selegiline

Adjunctive therapy • Brands: Eldepryl, Zelapar

Last reviewed: 2025-10-05

General information

Class: Adjunctive therapy
Common US brands: Eldepryl, Zelapar
Typical dose range: Parkinson disease: 5 mg tablet with breakfast and lunch (max 10 mg/day); Zelapar ODT 1.25 mg each morning, titratable to 2.5 mg/day.
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-10-05

Dosing & forms

Forms/strengths: Tablets: 5 mg scored.; Orally disintegrating tablets: 1.25 mg, 2.5 mg.
Frequency: Legacy antidepressant (off-label): begin 5 mg three times daily, titrate cautiously to 10 mg three times daily while enforcing tyramine restriction and monitoring blood pressure.
Typical range: Parkinson disease: 5 mg tablet with breakfast and lunch (max 10 mg/day); Zelapar ODT 1.25 mg each morning, titratable to 2.5 mg/day.

Mechanism (brief)

Selective MAO-B inhibitor at low doses; becomes nonselective at 10 mg/day, increasing serotonin and norepinephrine.

Metabolism & Half‑life

Metabolism: CYP2B6, CYP2C19, CYP3A4
Half‑life: Single-dose mean 10 h

Therapeutic Drug Monitoring (TDM)

Recommended: No

View labelExact

Monitoring highlights

Blood pressure during titration and after medication changes, with a clear plan for hypertensive crisis symptoms and emergency evaluation.
Medication reconciliation to prevent accidental exposure to contraindicated serotonergic agents, sympathomimetics, or opioids.
Sleep and activation (insomnia, jitteriness), especially because amphetamine-like metabolites can be stimulating.
Mood elevation or mixed features in bipolar-spectrum illness; coordinate plans via the bipolar disorder hub when antidepressant-dose MAOI activity is expected.

Sources

Selegiline oral tablets prescribing information — DailyMed (2024)
Clinical management of oral MAOIs — Journal of Clinical Psychopharmacology (2022)
CANMAT recommendations for oral MAOIs — Canadian Journal of Psychiatry (2024)
APA Clinical Practice Guideline for the Treatment of Depression — American Psychiatric Association (2023)
Monoamine oxidase inhibitors: Seriously underused in the treatment of major depression — Acta Psychiatrica Scandinavica (2024)

Dosing & forms

Forms/strengths: Tablets: 5 mg scored.; Orally disintegrating tablets: 1.25 mg, 2.5 mg.

Frequency: Legacy antidepressant (off-label): begin 5 mg three times daily, titrate cautiously to 10 mg three times daily while enforcing tyramine restriction and monitoring blood pressure.

Typical range: Parkinson disease: 5 mg tablet with breakfast and lunch (max 10 mg/day); Zelapar ODT 1.25 mg each morning, titratable to 2.5 mg/day.

Monitoring highlights

Blood pressure during titration and after medication changes, with a clear plan for hypertensive crisis symptoms and emergency evaluation.

Medication reconciliation to prevent accidental exposure to contraindicated serotonergic agents, sympathomimetics, or opioids.

Sleep and activation (insomnia, jitteriness), especially because amphetamine-like metabolites can be stimulating.

Mood elevation or mixed features in bipolar-spectrum illness; coordinate plans via the bipolar disorder hub when antidepressant-dose MAOI activity is expected.