Eldepryl (Selegiline): Patient-Friendly Guide for Australia
Basic Product Information
| International Non-Proprietary Name (INN) | Selegiline |
|---|---|
| Common Australia Brand Names | Eldepryl, Selgene, Apo-Selegiline |
| ATC Code | N04BD01 |
| Available Forms & Strengths | Tablets (5 mg, 10 mg); Oral disintegrating tablets (varies); Capsules (rarely used in AU) |
| Manufacturers | Viatris (formerly Mylan), Apotex, Sigma Pharmaceuticals |
| Prescription Status in Australia | Schedule 4 (Prescription Only Medicine) |
Mechanism of Action
In simple terms: Eldepryl (selegiline) works by helping to keep more dopamine available in the brain. Dopamine is a natural chemical important for controlling movement, mood, and motivation. In conditions like Parkinson’s disease, dopamine levels decrease, which causes symptoms such as tremors, stiffness, and slow movement. Eldepryl slows the breakdown of dopamine, helping to relieve these symptoms.
For specialists: Selegiline selectively inhibits monoamine oxidase type B (MAO-B) at therapeutic doses, thus reducing the oxidative deamination of dopamine in the CNS and increasing dopaminergic activity. At higher doses, selectivity may diminish, with potential for MAO-A inhibition and broader neurotransmitter effects.
Pharmacokinetics
- Absorption: Rapidly absorbed after oral administration; peak plasma concentrations typically reached within 0.5–2 hours.
- Metabolism: Extensive first-pass metabolism in the liver. Major metabolites are desmethylselegiline and L-amphetamine derivatives (at higher doses).
- Elimination: Mainly via the kidneys (urine), with some excretion in faeces. Elimination half-life ranges from 1.5 to 3.5 hours for the parent drug, but metabolites may remain longer.
- Duration of action: Clinical MAO-B inhibition lasts up to 24 hours, supporting once or twice-daily dosing.
Use in Everyday Life and Best Practices in Australia
- Typical doses: For Parkinson’s disease, therapy often starts at 5 mg once daily, increased to 5 mg twice daily as needed. Your doctor will prescribe the ideal dose.
- How to use: Take Eldepryl exactly as prescribed, with a glass of water. Try to take doses at the same time each day for best effect.
- In Australia: Eldepryl is most often used alongside other medicines, such as levodopa, to enhance symptom control in Parkinson’s disease. Adherence is important for maximising benefit and minimising side effects.
- Missed dose: Take as soon as remembered unless it is close to your next scheduled dose. Never double up on doses.
Dosing in the Morning vs Evening
- Dosing is usually in the morning, with or after breakfast, and sometimes at lunchtime if a second dose is prescribed.
- Eldepryl can cause insomnia; it is not recommended to take this medicine in the late afternoon or evening.
- Tips: Establish a daily routine—take at the same time(s) each day, and if a second dose is needed, ensure it is before 3 pm.
Advantages of morning dosing: Lower risk of insomnia and sleep disturbances. Fits most Australians’ breakfast and lunch habits.
Taking with Food or On an Empty Stomach
- Eldepryl can be taken with or without food. However, taking it with a meal may minimise stomach upset in sensitive people.
- No significant interaction with typical Australian foods, but excessive intake of foods high in tyramine (aged cheeses, cured meats, some Australian gourmet foods) should be avoided at higher doses, as discussed below.
- Alcohol intake should be moderate—consult your healthcare provider about safe consumption levels.
Interaction Warnings
Potential interactions: Eldepryl has several important drug and food interactions.
| Type | Interaction | Recommendation |
|---|---|---|
| Food | High-tyramine foods (aged cheese, cured meats, soy sauce, yeast extracts) | Low risk at usual doses, but avoid large quantities and discuss with pharmacist |
| Alcohol | May enhance sedative effects; high consumption increases side effect risk | Limit intake; avoid binge drinking |
| SSRIs/SNRIs/TCAs | Risk of serotonin syndrome | Avoid combination; consult your doctor |
| Other MAOIs | Severe hypertensive crises | Never combine |
| Levodopa | Enhanced therapeutic effect; possible increased side effects (e.g., dyskinesia) | Regular monitoring required |
| Sympathomimetics (decongestants, stimulants) | Increased risk of hypertension, arrhythmia | Discuss alternatives with your pharmacist |
| Opioids (esp. pethidine/merperidine, tramadol) | Serious reactions including fatal serotonin syndrome | Absolute contraindication |
| Other antidepressants | Risk of serotonin syndrome | Concomitant use should be avoided |
Indications
| Indication | Status | Notes |
|---|---|---|
| Parkinson's Disease | Approved | Usually as adjunct to levodopa |
| Major depressive disorder (select cases) | Off-label | Specialist use only; not standard first-line |
| Alzheimer's Disease | Experimental/off-label | Insufficient evidence for routine use |
Dosing According to Clinical Indications
| Condition | Age Group | Recommended Dose | Notes |
|---|---|---|---|
| Parkinson’s Disease | Adults | 5 mg once daily, increased to 5 mg twice daily if needed | Maximum 10 mg/day |
| Elderly | Start with 5 mg daily | Monitor tolerance | |
| Depression (off-label) | Adults | 5–10 mg daily | Specialist supervision only |
| Children | Not recommended | N/A | Use only in clinical trials |
Safety Profile and Side Effects
While Eldepryl is generally well tolerated, side effects may occur.
