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Hi Janet!

My aloha comes from Oregon.  Actually Aloha, Oregon.......seriously!  However, my
aloha(s) are each created with the "Island spirit" only fully appreciated by their
past & present residents.  I spent many years in Hawaii, specifically near Diamond
Head (Hawaii Kai) on Oahu as well as on Kauai for a short time.

Janet, I realize that Canada must be a magical place :-) but the aloha I send to
you is a very special one......for the Islands will be "calling you" for the rest
of your life.

Much aloha!

Jay Henkelman
48/8++Sinemet/Selegiline
[log in to unmask]
  ------------------------------------------------------------------------

Janet313 wrote:

> hi jay
>
> you wrote:
> >:-)  :-)  :-)
> >...
> >Janet........are you awake now?
> >Question!   For quite some time now,  it has been my understanding
> >that Selegiline and Prozac could be a problem when prescribed
> >together.  If you have a comment or two regarding this issue,
> >please share.
> >Aloha!
> >Jay Henkelman
> >48/8++ Sinemet/Selegiline
> >[log in to unmask]
>
> i was awake and then i wasn't...
> but i think i am now!
>
> i've copied three abstracts of medical studies on the issue below
> i think the key here is "could be a problem"
> with a big emphasis on the "could"
>
> in my humble opinion
> somerset pharmaceuticals' legal department
> are simply being hyper-vigilant
> to the extent of causing
> needless worry
>
> this may be a case of a 'syndrome' that exists only on paper
> my history = 7 years of this drug combination, no problems
>
> more info is available for digging
> at our list archive site:
> http://new.parkinsons.org.uk/index.htm
> and at the pubmed site:
> http://www.ncbi.nlm.nih.gov/PubMed/
>
> aloha back!
> as a former islander, may i ask, dare i ask, where you aloha from?
>
> your cyber-sibling in sinemet/selegiline/serotonin swillage
>
> janet
>
> janet paterson
> 51/10 - sinemet/selegiline/prozac
> almonte/ontario/canada - [log in to unmask]
>
> ----------------------------------------------------------------
> TITLE: Retrospective study of selegiline-antidepressant drug interactions and
> a review of the literature.
>
> ABSTRACT: Selegiline [trade name Eldepryl] is a selective monoamine oxidase
> inhibitor used in the treatment of Parkinson's disease.
>
> It is estimated that approximately one-half of Parkinsonian patients will
> develop depression requiring antidepressant drug treatment.
>
> Recently, selegiline's package insert was revised to reflect the potential
> risk of adverse effects when it is used in combination with selective
> serotonin reuptake inhibitors and tricyclic antidepressants.
>
> The objective of our study is to assess the safety of combining selegiline
> with antidepressants.
>
> A retrospective chart review was performed on all 28 patients with Parkinson's
> disease receiving selegiline and antidepressants concurrently to identify
> possible drug interactions.
>
> Compliance was assessed according to prescription refill records.
>
> Suspected adverse reactions with combination therapy were documented.
>
> There was a total of 40 selegiline-antidepressant drug combinations involving
> tricyclic antidepressants (n = 25), selective serotonin reuptake inhibitors (n
> = 7), trazodone (n = 5), and bupropion (n = 3).
>
> One patient receiving fluoxetine [trade name Prozac] developed a reaction
> consistent with the serotonin syndrome; however, it was never documented as
> such.
>
> No other selegiline drug interactions were found.
>
> Adverse effects noted were typical of antidepressant monotherapy.
>
> Although no selegiline drug interactions were documented in our study, the
> concurrent administration of selegiline and selective serotonin reuptake
> inhibitors should be avoided because of literature-reported interactions.
>
> We believe that bupropion, tricyclic antidepressants, and trazodone are
> reasonable choices in combination with selegiline, although tricyclic
> antidepressants and trazodone may be reserved as second-line treatments.
>
> Ritter JL, Alexander B
> University of Washington Medical Center, Seattle 98105, USA.
> Ann Clin Psychiatry 1997 Mar;9(1):7-13
> PMID: 9167831, UI: 97310932
>
> ----------------------------------------------------------------
> TITLE: 'Serotonin syndrome' and the combined use of
> selegiline/deprenyl/eldepryl and an anti-depressant in Parkinson's disease.
> Parkinson Study Group.
>
> ABSTRACT: The manufacturer of deprenyl/selegeline/Eldepryl (Somerset
> Pharmaceuticals, Tampa, FL) recently advised physicians to avoid prescribing
> the drug in combination with an antidepressant because of potentially serious
> CNS toxicity that may represent the 'serotonin syndrome'.
>
> Manifestations of the 'serotonin syndrome' vary but may include changes in
> mental status and motor and autonomic function.
>
> To better estimate the frequency of the 'serotonin syndrome' in patients with
> Parkinson's disease (PD) treated with deprenyl and an antidepressant, we
> surveyed all investigators in the Parkinson Study Group.
>
> Based on estimates provided by the 47 investigators (75%) who responded, 4,568
> patients were treated with the combination of deprenyl and an antidepressant
> medication.
>
> Eleven patients (0.24%) were reported to have experienced symptoms possibly
> consistent with the 'serotonin syndrome'.
>
> Only two patients (0.04%) experienced symptoms considered to be serious.
>
> No deaths were reported.
>
> We also reviewed all published case reports and adverse experiences reported
> to the U.S. Food and Drug Administration and the manufacturer of Eldepryl.
>
> Available information indicates that serious adverse experiences resulting
> from the combined use of deprenyl and an antidepressant medication in patients
> with PD are quite rare and that the frequency of the true "serotonin syndrome"
> is even rarer.
>
> Richard IH, Kurlan R, Tanner C, Factor S,
> Hubble J, Suchowersky O, Waters C
> University of Rochester Medical Center, NY  14642-8673, USA
> Neurology 1997 Apr;48(4):1070-1077
> PMID: 9109902, MUID: 97264030
>
> ----------------------------------------------------------------
> TITLE: Fluoxetine and selegiline--lack of significant interaction.
>
> ABSTRACT: The use of the combination of fluoxetine [trade name Prozac], an
> anti-depressant serotonin uptake inhibitor, and selegiline [trade name
> Eldepryl] a monoamine oxidase -B inhibitor, was reviewed in a large population
> of patients with Parkinson's disease.
>
> All records were reviewed from a Parkinson's disease clinic to determine how
> many patients were treated simultaneously with selegiline and fluoxetine.
>
> Patient characteristics, duration and dose of treatment, side effects and
> reasons for discontinuation were noted.
>
> Twenty-three patients received both medications at the same time.
>
> No additional side effects were noted with the combination therapy that had
> not already been reported with each medication alone.
>
> No serious side effects were found.
>
> In this clinic population, fluoxetine and selegiline were used in combination
> without major side effects, but further observation is warranted.
>
> Can J Neurol Sci 1994 Aug;21(3):259-261
> Waters CH
> Department of Neurology, University of Southern California, Los Angeles 90033.
> PMID: 8000982, UI: 95094107
> ----------------------------------------------------------------



