Posted by myco on March 3, 2009, at 14:18:53
In reply to Re: Emsam/selegiline withdrawl » myco, posted by Timon on February 27, 2009, at 17:58:16
Hi,
It's typical to have to wait between a switch in maois...I didnt realize it was so long though from emsam to selegiline. This makes sense to me to some degree now that I think about it though.
Here is one logical theory based on metabolism:
As is known, the selegiline in Emsam patch goes straight into blood and bypasses the "first pass mechanism" of the liver allowing the med to go pretty much 'unaltered' to where it's needed. Now...first pass happens when you ingest a med and it has to be absorbed via stomach or intestine. It means that it goes into the blood then to the liver for 'processing' (like a 'pass' through the liver). The liver then metabolizes selegiline to an "active form" that is then sent back out into the blood to be used where needed. The metabilism also produces secondary compounds, some of which are passed back through the liver (second pass) and others not. These secondary compounds "hang out" in the body and may have additional unwanted effects, such as side effects etc. So it could be that there would be a reaction of some of these secondary metabolites with emsam selegiline that makes it "safer" to wait a few weeks.
It's also possible that selegiline oral or emsam have different effects on things like blood pressure and switching too quick could result in a bad 'synergistic' effect (i.e. 1 + 1 = 10)
Other than these, sounds like a possible lack of education/knowledge from the person you talked to. Some company reps, hell even pharmacists i've spoken to, have little/no idea about meds apart from what is "written" on product monographs.
myco
> Myco, I thought about that. My Doctor refuses to acknowledge that there is a pill with the same active ingredient as EMSAM. No surprise there.
>
> What surprises me is that without asking, the Bristol-Myers representative the initially took my call mentioned that 3 weeks are needed between the time the EMSAM is discontinued and the use of oral selegiline. She was very specific and told me that this was contraindicated.
>
> I am lost. Maybe there is a contraindication between Tylenol and acetaminophen.(lol)
>
>
poster:myco
thread:876580
URL: http://www.dr-bob.org/babble/wdrawl/20081229/msgs/883535.html