Diana and George,
Thanks for sharing your experiences with me. I have
collected some information on withdrawal patterns for
people on Eldepryl and find reactions as varied as
peoples response to anything else these days.
This is some of what I've found in the list archives and
on the internet :
http://www.medsafe.govt.nz/Profs/PUarticles/selegiline.htm
"Selegiline may smooth muscle fluctuations.
..... The inhibition of levodopa metabolism by
selegiline can effectively smooth out
predictable motor fluctuations in some patients. "
"For patients who are already taking selegiline, I personally
do not routinely stop the medication. Some patients
experience a feeling of wellbeing on selegiline, and they
may experience withdrawal symptoms on stopping the
drug. Many patients taking selegiline are troubled by insomnia;
in these patients, I stop selegiline therapy."
============
Slow recovery of human brain MAO B after L-deprenyl (Selegeline) withdrawal.
Synapse 1994 Oct;18(2):86-93
L-Deprenyl (Selegeline) is an enzyme-activated irreversible inhibitor of monoamine
oxidase B . It is used to treat Parkinson's disease at a dose of
5 mg twice a day. Since enzyme inhibition is irreversible, the recovery of
functional enzyme activity after withdrawal from L-deprenyl requires the synthesis
of new enzyme. We have measured a 40 day half-time for brain
MAO B synthesis in Parkinson's disease and in normal subjects after withdrawal from
L-deprenyl. This is the first measurement of the synthesis
rate of a specific protein in the living human brain. "
==========================================
http://www.parkinsons-information-exchange-network-online.com/drugdb/120.html
"...selegiline caused slight improvement in motor performance
at the start of therapy and * worsening at its discontinuance; "
" Selegiline doses of 10 mg/day block essentially all the MAO-B
in the adult brain. Selegiline's duration of action depends on the
time required to regenerate MAO type B. At higher selegiline doses
(e.g., 20-40 mg/day), brain MAO is blocked nonselectively, predisposing patients to
the risks of traditional MAOIs that block MOA type A (e.g., hypertension). Like
phenelzine, the effects of selegiline are cumulative,
with beneficial effects seen in a few days to several months. "
"Pharmacokinetics: Selegiline is administered orally and is readily
absorbed from the GI tract and crosses the blood/brain barrier. Peak
serum concentrations are found in 0.5-2 hours. The drug is rapidly and completely
metabolized to three active derivatives with the following
half-lives:
N-desmethyldeprenyl, 2 hours;
1-amphetamine, 17.7 hours; and
1-methamphetamine, 20.5 hours.
Selegiline is eliminated slowly by the kidneys; about 45% of a single
10 mg dose is eliminated in the urine as the three active metabolites
in 48 hours."
======================================================
"What do I need to watch for while I take selegiline?
"Visit your doctor for regular checks on your progress.
It can take up to 4 weeks to see the full effects of selegiline.
* Do not suddenly stop taking your medicine; this may make your
condition worse or give you withdrawal symptoms.*
Ask your doctor for advice about gradually reducing your dosage.
Even after you stop taking selegiline the effects can last for at least
two weeks. "
======================================================
http://www.parkinsons-information-exchange-network-online.com/archive/105.html
"Eldepryl (selegiline) is a monoamine oxidase type B inhibitor..."
Monoamine oxidase is an enzyme used by the brain to metabolize,
or break down, dopamine.
* Eldepryl often prolongs the effects of levodopa
therapy by prolonging dopamine action in the brain. *
[My conclusion is that when you stop taking Eldepryl, you probably
will need more Sinemet to achieve the same level of symtomatic
control if you have been on it for a long time.]
===============
Brian Collins, a list member had posted:
"The neuros are now grappling with the question of whether Selegeline
should be discontinued. * Some of the long-term takers have reported quite
severe withdrawal symptoms and are continuing to take it because of that."
===============
Gradual withdrawal [of most drugs] is recommended to prevent acute return
of parkinsonian symptoms.
Any other information and personal experiences will be appreciated.
Gail Vass, R.N.
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