What are the precautions for taking Selegiline Hydrochloride Tablets?

Even at the recommended daily dose of 10 mg per day the selectivity of Selegiline hydrochloride tablets (Selegiline) for MAO B may not be absolute. Rare cases of hypertensive reactions related to the ingestion of tyramine-containing foods have been reported in patients taking the recommended daily doses of selegiline hydrochloride tablets. Selectivity further decreases with increasing daily dose. The exact dose at which selegiline hydrochloride becomes a non-selective inhibitor of all MAOs is unknown but may be in the range of 30 to 40 mg per day.

Concomitant administration of tricyclic antidepressants and nonselectiveMAOIs has been reported to cause severe central nervous system toxicity, associated with hyperthermia and death. A similar reaction to amitriptyline and selegiline hydrochloride tablets was reported in one patient. Another patient who was treated with protriptyline and selegiline hydrochloride tablets developed tremors, agitation, and restlessness two weeks after taking selegiline, followed by unresponsiveness and death. Related adverse events, including hypertension, syncope, asystole, diaphoresis, seizures, changes in behavior and mental status, and muscle rigidity, have also been reported in some patients receiving selegiline hydrochloride tablets and various tricyclic antidepressants.

Severe and sometimes fatal reactions have been reported in patients receiving selegiline hydrochloride tablets in combination with non-selective MAOIs. Signs and symptoms may include hyperthermia, stiffness, myoclonus, autonomic instability and rapid fluctuations in vital signs, as well as mental status changes, including extreme agitation progressing to delirium and coma. Similar symptoms have been reported in some patients taking selegiline hydrochloride tablets (10 mg daily) and selective serotonin reuptake inhibitors (including fluoxetine, sertraline, and paroxetine).