Posted by chdurie2 on November 1, 2000, at 12:25:57
In reply to Re: Selegeline Patch - Update?, posted by Deborah14 on October 31, 2000, at 20:48:03
> > > Caroline
> I spoke yesterday with Mike Pass at Family Pharmacy in Sarasota, Florida and Steve at College Pharmacy in Boulder, Colorado about the selegeline gel. If ever I came away from two phone calls totally confused - it was yesterday. Mike, at Family, has made the selegeline gel before with the piracetam/hydergine. He also said that he could make it without the piracetam/hydergine although I do not believe he ever has. When I said I wanted the selegeline alone I felt that he was pushing the P/H combination, probably to make the drug more expensive. He couldn't give me a good explanation on what P/H does and why it is mixed with the selegeline. Could you explain what piracetam/hydergine is and why your p-doc prescribed it for you.
> Mike said that without first speaking with my p-doc he estimates that I probably should start with the equivalent dose to one quarter of the amount I take orally. However, to tell you the truth, I felt uneasy about the conversation - as if he wasn't being totally upfront and truthful with me. I had to pry out information about possible allergic reactions to the bases that the gels were made from. He also said there was less adverse side effects from the gels than the pills but he really didn't or couldn't explain why.
> I next spoke with Wellness Pharmacy in Alabama and they were very forthright about never having made a selegeline compound and were not comfortable doing it.
> I finally spoke with, I believe it was, Steve at College Pharmacy and he also said that he had never made a selegeline gel. He told me that he did not think that it would have fewer side effects than the pills and explained to me why. I believe he said that only 19% of selegeline pills are metabolized on the first pass through the liver and that was a small amount and that a gel would pass the equivalent amount through too. He also said that I would need much higher amounts of the gels to get the equivalent effect as from the pills with the same adverse side effects. At this point, I don't know who to believe since organic chemistry is totally new to me. However, after reading the abstracts on the comparisons between the patch and the selegeline pills, I don't understand how College Pharmacy could be correct. The studies seems to indicate that the transdermal patch is more effective than the equivalent dose of the selegeline orally. I went back and even found an early study discussing the application of the selegeline directly to the skin of dogs (or maybe it was rats, who knows.) If the patch works, I don't understand why a gel won't work if the selegeline is mixed with an "effective" sterile base that enables it to be absorbed evenly into the skin without irritation, allergic reaction, and evaporation. Of course, it goes without saying in my mind that it appears that the transdermal delivery system has to be more efficacious; however under the Pharmacy Preservation Act of 1997, the FDA will not permit compounding pharmacists to formulate or make transdermal patch delivery systems for pharmaceuticals (inhalers are not permitted either).
> I recounted all this information and gave the Medline abstracts I printed out to my p-doc today and he is more encouraging about trying the gel than I am at this point. Since I've been informed that the patch will not be commercially available for at least a year and I believe that a year is way overly optimistic for FDA approval, my pdoc is more than willing to try the gel since he knows that the selegeline works well for me. He first wants to speak with his psychopharmacy guru on the subject (who is "the" guru in the area) before jumping into purchasing the gel but he does not think , at this point, that it will hurt me and he is trying to find a way to up the dosage without increasing the side effects.
> As I mentioned before, I have been on selegeline for over eight years as an AD. 30 mgs a day in the morning is the lowest amount I can take for it to be effective when my depression is under control. However, when my depression goes out of control, so to speak, I need to take 50 mgs a day. The adverse side effects at 30 mgs include an inability to fall sleep and sleep through the night uniterrupted, which is counteracted effectively by other medications at bedtime. The selegeline has to be taken in the morning otherwise, the adverse side effect on sleep is even more pronounced at 30 mgs. For example, I took the selegeline yesterday afternoon because I had to refill my prescription and even with my nightly meds, I was waking up every hour on the hour. By the way, Steve at College said that I should try the herb Triptophane to sleep. Also a 30 mgs, I have total lost my bowel function and have to take Miralax nightly to counteract the constipation. It works. The third side effect is very low libido.
> However, if I increase the selegeline to 40 or 50 mgs I can' t sleep through the night no matter what I take to counteract this side effect. I can't fall asleep for hours and if I do I get maybe two or three hours of sleep, which is interrupted hourly. I'm up by 4 AM wide awake. The Miralax stops working at the increased dose of selegeline and I not only lose my libido entirely, I cannot respond. Its like the switch has been cut to my brain.
> As a result, I keep ending back at 30 mgs a day when I really should be taking 50 mgs. My pdoc has even suggested alternating days between 30 and 40, or 40 and 50 but as soon as I go over the threshold of 30, the adverse effects become intolerable - immediately.