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Hi Janet!

<P>My aloha comes from Oregon.&nbsp; Actually Aloha, Oregon.......seriously!&nbsp;
However, my aloha(s) are each created with the "Island spirit" only fully
appreciated by their past &amp; present residents.&nbsp; I spent many years
in Hawaii, specifically near Diamond Head (Hawaii Kai) on Oahu as well
as on Kauai for a short time.

<P>Janet, I realize that Canada must be a magical place :-) but the aloha
I send to you is a very special one......for the Islands will be "calling
you" for the rest of your life.

<P>Much aloha!

<P>Jay Henkelman
<BR>48/8++Sinemet/Selegiline
<BR>[log in to unmask]
<BR>
<HR WIDTH="100%">

<P>Janet313 wrote:
<BLOCKQUOTE TYPE=CITE>hi jay

<P>you wrote:
<BR>>:-)&nbsp; :-)&nbsp; :-)
<BR>>...
<BR>>Janet........are you awake now?
<BR>>Question!&nbsp;&nbsp; For quite some time now,&nbsp; it has been my
understanding
<BR>>that Selegiline and Prozac could be a problem when prescribed
<BR>>together.&nbsp; If you have a comment or two regarding this issue,
<BR>>please share.
<BR>>Aloha!
<BR>>Jay Henkelman
<BR>>48/8++ Sinemet/Selegiline
<BR>>[log in to unmask]

<P>i was awake and then i wasn't...
<BR>but i think i am now!

<P>i've copied three abstracts of medical studies on the issue below
<BR>i think the key here is "could be a problem"
<BR>with a big emphasis on the "could"

<P>in my humble opinion
<BR>somerset pharmaceuticals' legal department
<BR>are simply being hyper-vigilant
<BR>to the extent of causing
<BR>needless worry

<P>this may be a case of a 'syndrome' that exists only on paper
<BR>my history = 7 years of this drug combination, no problems

<P>more info is available for digging
<BR>at our list archive site:
<BR><A HREF="http://new.parkinsons.org.uk/index.htm">http://new.parkinsons.org.uk/index.htm</A>
<BR>and at the pubmed site:
<BR><A HREF="http://www.ncbi.nlm.nih.gov/PubMed/">http://www.ncbi.nlm.nih.gov/PubMed/</A>

<P>aloha back!
<BR>as a former islander, may i ask, dare i ask, where you aloha from?

<P>your cyber-sibling in sinemet/selegiline/serotonin swillage

<P>janet

<P>janet paterson
<BR>51/10 - sinemet/selegiline/prozac
<BR>almonte/ontario/canada - [log in to unmask]

<P>----------------------------------------------------------------
<BR>TITLE: Retrospective study of selegiline-antidepressant drug interactions
and
<BR>a review of the literature.

<P>ABSTRACT: Selegiline [trade name Eldepryl] is a selective monoamine
oxidase
<BR>inhibitor used in the treatment of Parkinson's disease.

<P>It is estimated that approximately one-half of Parkinsonian patients
will
<BR>develop depression requiring antidepressant drug treatment.