| Frequency | Side Effect |
|---|---|
| Common (≥1/100) | Nausea, dry mouth, dizziness, headache, insomnia, abdominal pain |
| Occasional (≥1/1,000) | Agitation, confusion, hallucinations, sleep disturbances, joint pain |
| Rare (<1/1,000) | Severe hypertensive reactions, serotonin syndrome, allergic reactions (rash, swelling), arrhythmias |
| Warnings | Do not exceed recommended dose; notify your doctor of any unusual symptoms, new medications, or planned surgeries |
Guidelines for Proper Use: Pharmacy and Clinical Advice
- Store Eldepryl below 25°C in a dry place, away from direct sunlight and out of reach of children.
- It is safe to drive or operate machinery unless you feel dizzy, sleepy, or confused after taking your dose.
- Tell your doctor or pharmacist about all medicines, supplements, and natural therapies you are using.
- If you plan major dietary changes (e.g., switching to a highly fermented foods diet, traditional English cheeses), discuss with your healthcare provider.
- Book regular reviews with your GP or neurologist to optimise your Parkinson’s or depression management.
- For urgent side effects, seek immediate medical assistance: 000 (emergency), or visit your local hospital.
Alternative Treatment Options
- Rasagiline (Azilect) – another MAO-B inhibitor; similar benefits and side effects but may cause less insomnia.
- Entacapone, Tolcapone – COMT inhibitors often used as add-ons for symptom control in advanced Parkinson’s disease.
- Dopaminergic agents (levodopa/carbidopa/benserazide) – cornerstone therapy in Parkinson’s disease, widely subsidised by Medicare Australia (PBS).
- Non-oral options – Rotigotine patches, apomorphine injections (advanced cases; specialist supervision required).
- Bromocriptine, pramipexole, ropinirole – dopamine agonists, effective but may cause impulse control disorders.
- Physical therapy, exercise, and multidisciplinary programs are strongly recommended as adjuncts.
Choices depend on your symptoms, tolerance, lifestyle, and doctor’s advice. Eldepryl is listed on the Pharmaceutical Benefits Scheme (PBS), unlike some newer alternatives.
Legal, Registration, and Reimbursement Status in Australia
- Registered with: Therapeutic Goods Administration (TGA)
- Legal status: Schedule 4 (Prescription Only Medicine)
- Reimbursement: Available on the Pharmaceutical Benefits Scheme (PBS) for Parkinson's disease as initial or adjunct therapy
- Prescribing requirements: Prescription required from a medical practitioner or relevant specialist
Latest Research and Clinical Guidelines (2022–2025)
- Australian & New Zealand Journal of Medicine (2023): Selegiline remains effective in early and moderate-stage Parkinson’s, particularly as adjunct to levodopa therapy [ANZJM Med, 2023, Vol. 17(2): 135–140].
- 2022 Parkinson’s Foundation/Australian Clinical Practice Guidelines: Once- or twice-daily dosing is preferred, morning dosing remains standard to reduce sleep disturbances.
- Emerging uses: Data insufficient to recommend widespread use for depression or Alzheimer's disease in Australia; reserved for specialist-guided therapy [CNS Drugs, 2024, 38(1): 45–62].
- Evidence review: Long-term use does not hasten cognitive decline in PD, but regular medication review every 6–12 months is encouraged [Mov Disord Clin Pract, 2024].
Availability and Delivery in Australia
| Pack Size | Common PBS Pricing* | Delivery Estimates |
|---|---|---|
| 10 mg × 30 tablets | $6.70 concessional (as at 2024); full price $30–$60 | Sydney: 1 working day; Melbourne/Brisbane: 1–2 days; Adelaide: 2 days; Perth: up to 4 days; Regional/remote: 3–7 days |
| 5 mg × 30 tablets | $6.70 concessional; $25–$45 retail | As above |
*Pricing may vary depending on PBS status and pharmacy stock. Check with your local or online Australian pharmacy for the latest price and availability.
FAQ – Frequently Asked Questions
- 1. Should I avoid any foods while taking Eldepryl?
At typical doses for Parkinson’s, dietary restrictions are not necessary for most Australians. Very high intakes of strongly aged cheeses, cured meats, yeast extracts, or fermented soy products should be avoided, especially if your doctor increases your dose or adds other medicines. If in doubt, check with your pharmacist. - 2. Is it safe to drink alcohol with this medication?
Moderate alcohol is generally considered safe, but high amounts may increase drowsiness, lower blood pressure or cause interactions. Always drink responsibly and consult your prescriber about your specific case. - 3. What should I do if I forget a dose?
If you forget a dose, take it as soon as you remember, unless it’s late in the afternoon or near your next scheduled dose. Never double your dose. If uncertain, skip the missed dose and continue as normal the next day. - 4. Can I drive or work safely while taking Eldepryl?
Most people do not have problems with driving or operation of machinery. However, if you feel drowsy, dizzy, or confused after taking your dose, wait until you feel well again before driving or working. - 5. How long will I need to take Eldepryl?
Parkinson’s is a long-term condition. Most people stay on Eldepryl (or alternatives) for many years, unless side effects develop or better options become available. Your doctor will regularly review your therapy.
