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Selegiline
It is a selective MAO type B inhibitor given alongwith L-dopa and Carbidopa combination. The action occurs as the drug potentiates the effect of Levodopa by decreasing the metabolism of dopamine. Given orally it can reduce the dose of levodopa needed to control parkinsonism and decreases the "Wearing off" effects. After administration it enters the CNS and if patients takes Levodopa rise in blood pressure does not occur.
INDICATIONS : Used for the treatment of parkinsonism. It prolongs the duration of improvement brought about by L -dopa, It also di¬minishes the diurnal fluctuations in strength. Treatment with selegiline postpones the need of levodopa for 6 to 9 months.
CONTRAINDICATIONS : History of allergy. Patients with history of epilepsy. Tardive dyskinesia, HUNTINGTON'S diseases.
SAFETY PROFILE : Increase in dopaminergic adverse effects such as dyskinesia, nausea and hallucination. Selegiline is a MAO in¬hibitor, the drug should be discontinued for some time before starting an antidepressant. Recent trails have indicated that the mortality may be higher in Patients treated with levodopa +carbidopa+ selegiline than in those with levodopa+ carbidopa alone. Hence it is recommended that newly diagnosed patients Should not be treated with such triple drug combination.
ADVERSE EFFECTS: Involuntary movements. Postural hypotension, nausea, confusion, psychosis, skin rash.
DRUG INTERACTIONS: With levodopa + carbidopa as mentioned above. Fluoxetine and meperidine have been associated with toxic reactions.
DOSAGE : Adults : 10mg/day in divided doses at breakfast & lunch or a single dose.