![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Deborah14 on October 19, 2000, at 21:09:36
I just found out about the selegeline patch by chance by "stumbling" onto this website. Since the last post was approximately 7 months ago, I would like to know if anyone has any up-to-date (Oct. '00) information about the clinical trials and whether the patch has been submitted to the FDA yet for approval.
I have been taking selegeline regularly for over 8 years for the treatment of major depression and chronic dysthymia. It has been the most effective anti-depressant to date for the treatment of MY symptoms. I take 30 mgs in the am with tolerable side effects. Although I have found that selegeline is more effective at 50 mgs per day, I cannot tolerate the side effects, especially the chronic sleep disturbance.
What is the dose of the patch that has been used in clinical trials? Is it the equivalent in efficacy to the same dose by mouth? Does it have less side effects than the oral selegeline?
If anyone has more up to date information on the selegeline patch, would you please post it. In addition, if anyone has successfully taken selegeline and then switched to moclobemide, could they compare the efficacy and side effects of the two?
Posted by AndrewB on October 20, 2000, at 17:25:27
In reply to Selegeline Patch - Update?, posted by Deborah14 on October 19, 2000, at 21:09:36
Deborah,
This isn't a topic I'm up on but if you do a search of past posts you will find that Adam posted a lot of info. about the patch. As I remember, he found the patch much more effective than the oral selegiline and a lower dose was required to be effective, no dietary restrictions, and there was less of a problem with jitteriness and insomnia. He said some months back was that the patch was unavailable at that point.
You might want to see if a compounding pharmacist can make up a patch or some other transdermal delivery system for selegiline. Try calling Liberty Drug about this, 1-800-58-LIBERTY.
The sleeplessness is caused by selegiline metabolizing into amphetamine and metamphetamine. This suggests that you may find an effective alternate treatment, without the side effects, with the combination of low dose selegiline (5-10mg/day, so only MAO-B inhibition is taking place) along with amphetamine taken during the day (i.e. adderall) and, if necessary, a reversible MAO-A inhibitor (i.e. moclobemide, reportedly few side effects, see Dr. Bob's tips section).
AndrewB
Posted by Deborah14 on October 21, 2000, at 22:29:35
In reply to Re: Selegeline Patch - Update?, posted by AndrewB on October 20, 2000, at 17:25:27
> Deborah,
>
> This isn't a topic I'm up on but if you do a search of past posts you will find that Adam posted a lot of info. about the patch. As I remember, he found the patch much more effective than the oral selegiline and a lower dose was required to be effective, no dietary restrictions, and there was less of a problem with jitteriness and insomnia. He said some months back was that the patch was unavailable at that point.
>
> You might want to see if a compounding pharmacist can make up a patch or some other transdermal delivery system for selegiline. Try calling Liberty Drug about this, 1-800-58-LIBERTY.
>
> The sleeplessness is caused by selegiline metabolizing into amphetamine and metamphetamine. This suggests that you may find an effective alternate treatment, without the side effects, with the combination of low dose selegiline (5-10mg/day, so only MAO-B inhibition is taking place) along with amphetamine taken during the day (i.e. adderall) and, if necessary, a reversible MAO-A inhibitor (i.e. moclobemide, reportedly few side effects, see Dr. Bob's tips section).
>
> AndrewBAndrew B
Thanks for responding to my post. This is only the second time I've written on this website. I read all the posts about the patch. However, they stopped in the spring and since there has been no new information about the SELEGELINE PATCH, I was hoping that I could find someone who would respond with updated information about whether the study is ongoing. Your idea about having a patch made was terrific. I appreciate the telephone number.
My pdoc has suggested that we look further into obtaining moclobemide from a doc in Canada. However, the posts have not been encouraging about the effectiveness of moclobemide. I was very discouraged after reading them. Selegeline, seems to be the most effective AD me. I have tried the tricyclics, the seretonin re-uptake drugs, etc. Parnate almost killed me.
Can you describe more fully Adderal. I've never heard of it and know nothing about it. In order to counter the side effects of the Selegeline, I take Inderal and klonopin to sleep. I've finally weaned myself off Xanax. However, they are totally ineffective to counter the side effects of 50 mgs Selegeline taken in the morning.
Has anyone on this site been on Selegeline for as long as I have (8 years)? If so, have you found anything more effective for chronic dysthymia?
