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selegiline transdermal system

Adjunctive therapy

Brands: EMSAM

Last reviewed 2025-10-05

Reviewed by PsychMed Editorial Team.

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Quick answers

  • What is selegiline transdermal system?

    Selegiline transdermal system (EMSAM) delivers once-daily monoamine oxidase inhibition for adults with major depressive disorder, bypassing gastrointestinal metabolism to sustain MAO-B selectivity at 6 mg/24 h while minimizing tyramine sensitivity.

  • What is EMSAM?

    EMSAM is a brand name for selegiline transdermal system.

  • What is EMSAM (selegiline transdermal system) used for?

    Label indications include: Major depressive disorder in adults.

  • What drug class is EMSAM (selegiline transdermal system)?

    Selective MAO-B inhibitor at 6 mg/24 h; loses selectivity at higher doses providing MAO-A inhibition.

  • What strengths does EMSAM (selegiline transdermal system) come in?

    Transdermal patches: 6 mg/24 h, 9 mg/24 h, 12 mg/24 h.

Snapshot

  • Class: Adjunctive therapy
  • Common US brands: EMSAM
  • Therapeutic drug monitoring not routinely recommended.
  • Last reviewed: 2025-10-05

Label indications

Major depressive disorder in adults.

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Clinical Highlights

Selegiline transdermal system (EMSAM) delivers once-daily monoamine oxidase inhibition for adults with major depressive disorder, bypassing gastrointestinal metabolism to sustain MAO-B selectivity at 6 mg/24 h while minimizing tyramine sensitivity. Higher doses (9 mg/24 h and 12 mg/24 h) expand to MAO-A inhibition, extending antidepressant efficacy but reintroducing dietary restrictions and hypertensive crisis risk.

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  • Transdermal delivery avoids the emetic and gastrointestinal intolerance seen with oral selegiline and is considered when patients have failed or cannot tolerate multiple oral antidepressants.
  • Used as a niche option for treatment-resistant depression where adherence to dietary restrictions and drug interaction management is feasible; higher cost and patch-specific counseling limit uptake.
  • The compare view can provide a quick look at dietary requirements and activation risk versus oral MAOIs, and the selegiline transdermal evidence feed can support dose escalation decisions.
  • Major depressive disorder (adults) (FDA 2006)
  • Generic: Brand only (EMSAM) in the United States.

Dosing & Formulations

Transdermal patches: 6 mg/24 h, 9 mg/24 h, 12 mg/24 h. Apply one 6 mg/24 h patch to dry, intact skin daily; rotate sites on the upper torso, upper thigh, or upper arm and avoid reuse within 14 days.

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  • Evaluate response after 4–6 weeks; if inadequate, titrate to 9 mg/24 h and, if necessary, to 12 mg/24 h. Apply each titration no sooner than every 2 weeks.
  • Tyramine dietary restrictions are not required at 6 mg/24 h, but are mandatory at 9 mg/24 h and 12 mg/24 h.
  • Discontinue serotonergic agents (SSRIs, SNRIs, TCAs, other MAOIs, linezolid, methylene blue, triptans) for the recommended washout period prior to initiation.

Monitoring & Risks

Blood pressure and heart rate at baseline, after dose increases, and periodically (watch for hypertensive crisis). Dermatologic inspection of application sites with each visit.

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  • Mood, suicidality, and emergent mania/hypomania symptoms throughout therapy.
  • Boxed warning: Antidepressants increase the risk of suicidality in children, adolescents, and young adults; monitor closely during initiation and dose changes.
  • Application-site reactions: Erythema, pruritus, or burning occurs in 20–30% of patients; rotate sites and avoid occlusive dressings.
  • Insomnia: Observed in ~12–14%; consider morning application and assess for activating co-medications.

Drug Interactions

Contraindicated with other MAO inhibitors, linezolid, methylene blue, and IV tryptophan. Serotonergic agents (SSRIs, SNRIs, TCAs, triptans, tramadol, dextromethorphan, St. John’s wort) increase serotonin syndrome risk; follow recommended washout periods.

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  • Sympathomimetic amines (pseudoephedrine, phenylephrine) and illicit stimulants may precipitate hypertensive crisis.
  • Meperidine and other opioids with serotonergic properties are contraindicated; alternative analgesics are required.

Practice Notes

Press firmly for 30 seconds to ensure patch adhesion and avoid external heat sources (heating pads, saunas) that can accelerate absorption. Remove the patch prior to MRI or cardioversion due to the embedded metallic backing.

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  • Counsel patients to fold used patches adhesive to adhesive and dispose of in a manner that prevents accidental exposure.
  • Screen for bipolar spectrum symptoms—patch therapy can precipitate mania/hypomania at higher doses; coordinate plans with the bipolar disorder hub.

References

  1. EMSAM (selegiline transdermal system) prescribing information — DailyMed (2024)
  2. Selegiline Transdermal System FOR THE Treatment OF Major Depressive Disorder: AN 8 Week, Double Blind, Placebo Controlled, Flexible Dose Titration Trial — Journal of Clinical Psychiatry (2006)
  3. Consensus recommendations for MAOI safety and dietary management — Journal of Clinical Psychopharmacology (2022)
  4. Monoamine oxidase inhibitors: Seriously underused in the treatment of major depression — Acta Psychiatrica Scandinavica (2024)
  5. APA Clinical Practice Guideline for the Treatment of Depression — American Psychiatric Association (2023)Guidelinedepressionclinical
Selegiline Transdermal System (EMSAM) — Summary — PsychMed