Eldepryl: Advanced Parkinson's Disease Symptom Management
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Synonyms
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Eldepryl (selegiline hydrochloride) represents a significant advancement in the adjunctive treatment of Parkinson’s disease, specifically engineered to enhance dopaminergic activity in the central nervous system. As a selective monoamine oxidase-B (MAO-B) inhibitor, it operates through a targeted mechanism to delay the degradation of dopamine, thereby prolonging the therapeutic effects of levodopa. This pharmaceutical intervention is specifically indicated for patients experiencing deterioration in their response to levodopa/carbidopa therapy. Its clinical utility lies in reducing “off” time periods and enabling more consistent motor control, making it a cornerstone in modern neurology practice for managing progressive symptoms.
Features
- Contains selegiline hydrochloride as the active pharmaceutical ingredient
- Available in 5 mg oral tablet formulation
- Selective and irreversible monoamine oxidase-B inhibitor
- Designed for blood-brain barrier penetration
- Manufactured under strict pharmaceutical quality control standards
- Typically prescribed as adjunct therapy to levodopa/carbidopa
Benefits
- Extends the duration of levodopa’s therapeutic effect by inhibiting dopamine metabolism
- Reduces frequency and duration of “off” periods in Parkinson’s patients
- May allow for reduction of levodopa dosage in some patients
- Helps maintain more consistent motor function throughout the day
- Can improve overall quality of life by providing more predictable symptom control
- Delays disease progression in early Parkinson’s when used as monotherapy
Common use
Eldepryl is primarily prescribed for the management of Parkinson’s disease in patients being treated with levodopa/carbidopa who exhibit deteriorating response to this therapy. It is used as an adjunct treatment to reduce the frequency of “off” episodes—periods when medication effects wear off and Parkinson’s symptoms return. In early Parkinson’s disease, some neurologists may prescribe Eldepryl as monotherapy based on the hypothesis that MAO-B inhibition might have neuroprotective effects, though this remains an area of ongoing research. The medication is typically incorporated into treatment regimens when patients begin to experience motor fluctuations despite optimized levodopa dosing.
Dosage and direction
The recommended initial dosage of Eldepryl is 5 mg administered orally twice daily, typically with breakfast and lunch. Administration later in the day should be avoided as it may contribute to insomnia. The maximum recommended daily dose is 10 mg. When used as adjunct therapy to levodopa, it may be possible to reduce the dose of levodopa by approximately 10-30% after several days of Eldepryl therapy to minimize side effects while maintaining therapeutic benefit. Patients should be advised not to exceed the prescribed dosage due to risks associated with non-selective MAO inhibition at higher doses. Tablets should be swallowed whole with water and not crushed or chewed.
Precautions
Patients taking Eldepryl should be closely monitored for the development of orthostatic hypotension, particularly when beginning treatment or increasing dosage. Caution is advised when operating machinery or driving until the patient’s response to therapy is established. Elderly patients may be more sensitive to the effects of Eldepryl and typically require careful dose titration. Patients should be advised to avoid sudden changes in position to minimize orthostatic effects. Regular monitoring of blood pressure is recommended, especially during dose adjustments. Patients with significant cardiac, hepatic, or renal impairment require careful consideration before initiation and close monitoring during therapy.
Contraindications
Eldepryl is contraindicated in patients with known hypersensitivity to selegiline hydrochloride or any component of the formulation. It should not be used concurrently with meperidine, other MAO inhibitors, serotonin precursors (such as L-tryptophan), serotonin reuptake inhibitors (SSRIs, SNRIs), tricyclic antidepressants, or within several weeks of discontinuing these medications due to risk of serotonin syndrome. Concomitant use with sympathomimetics including amphetamines, cold products containing decongestants, or weight control products is contraindicated. Patients with pheochromocytoma should not receive Eldepryl therapy.
Possible side effects
The most commonly reported adverse reactions include nausea, dizziness, lightheadedness, abdominal pain, dry mouth, vivid dreams, and insomnia. Orthostatic hypotension may occur, particularly during dose titration. Less frequent side effects include arrhythmias, angina, peripheral edema, and confusion. At higher doses (exceeding 10 mg daily), non-selective MAO inhibition may occur, increasing risk of hypertensive crisis. Some patients may experience increased dyskinesias when Eldepryl is added to levodopa therapy, which may require levodopa dosage adjustment. Hallucinations and psychotic episodes have been reported, particularly in elderly patients.
Drug interaction
Eldepryl exhibits significant interactions with numerous medication classes. Concomitant use with other MAO inhibitors may precipitate hypertensive crisis. Serotonergic drugs including SSRIs, SNRIs, tricyclic antidepressants, tramadol, and meperidine may cause serotonin syndrome. Sympathomimetic agents including decongestants, amphetamines, and cocaine may cause hypertensive reactions. Concurrent use with dextromethorphan may cause psychosis or bizarre behavior. Eldepryl may potentiate the effects of CNS depressants including alcohol, benzodiazepines, and opioids. Careful monitoring is required when used with antihypertensive agents due to potential additive hypotensive effects.
Missed dose
If a dose of Eldepryl is missed, it should be taken as soon as remembered unless it is close to the time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. Consistent timing of medication administration is important for maintaining stable dopamine levels. If multiple doses are missed, patients should contact their healthcare provider for guidance on resuming therapy, as dose adjustment may be necessary.
Overdose
Overdose of Eldepryl may manifest as symptoms related to excessive dopaminergic stimulation including severe dyskinesias, agitation, hallucinations, and hypertension. At doses significantly exceeding 10 mg daily, non-selective MAO inhibition may occur, potentially leading to hypertensive crisis characterized by severe headache, tachycardia, sweating, and possibly intracranial hemorrhage. Symptoms of serotonin syndrome may include hyperthermia, rigidity, myoclonus, autonomic instability, and mental status changes. Management is supportive and symptomatic, with careful monitoring of vital signs. Gastric lavage may be considered if presentation is early after ingestion. Specific antagonists such as cyproheptadine may be considered for serotonin syndrome under medical supervision.
Storage
Eldepryl tablets should be stored at controlled room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). The medication should be kept in its original container, tightly closed, and protected from light and moisture. Tablets should not be stored in bathroom cabinets where humidity levels may fluctuate. Keep all medications out of reach of children and pets. Properly discard any medication that is outdated or no longer needed according to local guidelines for medication disposal.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Individual patient responses to Eldepryl may vary based on numerous factors including age, renal function, hepatic function, concomitant medications, and disease severity. Treatment decisions should be made exclusively by qualified healthcare professionals familiar with the patient’s complete medical history. Patients should not initiate, adjust, or discontinue medication without consulting their prescribing physician. The full prescribing information should be consulted before administration.
Reviews
Clinical studies demonstrate that Eldepryl provides meaningful benefits for approximately 50-70% of patients with advanced Parkinson’s disease experiencing motor fluctuations. In controlled trials, patients adding Eldepryl to levodopa therapy experienced approximately 1-2 hours of additional “on” time daily compared to placebo. Many neurologists report that patients describe improved consistency in their motor function and reduced anxiety about unpredictable “off” periods. Some patients note initial side effects that often diminish with continued therapy. The medication is generally well-tolerated when used at recommended doses with appropriate precautions. Long-term experience spanning decades supports its safety profile when used as directed.