Posted by Deborah14 on October 21, 2000, at 22:43:37
In reply to Selegeline Patch - Update?, posted by Deborah14 on October 19, 2000, at 21:09:36
New Users "Dumb" Questions About Posting
1) Am I supposed to erase the previous persons message before I write and post mine?
2) When are you supposed to reload?
3) How do I easily find my postings? Do I just use a bookmark?
Posted by AndrewB on October 22, 2000, at 14:44:18
In reply to Re: Selegeline Patch - Update? » AndrewB, posted by Deborah14 on October 21, 2000, at 22:29:35
Deborah,
Supposedly the drug company with rights to the patch will apply for FDA approval in the first quarter of 2001.
Because the selegiline is absorbed through the skin with the patch, the creation of several metabolites (via the liver) from selegiline is avoided or reduced (i.e. amphetamine).
I realize moclobemide hasn't been effective in a lot of cases. It may however be effective when combined with low dose selegiline. Dr. Goldstein claimed that Tasmar (a COMT inhibitor) was more effective when combined with moclobemide. (COMTs like MAO-Bs prevent the breakdown of dopamine.)
I presume that you recieve benefits from the MOA-B inhibition and the MAO-A inhibition of selegiline, thus my suggestion of combining low dose selegiline with Moclobemide.
Part of the reason selegiline helps you may be because it metabolizes into amphet. and metamphet., but obviously it causes side effects also because of this. Anyway, if you do indeed benefit from the stimulant metabolites of selegiline, you may benefit from a stimulant taken only during the day. It is possible to take stimulant without having side effects. One such stimulant is adderall, a combo of equal amounts of dextroamphetamine and amphetamine.
Of course other things may work better for you for your chronic dysthymia. My dysthymia has been taken away with the combo of low dose amisulpride, low dose selegiline, and adderall. I have no side effects. Amisulpride has had a lot of studies done on it showing it to be efective for dysthymia. For an info piece on amisulpride email me at andrewb@seanet.com. Pramipexole, I theorize may substitue well for amisulpride, in some cases. Several other stimulants may subtitiue for adderall.
I wonder though if you don't require something more than such drugs would offer because you also have major depression. That is why I suggested an MAO-A inhibitor.
AndrewB
Posted by Deborah14 on October 23, 2000, at 19:47:04
In reply to Re: Selegeline Patch - Update?, posted by AndrewB on October 22, 2000, at 14:44:18
AndrewB
Please take this as a compliment. How do you know so much about these medications and the drug interactions between them? You sound like a walking PDR!
I am attempting to educate myself on the information you posted but I am still having trouble using this website. I went onto the Drug Tips (?) section, but I came up with a big fat zero. It is not from lack of trying. I'm just somewhat computer illiterate. If you could give me any tips on how to investigate on my own, I would appreciate it. What is the simplest way of using the Drug Tips section?
Posted by doug cater on October 24, 2000, at 0:05:07
In reply to Re: Selegeline Patch - Update?, posted by AndrewB on October 22, 2000, at 14:44:18
The truth remains that deprenyl hydrochloride iss markedly inferior to deprenyl citrate but remains the only one available by prescription due to the stranglehold it's manufacturer maintains via the FDA, it's bought and paid for lapdog. The sole American manufacturer of deprenyl citrae (aka liquid deprenyl) was shut down by jack booted strong-armed truncheons at the instigation of the company that makes deprenyl hydrochloride (aka selegeline)
Posted by noa on October 24, 2000, at 6:42:43
In reply to Re: Selegeline Patch - Update?, posted by doug cater on October 24, 2000, at 0:05:07
Adam (I wonder if he still lurks?) loved the patch when he was in the study, and then had to switch to the regular med. I hope the patch comes out soon, because it sounds like it will make a huge difference to many.
Posted by Judy on October 24, 2000, at 7:24:22
In reply to Re: Selegeline Patch - Update?, posted by noa on October 24, 2000, at 6:42:43
> Adam (I wonder if he still lurks?)
I was wondering the same thing, Noa. Adam was much more successful on the patch than the oral doses.
I'm still waiting for a Nardil patch. I know for a fact that they were being tested at McLean Hospital here in MA, but I can't find any info about it. I have my fingers crossed that one will eventually be approved and it will provide me the benefits without the side effects that made it necessary for me to give it up.
