thoughtscape NP Psychiatry · Patient education
Selegiline
Emsam / once-daily skin patch
An MAOI antidepressant delivered through the skin. Food rules depend on strength; medicine precautions always apply.
Draft for review · Clinical content has not been revalidated for this website.
For adult depression • Oral Parkinson disease products are not interchangeable with this patch
What it is used for
Emsam treats major depression in adults, including people who have not done well with other options. Response varies.
Oral selegiline has different dosing and a separate Parkinson disease indication. Do not substitute tablets or capsules for patches.
How it works
Blocks MAO enzymes that break down mood-related messengers. Antidepressant patch exposure affects both MAO-A and MAO-B.
Skin delivery reduces first-pass exposure in the gut and liver. The 6 mg patch needs no tyramine diet, but dangerous drug risks remain.
What to expect over time
EARLY DAYS
Skin irritation, headache, insomnia, or standing dizziness can occur. Medicine precautions begin before the first patch.
OVER SEVERAL WEEKS
Mood benefit builds gradually. Dose increases, if needed, are no more often than every two weeks; higher is not always better.
KEEPING BENEFIT
Many people remain at 6 mg. Check benefit, blood pressure, skin, and sleep regularly; do not change treatment on your own.
Taking your medication
Remove the old patch before applying one new patch each day. Wear for 24 hours; do not routinely remove it at bedtime for insomnia.
Use clean, dry, intact skin on the upper torso, outer upper arm, or upper thigh. Rotate sites; avoid lotions or oils under the patch.
Do not cut patches. Press firmly in place, then wash hands. Avoid heating pads, saunas, hot tubs, and prolonged direct sun over the patch.
When to get help
Sudden severe headache, stiff neck, chest pain, or pounding heartbeat: remove the patch and get emergency care; do not wait for home BP.
Confusion/agitation with fever, sweating, muscle jerks, or stiffness may be serotonin syndrome: remove the patch and get emergency care.
Report suicidal thoughts, worsening mood, or unusually high energy promptly. Emergency care for fainting, seizures, or immediate self-harm risk.
Early side effects
Skin redness/itching, headache, insomnia, diarrhea, dry mouth, or nausea can occur. Report irritation that persists or spreads.
Other effects to discuss
Standing dizziness, sleep trouble, weight, or sexual changes deserve review. Lower average trial rates do not mean effects cannot happen.
What to keep track of
Check blood pressure and pulse, standing symptoms, mood, sleep, and patch sites. Review every new medicine and each dose-related diet change. Routine drug-level tests are not used, but other tests may be needed for your medical risks. Follow-ups matter even when the patch feels easy to use.
Before you start
Discuss bipolar symptoms, seizures, self-harm risk, blood pressure, heart disease, skin reactions, pregnancy and nursing. Not for pheochromocytoma or under age 12; not recommended at 12-17. Confirm all medicine washouts first. Tell clinicians and dentists you use an MAOI; carry an alert.
Medicines & interactions
Prohibited combinations
Do not combine with SSRIs/SNRIs, imipramine, clomipramine, other MAOIs, carbamazepine, dextromethorphan, meperidine, tramadol, or methadone. Check the full lists.
Switching medicines
After Emsam, allow at least 14 days before prohibited medicines. Before Emsam, the gap depends on the prior drug: fluoxetine at least 5 weeks; vortioxetine 21 days.
Cold, pain, and other products
Check decongestants, stimulants, buspirone, triptans, supplements, linezolid, and IV methylene blue. Do not assume specialist combination reports make use safe.
Diet: 9 or 12 mg patches
Avoid aged/fermented meats, pickled herring, spoiled protein foods, fava pods, aged cheese, tap/unpasteurized beer, yeast extracts, sauerkraut, most soy products, and tyramine supplements.
Food choices / alcohol
Fresh, well-stored meat or fish, fresh cheeses, grains, and most vegetables are usually suitable. Ask if unsure. Avoid alcohol at every dose.
Everyday tips
At 9 or 12 mg, start the tyramine diet on day one. Continue for 14 days after stopping or reducing to 6 mg. Obtain the complete label food guide.
At 6 mg from the start, no tyramine diet is required. This does not make interacting medicines safe or remove every blood-pressure risk.
Rise slowly and avoid driving until your response is known. For sleep trouble, discuss a plan; do not shorten wear time or cut a patch.
Involve someone you trust in watching mood changes. Risk needs monitoring at every age, particularly early and after dose changes; under-25 risk is increased.
Your questions, answered
Patch forgotten or fallen off?
Remove any old patch, apply a new one at a new site and return to your usual change schedule. Never wear extra patches to catch up.
Can I stop or taper?
Agree on a plan using available strengths, never cut patches. Medication precautions last at least 14 days after stopping; higher-dose food rules also persist.
How do I dispose of patches?
Fold sticky sides together and promptly place in a lidded container out of reach of children and pets. Used patches still contain medicine. Wash your hands.
Pregnancy or breastfeeding?
Discuss pregnancy risks and alternatives promptly. Do not breastfeed during Emsam treatment or for 5 days after the final dose; arrange another feeding plan.
Storage & safety
Keep unopened patches in sealed pouches at room temperature, away from children and pets. Suspected overdose: remove patches and seek immediate emergency/poison-center advice, even if feeling well; symptoms can be delayed. U.S. Poison Help: 1-800-222-1222. Call 911 for collapse, seizure, breathing difficulty, or immediate danger.
About this information
For general information only; not a substitute for individualized medical advice. This sheet does not cover every risk or interaction. Ask your prescriber or pharmacist before changing how you take this medication.
Sources
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.