Posted by Ktemene on September 22, 2005, at 15:14:54
In reply to Re: FDA panel to review EMSAM on Oct 25th » gromit, posted by SFY on September 22, 2005, at 13:45:12
The person who discovered selegiline, Joseph Kroll, does think that it is less likely to cause the cheese reaction than other MAOI's. (I have been told that Kroll thinks that through some mechanism selegiline at least to some degree acts to prevent tyramine from replacing norepinephrine in brain neurons, and it is because these neurons tend to soak up tyramine that they expel norepinephrine to make room for more tyramine, and it is the excess intercellular norepinephrine that causes the acute rise in blood pressure.) (Knoll, J. (1983) Deprenyl (selegeline):the history of its development and pharmacological action Acta Neurol Scand (Suppl)95, 57-80.) But selegiline still does cause this high blood pressure reaction in some cases, and that is why the diet restrictions apply for people taking more than 10mg per day. But in some other respects selegiline does not have a better side effect profile than other MAOI's. I haven't seen reports on clinical trials showing this, but I suspect that selegiline causes more insomnia than Nardil does.
If the FDA allows the transdermal patch to be sold without diet restrictions, this will be an advantage that transdermal selegiline will have in comparison to other MAOI's. But the transdermal delivery system has one other advantage. It avoids the first pass effect which is apparently very great in the case of selegiline. Because the transdermal delivery system means selegiline gets into the bloodstream before it is metabolized in the liver, a much higher percentage of selegiline is active in the body. And this seems to make a big difference, at least for some people. At any rate, several people who were part of the clinical trials of the selegiline transdermal patch reported on Babble much greater antidepressant effects from the patch than from higher doses of the oral form of selegiline. The person who wrote best about his experience with the patch is Adam, who got well and doesn’t drop by very often, so I have copied the URL’s of some of his posts below.
Adam on the patch vs. oral selegiline:
http://www.dr-bob.org/babble/20001115/msgs/49187.htmlAdam’s initial reaction to the patch:
http://www.dr-bob.org/babble/19991001/msgs/12534.htmlAdam’s thoughts on the patch a year later:
http://www.dr-bob.org/babble/20001115/msgs/48935.html
poster:Ktemene
thread:555724
URL: http://www.dr-bob.org/babble/20050921/msgs/558175.html