Judy
Posted by AndrewB on October 24, 2000, at 9:44:21
In reply to Re: Selegeline Patch - Update? » AndrewB, posted by Deborah14 on October 23, 2000, at 19:47:04
Deborah,
Go to the search section of Dr. Bob's tips. This allows you to put in keywords like 'selegiline'.
Also search using keywords at:
www.google.com
http://www.medscape.com/server-java/MedlineSearchFormBest of luck. Maybe after looking around you will be able to give us some advice on selegiline!
AndrewB
Posted by SadSuzie on October 27, 2000, at 11:52:04
In reply to Re: Selegeline Patch - Update?, posted by AndrewB on October 24, 2000, at 9:44:21
Hi Guys,
I participated in a selegline patch study in Dayton, Ohio. The strength of the patch was 30 mg. It completely wiped out my depression. My problem was increased anxiety and problems sleeping. Since participation in the study required that you use no other drugs, I couldn't take anything for anxiety. They did allow Ambien for sleep.
I'm very encourgaged by this patch. I believe my anxiety was dose related and it could have easily been controlled with an anti-anxiety med.Hope this info helps.
Suzie
Deborah,
>
> Go to the search section of Dr. Bob's tips. This allows you to put in keywords like 'selegiline'.
>
> Also search using keywords at:
> www.google.com
> http://www.medscape.com/server-java/MedlineSearchForm
>
> Best of luck. Maybe after looking around you will be able to give us some advice on selegiline!
>
> AndrewB
Posted by Deborah14 on October 27, 2000, at 16:16:39
In reply to Re: Selegeline Patch - Update?, posted by AndrewB on October 20, 2000, at 17:25:27
AndrewB
I keep trying to call Liberty Drug and all I get is a fast busy signal. Where are they located so I can get their local number, instead? What is a compounding pharmacist, specifically?I spoke with Dr. Bodkin and the clinical trials of the selegeline patch have been concluded. You are correct that the results will be submitted to the FDA sometime early next year. All the data has yet to be collected, collated and "tweaked" for submission to the FDA.
My concern is that the approval process is going to take more than the year predicted. Somerset is seeking FDA approval for not only the transdermal patch but use of l-deprenyl as a medication for the treatment of depression. This is a brand new submission to the FDA, under a new brand name. The submission for depression requires the drug to be submitted under a PMA and not under 510K approval, the later form of submission being much faster. The PMA requires the manufacturer to show first that l-deprenyl is safe and effective for the treatment of depression, and then seek approval for the patch as the delivery system.
I know quite a bit about the FDA approval process and I do not believe the submission of l-deprenyl as an anti-depressant is going to receive quick approval. Approval for the delivery system is not the problem for quick (relatively)approval. Since I don't have all the facts, I hope that my gut instrincts are wrong and that the patch gets approved by the end of 2001.
Posted by AndrewB on October 27, 2000, at 19:29:08
In reply to Re: Selegeline Patch - Update? » AndrewB, posted by Deborah14 on October 27, 2000, at 16:16:39
Deborah,
A compounding pharmacist formulates drugs into forms that are not available over the counter such as a capsule of a med at a strength a doctor has specified, a nasal spray dilution of a drug, or a transdermal gel.
It is a bit of a long-shot that a compounding pharmisist can make a selegiline patch.
To find names of compounding pharmcacies, do a google search engine search using the keywords 'compounding pharmacy'.
AndrewB
Posted by chdurie2 on October 27, 2000, at 23:28:38
In reply to Re: Selegeline Patch - Update?, posted by AndrewB on October 27, 2000, at 19:29:08
> Deborah,
>
> A compounding pharmacist formulates drugs into forms that are not available over the counter such as a capsule of a med at a strength a doctor has specified, a nasal spray dilution of a drug, or a transdermal gel.
>
> It is a bit of a long-shot that a compounding pharmisist can make a selegiline patch.
>
> To find names of compounding pharmcacies, do a google search engine search using the keywords 'compounding pharmacy'.
>
> AndrewBAndrew-
au contraire, i've had no problem finding a compounding pharmacist to make a selegeline gel for me, but i have no need.
Mike Webber from Family Pharmacy in Sarasota, Florida will do it with a prescription, and his work is high-quality. A local NJ guy would do it, but I don't trust his stuff. I would think Wellness Pharmacy in Birmingham, Ala., and College Pharmacy in Boulder, Colorado would do it, cuz they do sophisticated compounding stuff. College has frequently screwed up my orders (late in sending out, etc.) and they make good by sending out free duplicates, but it's a hassle.
