Eldepryl

What Eldepryl is used for

The Eldepryl sold here is selegiline in tablet form, for Parkinson's disease — the condition in which nerve cells in the brain that make dopamine weaken and die, leaving movement stiff, slow and shaky. Selegiline is taken alongside levodopa (usually levodopa with carbidopa), not instead of it. Added to levodopa, it can allow a smaller levodopa dose, can stop each dose wearing off before the next is due, and can stretch out the hours when movement comes more easily. It eases symptoms; it does not cure the condition.

How selegiline works

Dopamine is the messenger the brain uses to set off smooth, deliberate movement. An enzyme called monoamine oxidase type B (MAO-B) clears dopamine away once it has done its work. Selegiline blocks that enzyme, so the dopamine already in the brain lasts longer and goes further. At the strengths sold here it works mainly on MAO-B — that is what "MAO-B inhibitor" means — while much higher daily amounts lose some of that selectivity and begin to affect the enzyme that handles tyramine from food.

When in the day do you take it?

Swallow the tablet whole with water at a regular time each morning; some people take part of the daily amount at breakfast and the rest at lunch. Meals themselves are not a problem at 5mg and 10mg. They become one at higher daily doses, when matured cheese, cured and fermented meats, fermented soy, broad bean pods and some draught beers can raise blood pressure sharply.

Side effects to expect — and the serious ones

Dry mouth, nausea, stomach pain, dizziness and trouble sleeping are the ones people notice most. Added to levodopa, selegiline can also make involuntary movements — twitching, restlessness, a hand that will not keep still — more obvious. Confusion, hallucinations and agitation are less common but more serious. Too much selegiline can cause a sudden, dangerous rise in blood pressure, which often shows up as a severe headache with a racing pulse. Fever with heavy sweating and stiff muscles, coming on after the tablets are stopped abruptly, needs urgent treatment. Keep the pack out of direct sunlight and use the tablets before the date printed on the strip.

What selegiline reacts with

Pethidine (also called meperidine), methadone, tramadol and propoxyphene can combine with selegiline to cause a serious reaction. So can other MAO inhibitors and many antidepressants, including ones stopped within the past two weeks. Dextromethorphan, the cough suppressant in a long list of over-the-counter syrups, is the one that most often catches people out.