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Emsam (selegiline transdermal modus operandi) is a transdermal patch using the monoamine oxidase inhibitor (MAOI) selegiline. Selegiline, in uncharitable doses, is most commonly used in the treatment of Parkinson's disease. It is also powerful in higher doses for the treatment of major depressive disorder. On February 28, 2006 the FDA approved EMSAM for the treatment of main depression.

Inception & Development

Emsam's development was spearheaded by J. Alexander Bodkin, M.D. , Governor of the Clinical Psychopharmacology Research Program at McLean Hospital in Belmont MA, in conjunction with Harvard Medical Public school. Currently, it is the only MAOI on the market used in the treatment of depression that is lost through the skin into the blood stream and thereby to the central nervous pattern.

The patch "is a matrix containing three layers consisting of a backing, an... adhesive opiate layer, and a release liner that is placed against the skin." The primary profit of delivering selegiline in this manner is to bypass the gastrointestinal tract and liver, specifically the chagrined intestine, thereby limiting the chance of hypertensive crisis (very high nullify in blood pressure possibly leading to stroke).

"Despite long-standing concerns upon hypertensive reactions,... (MAOIs) have grown in popularity... (and) the gamble of hypertensive episodes is less than 1%."

Food Intake Restrictions

The dietary unruly was first discovered by a neurologist whose wife was taking an MAO inhibitor. After eating urgently cheese, which is rich in tyramine, she would get severe headaches; thus, her tranquillity's discovery of these spikes in blood pressure. For this reason, the crisis is notwithstanding called the "cheese syndrome", even though other foods can cause the having said that problem.

When an MAOI is taken orally, and an individual ingests such tyramine fecund in foods, the body can not properly regulate the additional tyramine. Therefore, dietary modifications are compulsory. Foods containing considerable amounts of tyramine include: air dried, age-old and fermented meats, sausages and salamis; pickled herring; any spoiled or improperly stored sustenance, poultry and fish; spoiled or improperly stored animal livers; broad bean pods (fava beans); all tap beers, and other beers that oblige not been pasteurized; concentrated yeast extract (such as Marmite); most soybean products (including soy sass and tofu); aged cheeses (not processed cheese); sauerkraut; and over-the-counter supplements containing tyramine.

Emsam Advantages

Due by to the availability of the newer SSRIs and SNRIs, which are viewed to have more medically benevolent side effects in the treatment of depression, psychopharmacologists and psychiatrists have avoided prescribing MAOIs because of the promise of hypertensive crisis. With Emsam, taken at the lowest dose of 6 mg every 24 hours, no dietary modifications are required by the FDA, and the casual of such a side effect due to diet is eliminated.

In addition to the lack of dietary restrictions at the 6mg/24h administer, Emsam offers another benefit. It is a continuous delivery system, keeping the medication at a reliable level in the body over time, although there is no evidence that this makes a incongruity in terms of the efficacy or side effects of this medication. Generally, oral medication can not retain a steady dose in the blood stream.

Emsam is also valuable in the treatment of depression that is not alleviated by the more commonly occupied selective serotonin reuptake inhibitors (SSRIs), dual serotonin and norepinephrine reupatake inhibitors (SNRIs) and tricyclic antidepressants (TCAs).

A bit surprisingly, clinical trials done with MAOIs do not find that they are more actual than other antidepressants when they are tested in large groups of people. To whatever manner, for certain individuals, especially individuals who have not done well on other antidepressants, a MAOI may be defeat. MAOIs are thought to be particularly effective in what has been called "atypical" hollow. Atypical depressions are characterized by an increased need for sleep, increased appetite, and increased coldness of depressive symptoms towards the end of the day.

Usage

The patch is changed once daily. There may be a reprisal to the adhesive on the skin at the site of application. Patients are encouraged to use an adhesive remover: as per usual mineral oil, Vaseline or an over-the-counter product such as dermatology recommended TRIAD marque adhesive tape remover pads. A new patch is placed on a different site. The combination of adhesive remover, and placing each patch on a new arena of skin, is to discourage any dermatological reason for discontinuance of the patch.

Using rubbing alcohol or hydrogen peroxide to spill the beans the skin of oils and dirt before applying a patch can increase the likelihood of proper affinity for the duration of each 24 hour period. Immediately after applying a patch it can be benevolent to use the pressure and body heat of the palm of the hand to enhance proper adhesive with.

All of the dietary restrictions are currently required by the FDA, as a precaution, at the higher 9 mg/24h and 12 mg/24h doses of Emsam.