A study done, I believe, by Johns Hopkins, and reported in, I believe, the January 2000 issue of Neurology concluded there was no advantage in patch/gel. i found this in a medline search.
my p-doc says only reason for gel is if nausea or stomach stuff is a problem. had to use a gel for piracetam/hydergine combination touted in the Dean & Morganthaler book, Smart Drugs.
My p-doc wanted to keep selegeline out of this gel because he wanted greater control of the selegeline, given my history of a near-fatal hypertensive incident with a minor dietary abuse with Parnate, even with my low blood pressure. my current p-doc said he saw no reason for incident unless i was predisposed to such, and this happened 15 years ago with a different p-doc.
consequently, my current p-doc approached my request for selegeline with great trepidation, and only reluctantly agreed when it seemed there was no alternative for me. I now take 30 mgs/daily and do not need to observe the dietary restrictions, although several doctors gave differing opinions on this.
i also now just take Eldapryl for quality-control purposes, because I noticed varying degrees of quality among the various selegelines (generics.)
caroline h.
Posted by Deborah14 on October 28, 2000, at 11:40:49
In reply to Re: Selegeline Patch - Update? » AndrewB, posted by chdurie2 on October 27, 2000, at 23:28:38
Caroline
I'm confused. Are you taking the selegeline in a patch/and or gel combo made by one of these compounding pharmacists, or orally by mouth?I already take the 30 mgs of selegeline by mouth but I need to increase it to 50. However, at 50 mgs the side effects are intolerable. My pdoc wants to try the patch because of its supposedly greater efficacy at 30 mgs with less side effects. He explained that medication released transdermal is not metabolized by the liver to the extent that pills are.
Please elaborate further on the differences between the generics and Eldypryl made by Somerset Pharmaceuticals? I was switched by my insurance co. from Eldypryl to a generic that is a white pill. I have no idea who manufactures it. I actually voiced this concern to my pdoc yesterday.
I too ended up in the ER after increasing my dose of Parnate, per my former pdocs instructions, from one to two pills. (We are no longer on speaking terms.) I too have low blood pressure and there was no food interaction. They thought I burst a blood vessel in my brain. I experienced the most sudden onset of head pain and dizziness in my entire life, as well as chest pains and sweating. It was the worst pain I have ever had beside a collapsed lung. I thought I was going to die. It is believed that my blood pressure spiked from the Parnate even at that low dose. It goes without saying that was the last time I ever went near Parnate.
Posted by chdurie2 on October 28, 2000, at 17:20:54
In reply to Re: Selegeline Patch - Update? » chdurie2, posted by Deborah14 on October 28, 2000, at 11:40:49
> Caroline
> I'm confused. Are you taking the selegeline in a patch/and or gel combo made by one of these compounding pharmacists, or orally by mouth?
>
> I already take the 30 mgs of selegeline by mouth but I need to increase it to 50. However, at 50 mgs the side effects are intolerable. My pdoc wants to try the patch because of its supposedly greater efficacy at 30 mgs with less side effects. He explained that medication released transdermal is not metabolized by the liver to the extent that pills are.
>
> Please elaborate further on the differences between the generics and Eldypryl made by Somerset Pharmaceuticals? I was switched by my insurance co. from Eldypryl to a generic that is a white pill. I have no idea who manufactures it. I actually voiced this concern to my pdoc yesterday.
>
> I too ended up in the ER after increasing my dose of Parnate, per my former pdocs instructions, from one to two pills. (We are no longer on speaking terms.) I too have low blood pressure and there was no food interaction. They thought I burst a blood vessel in my brain. I experienced the most sudden onset of head pain and dizziness in my entire life, as well as chest pains and sweating. It was the worst pain I have ever had beside a collapsed lung. I thought I was going to die. It is believed that my blood pressure spiked from the Parnate even at that low dose. It goes without saying that was the last time I ever went near Parnate.Deborah-
I take Eldepryl in pills (30 mgs.) But the way I got there was in the context of dicussing a gel to be mixed with piracetam/hydergine, which is what Dean & Morganthaler recommend for cognitive enhancement. I had the gel made without the selegeline becuz my p-doc was concerned about my Parnate reaction. But Mike Webber at Family Pharmacy offered to make a selegeline gel by itself or one that would combine the three (by prescription, of course.) His point was that the selegeline gave the mix a powerful punch. The reason to use a gel with piracetam is that you have to take huge quantities for it to be effective, and it is unbelievably nauseating, not to mention tedious to take so many pills.
