On the 21st of December I received a letter (dated November
14) from Somerset Pharmaceuticals (distributors of Eldepryl.)
The letter was written to inform physicians "that the labeling
for Eldepryl has been changed to warn prescribers of the
potential for serious CNS (central nervous system) toxicities
associated with the combined use of Eldepryl andtricyclic
antidepressants (TCAs) and Eldepryl and serotonin re-uptake
inhibitors (SSRIs). The combined use of TCAs and Eldepryl has
been associated with hyperpyrexia (elevated body temperatures),
tremors, agitation, restlessness, reduced levels of
consciousness, and in rare instances, fatalities. The combined
use of SSRIs and Eldepryl has been associated with reports of
muscular rigidity, autonomic instability, and severe agitation,
in some instances progressing to delirium."
The letter states that although these reports do not prove
this interaction, similar cases have been reported with non-
selective monoamine oxidase inhibitors (MAOIs, like Parnate and
Nardil); "therefore, it is prudent to behave as if a causal
relationship exists."
What does this mean? When you look at the evidence they
have accumulated, 16 reports involving patients taking Eldepryl
and tricyclic antidepressants and 15 reports about the
combination of Eldepryl and selective serotonin reuptake
inhibitors were received. Added now to the WARNINGS: section is
the sentence "Selegiline (Eldepryl) should not be used at daily
doses exceeding those recommended (10mg/day) because of the risks
associated with non-selective inhibition of MAO.
As summarized earlier, one death was in a patient receiving
non-selective MAOInhibitor and a tricyclic antidepressant. One
death was reported on the combination of protriptyline and
Eldepryl. Fatal reactions have been reported with the
combinationof Prozac and non-selective MAOIs. Similar, but as
yet non-fatal reactions have been reported with 10mg/day Eldepryl
and SSRIs Prozac, Zoloft, and Paxil.
Should you consider discontinuing medications if you are now
taking one of these combinations? By all means, discuss this
latest warning with your prescribing physician. Your doctor can
speak directly with Somerset's Professional Service Department at
1-800-892-8889.
I am posting this because no one else has. If you wish to
discuss it with me, I would be glad to do so. Ellis "Don" Penny,
M.D., [log in to unmask], [log in to unmask]
12508 W. 56th Place, Arvada, Colorado 80002-1324.