> My p-doc may be less concerned about the hypertensive side effects of the selegeline than yours because I have been on it so long without any ill effects of that sort and I am allergic to all the foods one isn't supposed to eat - I don't eat cheese or any of the "forbidden" foods ever anyway. Also, he monitors my meds very strictly and I see him more than once a week.
> On the one hand, I am very lucky because selegeline is the only AD to date that works, at all, for me. On the otherhand, it could work better. Each of us has our own unique brain chemistrys and backgrounds that makes our psychopharm treatment different. I don't want you to think that selegeline is a panacea in and of itself for me because it isn't, I take additional meds too for my other issues. However, because of my medical privacy beliefs - I am almost a "fanatic" in this area, I believe that it is not in my best interest nor anyone elses to discuss their private medical information on the Internet. The little I have revealed is a lot for me and goes against every thing I believe in. However, I believe that what I am gaining and giving by participating and trusting the people on this website is more than any identifiable information that may be revealed or invasion of my medical privacy that may occur.
> P.S. I found the article you mentioned on Medline along with a slew of others that I bookmarked and printed out for my p-doc. Thanks for the help.Deborah--
I didn't tell you that Mike at Family Pharmacy can be a little difficult at times (explaining side effects, etc.) but he does make a quality product. He works or has worked with my cfs doctor, Dr. Paul Cheney, who is nationally known and will only deal with the best. (Cheney also works with Wellness.) I think Mike is more comfortable discussing technical stuff with doctors, so I would get your p-doc on the phone with him to discuss levels, etc., how the pill dosage translates to gel, etc. if he made the piracetam/hydergine gel for me, he wanted to start on a 10 percent dosage; i was uncomfortable with that since i had already tried it and was up to a 20 percent, and it wasn't working, so i abandoned gel thing.
the piracetam/hydergine or piracetam/hydergine/selegeline pill or gel combination is recommended by some doctors, and featured prominently in the book Smart Drugs, for cohnitive enhancement of normal people. i don't think anyone really understands precisely how it works, only that the synergy is the most important thing. mike may have thought you were looking for cognitive strength rather than anti-d.i think the difference between what mike was saying, your own conclusions, your p-doc's and college's conclusions reflects the ambivalence in the medical/pharmaceutical community on transdermal pharmaceutical preparations.but if i read you correctly, compounding pharmacists by law are not allowed to make this stuff-but hydergine is prescription and piracetam is in some states and obviously selegeline is, too. the new jersey guy also offered to make me a ritalin gel, which he has made before, so obviously that can't be the case - or else they're a superceding law.
i guess you and your p-doc don't want to try augmenting 30 mgs of selegeline with another anti-d? sometimes its the synergy that works even if the individual thing hasn't worked.
another source on the gel, i'm guessing, would be American Preferred Prescriptions. you want the one out on Long Island in New York, not the New York City pharmacy. i haven't tried them on gels, but they're pretty sophisticated in compounding. then you have to sign up as a member through their administrative office, and the good thing is they work with insurance companies, take only what the insurance companies will pay, and don't charge you anything. i used them until i got an insurance company that insists on reimbursing me, not the provider, and i guess APP can't work that way. or at least they didn't a few years ago. they also have 800 numbers.
you're right; we're not organic chemists, and my own opinion is that some people are trying to be them, or else pharmacists/p-docs without licenses. don't get me wrong. i think it's good to share information/experience, but i think that when you get lay people discussing with alleged authority the intricate workings of the body/brain, things get a little afar with me. i have no idea what the effect of high dosages of selegeline is on the liver or whether a gel would reduce that. you may be expecting greater clarity aand consistency than anyone can give. for example, with zyprexa, the two pharmacists i asked couldn't answer my questions, cuz they said zyprexa is too new to know about- that sounded like b.s. to me until the one i know the best said any answer would be theoretical, cuz no one had the experience base to make it knowledge.
you obviously want to try this. everyone you ask will have different opinions. you could take a poll or just have it done and see. no one has a crystal ball, especially on stuff that's fairly new (pharmaceutical gels.)
my other suggestion might be to keep taking your 50mgs by mouth and try seroquel for sleep. a true insomniac, nothing else really worked for me until i made it clear to my p-doc that i wanted to be knocked out. zyprexa does the same thing, but it may put a lot of weight on you that will be hard to get off. seroquel is VERY sedating and has few side effects.
but again, i'd definitely get my p-doc on the phone with these folks to discuss dosage translations, formulas, etc. i think you're just begging for problems to try to do that yourself-and i mean no putdown there. we just don't have the pharmaceutical training.
please let me know how it works out.
caroline h.
poster:chdurie2
thread:46818
URL: http://www.dr-bob.org/babble/20001022/msgs/47922.html