So it was in this whole exploration that my p-doc said no to the selegeline gel, because he wanted more control over dosage than he thought the gel would give, and he didn't see a good reason from a side effects point of view why the gel would be superior. so i ran selegeline on medline, and came up with this seemingly good study that said it made no difference - i believe they matched equal amounts of selegeline in both pill and gel study groups.
so i don't know if the liver is a problem at 50 mgs. i know that 40 mgs is the normal dosage for those who have parkinson's and need help with depression.
what kind of side effects do you have at 50 mgs? i'm interested cuz i may ask my p-doc to raise the dosage. But when i felt that 30 mgs was no longer doing the job, eldepryl or generic, i asked for something else to augment it rather than suggesting an increased dosage. I'm now on wellbutrin, 300 mgs daily, and i think that's doing okay. my last try with wellbutrin alone, which was my second wellbutrin try, was a bust.
so it may be that eldepryl and wellbutrin work well together, i don't know. the other possible candidate for augmentation was prozac, which i've done several times before with mixed results, but my p-doc picked wellbutrin becuz of its "activating" aspect.the little round white pill you mention, if it's the same one i had, is the reason i then insisted on eldepryl. the first selegeline i got was a light blue and navy capsule, and that was great. then i got the little white round pill, and i immediately noticed it was less effective. i asked my pharmacist if she could get me the light blue and navy capsule again, and she said she's at the mercy of whatever the wholesaler/distributor gives her as a generic-so she couldn't be sure what she got with each order.that's when i suggested to my p-doc that we go with eldepryl, cuz brand names are generally better and more even in quality. he concurred. the eldepryl pills are solid light blue capsules. i mentioned this difference to the part-time pharmacist, and he said he thought the light blue and navy capsules were in fact eldepryl sold under a generic name; he said brand name manufacturers sometimes make and sell generics, but really it's all the same if it comes from them-it's just a way for them to sell more eldepryl, he said, cuz they know many hmo's etc won't authorize brand name if a generic is available.
so that's what i know about eldepryl/selegeline. obviously, your p-doc and mine differ on whether a gel would be more effective.
mike webber at family pharmacy is very good but he's on the expensive side. wellness and college are similar and cheaper; i prefer wellness cuz college has a habit of screwing up my order - they send free duplicates, but it's a hassle. i have used all to compound liquid injectables.
i know what you mean about parnate. if i didn't say so before, my p-doc now says my minor dietary transgression had nothing to do with what happened - the transgression wasn't serious enuf to bring on a near-fatal reaction. (i drank a chocolate milk shake without thinking, and wound up almost having a stroke. went by ambulance to the emergency room, and they were already administering the antidote via iv in the ambulance-then at hospital they immediately induced vomiting and diarrhea. said i made it in the nick of time. at one point i remember nurses outside my room whispering whether i was gonna make it or not- i was in a "coma" and i just told myself that i had to make it.) that was my first and only day of parnate.
Caroline
Posted by chdurie2 on October 28, 2000, at 17:51:35
In reply to Re: Selegeline Patch - Update? » Deborah14, posted by chdurie2 on October 28, 2000, at 17:20:54
> > Caroline
> > I'm confused. Are you taking the selegeline in a patch/and or gel combo made by one of these compounding pharmacists, or orally by mouth?
> >
> > I already take the 30 mgs of selegeline by mouth but I need to increase it to 50. However, at 50 mgs the side effects are intolerable. My pdoc wants to try the patch because of its supposedly greater efficacy at 30 mgs with less side effects. He explained that medication released transdermal is not metabolized by the liver to the extent that pills are.
> >
> > Please elaborate further on the differences between the generics and Eldypryl made by Somerset Pharmaceuticals? I was switched by my insurance co. from Eldypryl to a generic that is a white pill. I have no idea who manufactures it. I actually voiced this concern to my pdoc yesterday.