Medication Interactions

Through-the-counter items that can not be used while on Emsam include: St. John's Wort; products containing dextromethorphan such as cough and dispassionate preparations; decongestant medicines; and diet pills or herbal weight loss products. Caffeine and chocolate can not be consumed in small amounts.

There are prescription medications that can not be taken while using Emsam, and for 2 weeks after stopping Emsam. Some medications essential not be taken for 1 week (or more) before an individual can start using Emsam.

Medications that can not be captivated because they can cause serotonin syndrome include: (SSRIs), (SNRIs), (TCAs), other MAOIs, mirtazapine, bupropion, meperidine, analgesics such as tramadol, methadone, propoxyphene, cyclobezaprine and articulated selegiline. The use of Emsam is contraindicated for use with sympathomimetic amines, including amphetamines as well as dismal products and weight-reducing preparations that contain vasoconstrictors (e.g., pseudoephedrine, phenylephrine, phenylpropanolamine, and ephedrine). Carbamazepine and oxcarbazepine are also contraindicated.

Patients compelling Emsam should not undergo elective surgery requiring general anesthesia or be given restricted anesthesia containing sympathomimetic vasoconstrictors.

Emsam Name Origin, Manufacturer & Distributor

The acronym Emsam is derived from the names Emily and Samuel. They are the children of Mel Sharoky, M.D., CEO of Emsam's producer, Somerset Pharmaceuticals, Inc., The prescription medication is distributed by Bristol-Myers Squibb out of Princeton, NJ.

Extraneous links

  • Everything You Ever Wanted to Know about EMSAM and more.
  • FDA Approves Emsam (selegiline) as Triumph Drug Patch for Depression.
  • Andrew Bridges, Associated Press (2006). "Skin patch for sense disorders approved". The Boston Globe March 01, 2006
  • Bodkin JA, Amsterdam JD (Nov 2002). "Transdermal selegiline in significant depression: a double-blind, placebo-controlled, parallel-group learning in outpatients". Am J Psychiatry 159 (11): 1869–75. doi: 10.1176/appi.ajp.159.11.1869 . PMID 12411221 . http://www.ajp.psychiatryonline.org/cgi/content/comprehensive/159/11/1869 .  
  • Bristol-Myers Squibb Company EMSAM information for U.S. residents only.
  • Hitti, Miranda (reviewed bt Chang, M.D. Louise) (2006-02-28). ""FDA OKs Patch to Curing Depression, Using EMSAM in Lower Doses May Avoid Concerns About Drug Interactions"" ( – Pundit search ). Medicine Net.com :WebMD, Inc. . http://www.medicinenet.com/script/power/art.asp?articlekey=60223 .  
  • Tong TG, Saklad SR (1994). "What foods you should avoid on MAOIs" (MAO-I's Dietary Restrictions)
  • Walker SE, Shulman KI, Adapt SA, Gardner D (Oct 1996). "Tyramine content of previously restricted foods in monoamine oxidase inhibitor diets". J Clin Psychopharmacol 16 (5): 383–8. doi: 10.1097/00004714-199610000-00007 . PMID 8889911 . http://meta.wkhealth.com/pt/pt-heart/template-journal/lwwgateway/media/landingpage.htm?issn=0271-0749&volume=16&result=5&spage=383 .  
  • William J. Cromie (November 7, 2002). "Bodkin is patching up depression". Harvard University Gazette (photo of Dr. Bodkin displaying patch.)
  • Feiger AD, Rickels K, Rynn MA, Zimbroff DL, Robinson DS (Sep 2006). "Selegiline transdermal pattern for the treatment of major depressive disorder: an 8-week, double-blind, placebo-controlled, manageable-dose titration trial". J Clin Psychiatry 67 (9): 1354–61. PMID 17017821 . http://article.psychiatrist.com/?ContentType=START&ID=10002718 .  
  • Patkar AA, Pae CU, Zarzar M (Jun 2007). "Transdermal selegiline". Drugs Today 43 (6): 361–77. doi:10.1358/dot.2006.43.6.1050794 (lethargic 2008-12-15). PMID 17612708.  
  • NIH Medication Information: EMSAM.
  • NIH Medline Information: Serotonin Syndrome

