Selegiline

Indications
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By K K Jain MD

Selegiline hydrochloride is indicated as an adjunct in the management of parkinsonian patients being treated with levodopa and carbidopa who exhibit deterioration in the quality of their response to this therapy.

Off-label and investigational uses:

  • A meta-analysis of published trials of selegiline in the treatment of Alzheimer disease showed some evidence of short-term improvement in cognition and activities of daily living, but the results were not clinically significant (Wilcock et al 2002).
  • Low-dose oral selegiline has been used for treating negative symptoms of schizophrenia, but this is not recommended in view of the limitations of current studies (Fohey et al 2007).
  • A randomized, double-blind, placebo-controlled clinical trial of the transdermal administration of selegiline in HIV patients has shown that long-term treatment is well tolerated and improves cognitive impairment (may be delayed, suggesting that trials longer than 6 months may be necessary to assess neuroprotective efficacy) (Evans et al 2007).
  • Selegiline can be used for management of haloperidol-induced parkinsonism in schizophrenic patients.
  • Juvenile neuronal ceroid lipofuscinosis.
  • Results of a double-blind, placebo-controlled, randomized clinical trial with nicotine-dependent cigarette smokers suggest that selegiline was safe and well-tolerated but did not improve smoking abstinence rates compared to placebo (Weinberger et al 2010).
  • Attention deficit hyperactivity disorder.
  • A double-blind, placebo-controlled trial of the selegiline transdermal system did not find it to be effective for the treatment of cocaine dependence (Elkashef et al 2006).
  • Selegiline transdermal system therapy in the treatment of major depressive disorder (not an approved indication) was generally well tolerated in placebo-controlled studies with some reports of application site reactions (Frampton and Plosker 2007). This route of administration is being explored to avoid high oral doses of selegiline required for treatment of depression, which cause suppression of the enzyme monoamine oxidase-A and requires tyramine dietary restrictions. A meta-analysis shows that short-term therapy with transdermal selegiline does not impair sexual function in patients with major depressive disorder (Clayton et al 2007).
  • Selegiline has been used for slowing the age-induced decline of brain function (Miklya 2009).
  • Apathy following head injury (Moutaouakil et al 2009).