> >
> > I too ended up in the ER after increasing my dose of Parnate, per my former pdocs instructions, from one to two pills. (We are no longer on speaking terms.) I too have low blood pressure and there was no food interaction. They thought I burst a blood vessel in my brain. I experienced the most sudden onset of head pain and dizziness in my entire life, as well as chest pains and sweating. It was the worst pain I have ever had beside a collapsed lung. I thought I was going to die. It is believed that my blood pressure spiked from the Parnate even at that low dose. It goes without saying that was the last time I ever went near Parnate.
>
> Deborah-
>
> I take Eldepryl in pills (30 mgs.) But the way I got there was in the context of dicussing a gel to be mixed with piracetam/hydergine, which is what Dean & Morganthaler recommend for cognitive enhancement. I had the gel made without the selegeline becuz my p-doc was concerned about my Parnate reaction. But Mike Webber at Family Pharmacy offered to make a selegeline gel by itself or one that would combine the three (by prescription, of course.) His point was that the selegeline gave the mix a powerful punch. The reason to use a gel with piracetam is that you have to take huge quantities for it to be effective, and it is unbelievably nauseating, not to mention tedious to take so many pills.
>
> So it was in this whole exploration that my p-doc said no to the selegeline gel, because he wanted more control over dosage than he thought the gel would give, and he didn't see a good reason from a side effects point of view why the gel would be superior. so i ran selegeline on medline, and came up with this seemingly good study that said it made no difference - i believe they matched equal amounts of selegeline in both pill and gel study groups.
>
> so i don't know if the liver is a problem at 50 mgs. i know that 40 mgs is the normal dosage for those who have parkinson's and need help with depression.
>
> what kind of side effects do you have at 50 mgs? i'm interested cuz i may ask my p-doc to raise the dosage. But when i felt that 30 mgs was no longer doing the job, eldepryl or generic, i asked for something else to augment it rather than suggesting an increased dosage. I'm now on wellbutrin, 300 mgs daily, and i think that's doing okay. my last try with wellbutrin alone, which was my second wellbutrin try, was a bust.
> so it may be that eldepryl and wellbutrin work well together, i don't know. the other possible candidate for augmentation was prozac, which i've done several times before with mixed results, but my p-doc picked wellbutrin becuz of its "activating" aspect.
>
> the little round white pill you mention, if it's the same one i had, is the reason i then insisted on eldepryl. the first selegeline i got was a light blue and navy capsule, and that was great. then i got the little white round pill, and i immediately noticed it was less effective. i asked my pharmacist if she could get me the light blue and navy capsule again, and she said she's at the mercy of whatever the wholesaler/distributor gives her as a generic-so she couldn't be sure what she got with each order.that's when i suggested to my p-doc that we go with eldepryl, cuz brand names are generally better and more even in quality. he concurred. the eldepryl pills are solid light blue capsules. i mentioned this difference to the part-time pharmacist, and he said he thought the light blue and navy capsules were in fact eldepryl sold under a generic name; he said brand name manufacturers sometimes make and sell generics, but really it's all the same if it comes from them-it's just a way for them to sell more eldepryl, he said, cuz they know many hmo's etc won't authorize brand name if a generic is available.
>
> so that's what i know about eldepryl/selegeline. obviously, your p-doc and mine differ on whether a gel would be more effective.
>
> mike webber at family pharmacy is very good but he's on the expensive side. wellness and college are similar and cheaper; i prefer wellness cuz college has a habit of screwing up my order - they send free duplicates, but it's a hassle. i have used all to compound liquid injectables.
>
> i know what you mean about parnate. if i didn't say so before, my p-doc now says my minor dietary transgression had nothing to do with what happened - the transgression wasn't serious enuf to bring on a near-fatal reaction. (i drank a chocolate milk shake without thinking, and wound up almost having a stroke. went by ambulance to the emergency room, and they were already administering the antidote via iv in the ambulance-then at hospital they immediately induced vomiting and diarrhea. said i made it in the nick of time. at one point i remember nurses outside my room whispering whether i was gonna make it or not- i was in a "coma" and i just told myself that i had to make it.) that was my first and only day of parnate.
