibitors (eg, phenelzine, rasagiline, tranylcypromine) and medicines to treat depression (eg, amitriptyline, doxepin, fluoxetine, fluvoxamine, nortriptyline, paroxetine, sertraline, Elavil®, Luvox®, Pamelor®, Paxil®, Prozac®, Zoloft®). Symptoms of serotonin syndrome include: anxiety, restlessness, fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or seeing or hearing things that are not there.
Check with your doctor or hospital emergency room immediately if severe headache, stiff neck, chest pains, fast heartbeat, or nausea and vomiting occur while you or your child are using this medicine. These may be symptoms of a serious side effect that should have a doctor’s attention.
Do not expose the applied skin patch to direct heat, such as heating pads, electric blankets, heat lamps, sauna, hot tubs, heated water beds, and prolonged direct sunlight.
Before you have any kind of surgery, tell the medical doctor in charge that you or your child are using this medicine. Using selegiline together with medicines that are sometimes used during surgery may increase the effects of these medicines.
This medicine may make you dizzy or drowsy. Do not drive or do anything else that could be dangerous until you or your child know how this medicine affects you. Standing up slowly from a sitting or lying position can lessen the chance of getting dizzy.
The use of alcohol is not recommended in patients who are taking this medicine.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or over-the-counter diet pills, herbal weight-loss products, cold medicines (eg, ephedrine, phenylephrine, phenylpropanolamine, pseudoephedrine, Neo-Synephrine®, Novafed®, Sudafed®), any herbal or dietary supplement that contains tyramine, or medicines called amphetamines (also called stimulants or “uppers”).
What Are Reasons I Shouldn’t Take Emsam?
Emsam is not appropriate for everyone. You should not take this medication if you are allergic to selegiline or any of the inactive ingredients in Emsam.
Other people who should not take Emsam include:
Emsam may be prescribed with caution in some people, only if the healthcare provider determines it is safe. This includes:
What Other Medications May Interact With Emsam?
Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter (OTC) medicines, and vitamins or supplements. While taking Emsam, do not start any new medications without approval from your healthcare provider.
Emsam should not be taken with drugs that increase serotonin because of the risk of serotonin syndrome. Some examples of these drugs include:
*While most drug interactions require a period (usually at least 14 days) between taking the drug and taking Emsam, Prozac (fluoxetine) lasts longer in the body. If stopping Prozac and switching to Emsam, a period of five weeks in between is required. (However, if switching from Emsam to Prozac, only 14 days is required.)
Examples of other drug interactions include:
This is not a full list of drug interactions. Other drug interactions may occur with Emsam. Consult your healthcare provider for a complete list of drug interactions.
Foods and drinks that are high in an amino acid called tyramine can interact with Emsam, causing a hypertensive crisis. Generally, those who take the 6 milligrams dose of Emsam can continue a normal diet. However, those who take the 9 milligrams or 12 milligrams dose will have to limit tyramine intake while taking Emsam and for at least 14 days after the last dose.
You can consult a registered dietician for help in modifying your diet. Here are some tips on foods to avoid or include in your diet when trying to limit tyramine:
Meat, chicken, and fish: Avoid meats that are dried, aged, or fermented; sausages; salamis; pickled herring; improperly stored foods or animal livers. Better options are fresh meats, poultry, and fish. This includes fresh processed meats like deli meats, hot dogs, and cooked, sliced ham.
Vegetables: Avoid fava bean pods. All other vegetables are low in tyramine.
Dairy: Avoid aged cheeses. Instead, choose processed cheeses; mozzarella, ricotta, cottage cheese, and yogurt.
Alcohol: Avoid all alcohol while taking Emsam.
Other: Avoid sauerkraut, most soybean products (soy sauce, tofu), and any supplements that contain tyramine.
What Medications Are Similar?
Emsam is an MAOI antidepressant. It is a patch that is applied to the skin. There are other MAOI antidepressants available that are taken by mouth. However, due to their side effect and food/drug interaction profiles, they are not prescribed as the first choice for depression.
SSRIs are the most commonly prescribed drugs for depression. Examples of SSRIs include:
SNRIs are another type of commonly prescribed antidepressant. Examples include:
Tricyclic antidepressants include:
Other commonly used antidepressants include:
This list is a list of drugs also prescribed for depression. It is NOT a list of drugs recommended to take with Emsam. Ask your pharmacist or a healthcare provider if you have questions.
Frequently Asked Questions
What is Emsam used for?
Emsam is used to treat adults with depression. It is a patch placed on the skin and delivers medication into the body through the skin.
How does Emsam work?
The way Emsam works is not completely understood. It is thought to balance levels of chemical messengers (dopamine, serotonin, and norepinephrine) in the central nervous system.
What drugs should not be taken with Emsam?
Many drugs can interact with Emsam, including other antidepressants, muscle relaxants, triptans, cough medications, and more. Before taking Emsam, tell your healthcare provider about all your medications, including prescription and OTC drugs, vitamins, and supplements. While taking Emsam, do not start taking any new medications unless approved by your healthcare provider.
How long does it take for Emsam to work?
Depression symptoms may start to improve within a few weeks of starting Emsam. Some people may need one or more dosage adjustments to find the right dose. Your healthcare provider can adjust the dosage every few weeks if needed. However, it may take up to six or eight weeks to see the medication’s full benefit.
What are the side effects of Emsam?
Common side effects may include redness, irritation, or itching at the application site, headache, trouble sleeping, diarrhea, dry mouth, indigestion, sore throat, and sinus infection. Other serious side effects can occur, often due to Emsam being combined with certain drugs or foods. Discuss potential side effects with your healthcare provider.
How Can I Stay Healthy While Taking Emsam?
MAOIs such as Emsam have long lists of side effects, warnings, and drug and food interactions. However, Emsam is generally safe and well tolerated when taken as directed. Many of the serious side effects occur because of drug or food interactions. This is why it is important to keep an open dialogue with your healthcare provider.
Before taking any new medications (including vitamins or supplements), always check with your healthcare provider. Talk about what dietary changes, if any, are necessary. Seek the advice of a registered dietician if your Emsam dosage requires you to restrict tyramine in your diet. Notify your healthcare provider of any side effects that are bothersome or concerning.
Verywell Health’s drug information is meant for education purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.