<P>Recently, selegiline's package insert was revised to reflect the potential
<BR>risk of adverse effects when it is used in combination with selective
<BR>serotonin reuptake inhibitors and tricyclic antidepressants.

<P>The objective of our study is to assess the safety of combining selegiline
<BR>with antidepressants.

<P>A retrospective chart review was performed on all 28 patients with Parkinson's
<BR>disease receiving selegiline and antidepressants concurrently to identify
<BR>possible drug interactions.

<P>Compliance was assessed according to prescription refill records.

<P>Suspected adverse reactions with combination therapy were documented.

<P>There was a total of 40 selegiline-antidepressant drug combinations
involving
<BR>tricyclic antidepressants (n = 25), selective serotonin reuptake inhibitors
(n
<BR>= 7), trazodone (n = 5), and bupropion (n = 3).

<P>One patient receiving fluoxetine [trade name Prozac] developed a reaction
<BR>consistent with the serotonin syndrome; however, it was never documented
as
<BR>such.

<P>No other selegiline drug interactions were found.

<P>Adverse effects noted were typical of antidepressant monotherapy.

<P>Although no selegiline drug interactions were documented in our study,
the
<BR>concurrent administration of selegiline and selective serotonin reuptake
<BR>inhibitors should be avoided because of literature-reported interactions.

<P>We believe that bupropion, tricyclic antidepressants, and trazodone
are
<BR>reasonable choices in combination with selegiline, although tricyclic
<BR>antidepressants and trazodone may be reserved as second-line treatments.

<P>Ritter JL, Alexander B
<BR>University of Washington Medical Center, Seattle 98105, USA.
<BR>Ann Clin Psychiatry 1997 Mar;9(1):7-13
<BR>PMID: 9167831, UI: 97310932

<P>----------------------------------------------------------------
<BR>TITLE: 'Serotonin syndrome' and the combined use of
<BR>selegiline/deprenyl/eldepryl and an anti-depressant in Parkinson's
disease.
<BR>Parkinson Study Group.

<P>ABSTRACT: The manufacturer of deprenyl/selegeline/Eldepryl (Somerset
<BR>Pharmaceuticals, Tampa, FL) recently advised physicians to avoid prescribing
<BR>the drug in combination with an antidepressant because of potentially
serious
<BR>CNS toxicity that may represent the 'serotonin syndrome'.

<P>Manifestations of the 'serotonin syndrome' vary but may include changes
in
<BR>mental status and motor and autonomic function.

<P>To better estimate the frequency of the 'serotonin syndrome' in patients
with
<BR>Parkinson's disease (PD) treated with deprenyl and an antidepressant,
we
<BR>surveyed all investigators in the Parkinson Study Group.

<P>Based on estimates provided by the 47 investigators (75%) who responded,
4,568
<BR>patients were treated with the combination of deprenyl and an antidepressant
<BR>medication.

<P>Eleven patients (0.24%) were reported to have experienced symptoms possibly
<BR>consistent with the 'serotonin syndrome'.

<P>Only two patients (0.04%) experienced symptoms considered to be serious.

<P>No deaths were reported.

<P>We also reviewed all published case reports and adverse experiences
reported
<BR>to the U.S. Food and Drug Administration and the manufacturer of Eldepryl.

<P>Available information indicates that serious adverse experiences resulting
<BR>from the combined use of deprenyl and an antidepressant medication
in patients
<BR>with PD are quite rare and that the frequency of the true "serotonin
syndrome"
<BR>is even rarer.

<P>Richard IH, Kurlan R, Tanner C, Factor S,
<BR>Hubble J, Suchowersky O, Waters C
<BR>University of Rochester Medical Center, NY&nbsp; 14642-8673, USA
<BR>Neurology 1997 Apr;48(4):1070-1077
<BR>PMID: 9109902, MUID: 97264030

<P>----------------------------------------------------------------
<BR>TITLE: Fluoxetine and selegiline--lack of significant interaction.

<P>ABSTRACT: The use of the combination of fluoxetine [trade name Prozac],
an
<BR>anti-depressant serotonin uptake inhibitor, and selegiline [trade name
<BR>Eldepryl] a monoamine oxidase -B inhibitor, was reviewed in a large
population
<BR>of patients with Parkinson's disease.

<P>All records were reviewed from a Parkinson's disease clinic to determine
how
<BR>many patients were treated simultaneously with selegiline and fluoxetine.

<P>Patient characteristics, duration and dose of treatment, side effects
and
<BR>reasons for discontinuation were noted.

<P>Twenty-three patients received both medications at the same time.

<P>No additional side effects were noted with the combination therapy that
had
<BR>not already been reported with each medication alone.

<P>No serious side effects were found.

<P>In this clinic population, fluoxetine and selegiline were used in combination
<BR>without major side effects, but further observation is warranted.

<P>Can J Neurol Sci 1994 Aug;21(3):259-261
<BR>Waters CH
<BR>Department of Neurology, University of Southern California, Los Angeles
90033.
<BR>PMID: 8000982, UI: 95094107
<BR>----------------------------------------------------------------</BLOCKQUOTE>
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