>
> CarolineDeborah- since i see you have questions on compounding, a compounding pharmacist is one who is licensed to make up things "from scratch" according to a formula. some compounders can only do pills, and some can do both pills and liquid, either oral or injectable. it has to do with how sophisticated their facility is - you need a separate room for liquids, i think.
if i were getting a selegeline gel, i would want to make sure that the compounder had made one before. although many have access to the same formulas, my NJ guy thought he was doing me a favor and put butene alcohol in one of my injectables without my authorization to help aleviate the pain of the stuff. problem was, my inquiries turned up the fact that the major ingredient in the thing is not stable enuf to withstand butene alcohol; that's why experienced guys don't do it. and he knew the stuff wasn't all that stable, but this was the first time he had made it. when i confronted him, he was not nice about it and refused my request to a "makegood." so although they all say they can read a formula and make stuff, i wouldn't buy it from anyone who hadn't made it before.
i probably would go with mike webber at family for a selegeline gel, cuz i know he's made it before. i would, i think, however, trust steve at wellness, cuz i know any time there has been the slightest question about anything he has checked with either me or my doctor, and he refused to make the piracetam gel for me because he was uncertain about how to do it, never having made it before. that's a lot of integrity. i might also try college, but they'd be a third choice - they're too big, in my opinion, to trust with a selegeline gel unless they've made it a lot before, which they may have. all three of these have 800 numbers. if you call, you can use the regular number and just ask for the 800 numbers and call them right back on those.
you certainly don't have to use these people, but because i've ordered from them a bunch of times, i know them.
let me know how it works out. if you have a better experience with the gel, maybe i'll do it too and talk my p-doc into it now that we know there's no problem with a possible hypertensive incident.
also, again, what are your side effects on 50 mgs? and is 50 mgs really more effective than 30?
caroline
Posted by Deborah14 on October 28, 2000, at 22:17:04
In reply to Re: On compounding--Deborah 14, posted by chdurie2 on October 28, 2000, at 17:51:35
Caroline
How is the gel administered? We know the patch is, at least, as effective or even more effective than selegeline capsules of the same dose and supposedly has fewer side effects. Is there any evidence that a selegeline gel is as effective and would have fewer side effects then pills?Do you have any of the 800 or local numbers you mentioned. Where are each of these pharmacies located so I can get their local numbers?
I'll answer the rest of questons in a separate posting.
Thanks for the help.
Posted by chdurie2 on October 29, 2000, at 13:23:10
In reply to Re: On compounding--Deborah 14 » chdurie2, posted by Deborah14 on October 28, 2000, at 22:17:04
> Caroline
> How is the gel administered? We know the patch is, at least, as effective or even more effective than selegeline capsules of the same dose and supposedly has fewer side effects. Is there any evidence that a selegeline gel is as effective and would have fewer side effects then pills?
>
> Do you have any of the 800 or local numbersDeborahmentioned. Where are each of these pharmacies located so I can get their local numbers?
>
> I'll answer the rest of questons in a separate posting.
>
> Thanks for the help.Deborah--I forgot to tell you: gel is applied to neck/under chin area, more than once a day if necessary. seems that's a great area for absorption. so skip the perfume!
caroline
Posted by chdurie2 on October 29, 2000, at 13:46:12
In reply to Re: On compounding--Deborah 14 » chdurie2, posted by Deborah14 on October 28, 2000, at 22:17:04
> Caroline
> How is the gel administered? We know the patch is, at least, as effective or even more effective than selegeline capsules of the same dose and supposedly has fewer side effects. Is there any evidence that a selegeline gel is as effective and would have fewer side effects then pills?
>
> Do you have any of the 800 or local numbers you mentioned. Where are each of these pharmacies located so I can get their local numbers?
>
> I'll answer the rest of questons in a separate posting.
>
> Thanks for the help.deborah- something seems not to have posted, so here goes again:
1) wellness pharmacy 800 number is 1-800-227-2627. local number is 205-879-6551. they're in birmingham, alabama. website is www.wellnesshealth.com
couldn't find numbers/websites for family or college pharmacies. but family pharmacy is in sarasota, florida, and college pharmacy is in boulder, colorado.2) checked my notes and study that said patch/gel no more effective than pills was done by johns hopkins and reported in the january 2000 issue of neurology. i made no notes about side effects, so don't know if article said. tried medline search for you but couldn't find. think i may have backed into it by going to ivillage.com, pluggling chronic fatigue syndrome into allhealth.com, then medline search for articles on cfs treatment or somesuch. abstract came right after one on selegeline providing energy benefits to those with cfs.
looking forward to hearing more from you and your research.
caroline
Posted by Deborah14 on October 31, 2000, at 20:48:03
In reply to Re: Selegeline Patch - Update? » Deborah14, posted by chdurie2 on October 28, 2000, at 17:20:54
> > 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.
