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MAO-B Inhibitor — Parkinson's Disease Pregnancy: UK SPC section 4.6: available safety data in pregnancy and lactation are insufficient to justify use; as a precautionary measure it is preferable to avoid selegiline in pregnancy, and it should not be used during breast-feeding.

Selegiline

Brand names: Eldepryl, Zelapar (buccal)

Selegiline is a selective monoamine oxidase-B (MAO-B) inhibitor used in Parkinson's disease, as monotherapy in early disease or as an adjunct to levodopa.

Adult dose

Dose: 10 mg daily
Route: Oral
Frequency: Once daily in the morning, or in two divided doses of 5 mg taken at breakfast and lunch
UK SPC (Eldepryl 10 mg Tablets) section 4.2: '10 mg daily either alone or as an adjunct to levodopa or levodopa/peripheral decarboxylase inhibitor.' When selegiline is added to a levodopa regimen it is possible to reduce the levodopa dosage by an average of 10-30%; reduction of the levodopa dose should be gradual, in steps of 10% every 3 to 4 days. Section 4.2 states that no dosage adjustment is required for patients with renal or hepatic impairment. Section 4.4 notes that the precise dose at which selegiline becomes a non-selective inhibitor of all MAO has not been determined, but that with doses higher than 10 mg/day there is a theoretical risk of hypertension after ingestion of tyramine-rich food. Paediatrics: the UK SPC gives no paediatric dose; the US label records that 'the effects of selegiline hydrochloride in children have not been evaluated' — verify any paediatric use against a children's formulary. The US label (selegiline hydrochloride tablets) gives the same total: 10 mg per day as divided doses of 5 mg each taken at breakfast and lunch, adding that higher doses give no additional benefit and should ordinarily be avoided.

Dose adjustments

Renal

UK SPC section 4.2: no dosage adjustment is required for patients with renal or hepatic impairment. Section 4.4 nonetheless advises that selegiline should be used with caution in severe liver or kidney dysfunction.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Known hypersensitivity (including severe dizziness or hypotension) to selegiline or any of the excipients
  • Patients receiving serotonin agonists (e.g. sumatriptan, naratriptan, zolmitriptan, rizatriptan)
  • Concomitant use with pethidine and other opioids
  • Patients being treated with antidepressants, including MAO inhibitors, tricyclic antidepressants, SNRIs (e.g. venlafaxine) and SSRIs (e.g. citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline)
  • Other monoamine oxidase inhibitors, e.g. linezolid
  • Combination with sympathomimetics
  • Active duodenal or gastric ulcer
  • Extrapyramidal disorders not related to dopamine deficiency
  • In combination with levodopa: severe cardiovascular disease, arterial hypertension, hyperthyroidism, phaeochromocytoma, narrow-angle glaucoma, prostatic adenoma with residual urine, tachycardia, arrhythmias, severe angina pectoris, psychoses, advanced dementia and thyrotoxicosis

Side effects

  • Stomatitis (very common)
  • Sleeping disorders, confusion, hallucinations, depression (common)
  • Abnormal movements such as dyskinesias, akinesia and bradykinesia, dizziness, headache, impaired balance, tremor (common)
  • Hypotension and hypertension, bradycardia (common)
  • Nausea, constipation, diarrhoea, mouth ulceration (common)

Interactions

  • Serotonin agonists (triptans), pethidine and other opioids, MAOIs (including linezolid), tricyclic antidepressants, SNRIs and SSRIs — contraindicated combinations (section 4.3)
  • Buprenorphine/opioids — concomitant administration may result in serotonin syndrome, a potentially life-threatening condition (section 4.4)
  • Medicines that inhibit MAO-A, or non-selective MAO inhibitors — can cause hypotensive reactions (section 4.4)
  • Sympathomimetics — should not be used in combination (section 4.3); the US label reports a case of hypertensive crisis with selegiline plus ephedrine
  • CNS depressants used for general anaesthesia — MAO inhibitors including selegiline may potentiate their effects; transient respiratory and cardiovascular depression, hypotension and coma have been reported (section 4.4)
  • Levodopa — selegiline potentiates its effect, so levodopa side effects may be emphasised unless the levodopa dose is reduced (section 4.8)

Clinical monograph

How it works

It selectively and irreversibly inhibits MAO-B, reducing dopamine breakdown in the brain and enhancing dopaminergic transmission; some of its metabolites are amfetamine derivatives.

Prescribing in practice

  • It must not be combined with pethidine, and concurrent serotonergic agents or other MAO inhibitors risk serotonin syndrome or hypertensive crisis, so combinations require careful review.
  • Amfetamine metabolites may cause insomnia or agitation, so dosing earlier in the day is generally preferred.
  • When added to levodopa it can intensify dopaminergic adverse effects, sometimes necessitating a reduction in the levodopa dose.

Monitoring

Monitor for dopaminergic effects, dyskinesia, impulse-control disorders, sleep disturbance and any features suggestive of serotonin toxicity when serotonergic drugs are co-prescribed.

Counselling the patient

  • Report new compulsive behaviours such as gambling, hypersexuality or excessive spending.
  • Take the medicine earlier in the day to reduce the chance of insomnia.
  • Tell any prescriber you take selegiline before starting new medicines, especially antidepressants and certain painkillers.

Evidence & guidelines

Selegiline is a long-established treatment option in Parkinson's disease and features among the MAO-B inhibitors recommended in NICE guidance.

Reference: NICE NG71 (Parkinson's Disease); DATATOP Trial; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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