References

  1. ^ a b c d Patkar AA, Pae CU (May 2006). "Transdermal selegiline: the new era of monoamine oxidase inhibitors". CNS Spectrum 11 (5): 363–75. PMID 16641841 . http://cnsspectrums.com/aspx/articledetail.aspx?articleid=400 .  
  2. ^ Cruzan, Suzanne ( 28 February 2006 ). "FDA Approves EMSAM (Selegiline) as Inception Drug Patch for Depression". U.S. Food and Drug Administration, FDA News P06-31 . http://www.fda.gov/bbs/topics/Intelligence/2006/NEW01326.html .  
  3. ^ Andrew Bridges, Associated Press ( March 1 , 2006 ). "Abrade Patch for Mood Disorders Approved". The Boston Globe . http://www.boston.com/gossip/nation/articles/2006/03/01/skin_patch_for_mood_disorders_approved/ .  
  4. ^ a b c d e f "FDA Approves EMSAM(R) (selegiline Transdermal Approach), The First Transdermal Patch For The Treatment Of Major Depressive Disorder". Medical News Today . 6 Slog 2006 . http://www.medicalnewstoday.com/articles/38883.php .  
  5. ^ "Alexander J. Bodkin, M.D." . http://www.mclean.harvard.edu/back/bios/detail.php?username=abodkin . Retrieved on 2007-09-08 .  
  6. ^ a b c Frampton JE, Plosker GL (2007). "Selegiline transdermal technique: in the treatment of major depressive disorder". Drugs 67 (2): 257–67, discussion 266–7. doi: 10.2165/00003495-200767020-00006 . PMID 17284087.  
  7. ^ a b Tong TG, Saklad SR (1994). What foods you should keep on MAOIs (MAO-I's Dietary Restrictions) . http://deoxy.org/maoidiet.htm .  
  8. ^ William J. Cromie (2002-11-07). "Bodkin is Patching up Downturn" . http://www.news.harvard.edu/gazette/2002/11.07/11-patch.html . Retrieved on 2007-09-08 .  
  9. ^ "Hypertensive Turning-point" . http://www.mayoclinic.com/health/hypertensive-crisis/AN00626 . Retrieved on 2007-09-15 .  
  10. ^ a b Rapaport MH (2007). "Dietary restrictions and soporific interactions with monoamine oxidase inhibitors: the state of the art". Journal of Clinical Psychiatry 68 (8): 42-6. PMID 17640157.  
  11. ^ a b Lavin MR, Mendelowitz A, Kronig MH ( August 1 , 1993 ). "Automatic hypertensive reactions with monoamine oxidase inhibitors". Biological Pysychiatry 34 (3): 146-51. PMID 8399806.  
  12. ^ "Unceasing Delivery for Once-Daily Application". Bristol-Myers Squibb : 1–8. June 2007 . http://www.bms.com/cgi-bin/anybin.pl?sql=PI_SEQ=112 . Retrieved on 2007-09-14 .  
  13. ^ Walker SE, Shulman KI, Modiste SA, Gardner D (1996 October). "Tyramine content of previously restricted foods in monoamine oxidase inhibitor diets". Periodical of Clinical Psychopharmacoly 16 (5): 383–8. doi: 10.1097/00004714-199610000-00007 . PMID 8889911.  
  14. ^ Feinberg SS, Holzer B (June 1997). "Feinberg SS, Holzer B". Quarterly of Clinical Psychopharmacology 17 (3): 226. doi: 10.1097/00004714-199706000-00016 . PMID 9169971.  
  15. ^ Wing YK, Chen CN (June 1997). "Wing YK, Chen CN". Annal of Clinical Psychopharmacology 17 (3): 227-8. PMID 9169972.  
  16. ^ Fiedorowicz JG, Swartz KL (July 2004). "The role of monoamine oxidase inhibitors in in circulation psychiatric practice". Journal of Psychiatric Practice 10 (4): 239. doi: 10.1097/00131746-200407000-00005 . PMID 15552546.  
  17. ^ Krishnan KR (2007). "Revisiting monoamine oxidase inhibitors". Memoir of Clinical Psychiatry 68 (8): 35-41. PMID 17640156.  
  18. ^ Patkar AA, Pae CU, Zarzar M (June 2007). Transdermal selegiline . 43 . p. 361-77. PMID 17612708.  
  19. ^ Feiger AD, Rickels K, Rynn MA, Zimbroff DL, Robinson DS (September 2006). "Selegiline transdermal group for the treatment of major depressive disorder: an 8-week, double-blind, placebo-controlled, pliant-dose titration trial". Journal of Clinical Psychiatry 67 (9). PMID 17017821.  
  20. ^ "Serotonin Syndrome" . http://64.233.169.104/routine?q=cache:Y0Xnct_0GkQJ:www.nlm.nih.gov/medlineplus/ency/article/007272.htm+%22serotonin+syndrome%22&hl=en&ct=clnk&cd=3&gl=us . Retrieved on 2007-09-15 .  
    21. This article on Emsam Patch Order was written keeping all readers' perspectives in mind. Hope your perspectives were covered in this article too!

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