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.
Posted by Deborah14 on November 1, 2000, at 18:41:35
In reply to Re: Selegeline Patch - Update? » Deborah14, posted by chdurie2 on November 1, 2000, at 12:25:57
> > > > Caroline
Under the Pharmacy Preservation Act of 1977, the compounding of a gel IS legal if the pharmacist is:
1) Not making it in bulk e.g.manufacturing it in mass quantities.
2) The "active drug" within the gel is FDA approved, or does not fall under the jurisdication of the FDA e.g. an herbal remedy.
3) Is not in competition with a manufacturer who formulates the same product the same way for the same use. e.g. a compounding pharmacist cannot make a selegeline capsule in direct competition with Somerset Pharmaceutical.
4) Is prescribed by a physcian for a specified person and is formulated by a licensed pharmacist.
Under the Pharmacy Preservation Act of 1977, it is ILLEGAL for a licensed pharmacist to use the following delivery systems for compounds:
1) Transdermal patches
2) Inhalers
3) A compound that is used to treat a open wound or area subject to contamination since the FDA does not have direct oversight or regulatory authority over compounding pharmacists' facilities. This authority is given to the states. The FDA is concerned about product contamination and lack of quality control (compounding pharmaceutical under non-sterile conditions)
From my research, it appears that the FDA is unhappy with the law and has repeatedly attempted to get Congress to delay implementation of it.As per the selegeline gel, my p-doc, who is pretty conservative, is all for me trying it. I am the one who is reluctant. What I was really confused about was the diametrically opposed positions concerning the selegeline gels efficacy explained by Mike at Family Pharmacy and Steve at College Pharmacy.
At this point, my pdoc is going to speak with the psychopharm "guru" and then speak with Mike at Family if he feels it is worth going ahead with a trial of the gel.
I can't believe that my insurance company would approve payment of the gel through the Long Island pharmacy you mentioned. It would mean that I would only pay my usual copay and they would get hit with the difference. Why would they do it if they can keep me on the generic brand?
Posted by Mr. Scott on March 11, 2001, at 14:29:57
In reply to Re: Selegeline Patch - Update?, posted by Deborah14 on November 1, 2000, at 18:41:35
> > > > > Caroline
> Under the Pharmacy Preservation Act of 1977, the compounding of a gel IS legal if the pharmacist is:
> 1) Not making it in bulk e.g.manufacturing it in mass quantities.
> 2) The "active drug" within the gel is FDA approved, or does not fall under the jurisdication of the FDA e.g. an herbal remedy.
> 3) Is not in competition with a manufacturer who formulates the same product the same way for the same use. e.g. a compounding pharmacist cannot make a selegeline capsule in direct competition with Somerset Pharmaceutical.
> 4) Is prescribed by a physcian for a specified person and is formulated by a licensed pharmacist.
> Under the Pharmacy Preservation Act of 1977, it is ILLEGAL for a licensed pharmacist to use the following delivery systems for compounds:
> 1) Transdermal patches
> 2) Inhalers
> 3) A compound that is used to treat a open wound or area subject to contamination since the FDA does not have direct oversight or regulatory authority over compounding pharmacists' facilities. This authority is given to the states. The FDA is concerned about product contamination and lack of quality control (compounding pharmaceutical under non-sterile conditions)
> From my research, it appears that the FDA is unhappy with the law and has repeatedly attempted to get Congress to delay implementation of it.
>
> As per the selegeline gel, my p-doc, who is pretty conservative, is all for me trying it. I am the one who is reluctant. What I was really confused about was the diametrically opposed positions concerning the selegeline gels efficacy explained by Mike at Family Pharmacy and Steve at College Pharmacy.
> At this point, my pdoc is going to speak with the psychopharm "guru" and then speak with Mike at Family if he feels it is worth going ahead with a trial of the gel.
> I can't believe that my insurance company would approve payment of the gel through the Long Island pharmacy you mentioned. It would mean that I would only pay my usual copay and they would get hit with the difference. Why would they do it if they can keep me on the generic brand?
>
> Hi,
Do you know if this patch is yet available in the states?
This is the end of the thread.
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