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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Cseagraves on March 14, 2009, at 20:14:37
Hi to all!
I'm not sure, but did someone here tell me that I could get Emsam in pill or liquid form? Pharmacist told me that it would cost me about 560.00 per month for the patches. Can't afford that one.
Thanks for any info.
Courtney
Posted by desolationrower on March 14, 2009, at 20:49:22
In reply to ENSAM-who told me I could get this in liquid or pi, posted by Cseagraves on March 14, 2009, at 20:14:37
its used in pill form for parkinson's. l-deprenyl aka selegiline. much cheaper, although i bought from overseas to save even more.
-d/r
Posted by myco on March 14, 2009, at 22:48:47
In reply to ENSAM-who told me I could get this in liquid or pi, posted by Cseagraves on March 14, 2009, at 20:14:37
I did. Comes in pill form, liquid form and believe it or not candy-like form (i'll look up the name for you). Patch is extremely expensive at the moment. Liquid seems the most potent from what ive heard
myco
> Hi to all!
>
> I'm not sure, but did someone here tell me that I could get Emsam in pill or liquid form? Pharmacist told me that it would cost me about 560.00 per month for the patches. Can't afford that one.
>
> Thanks for any info.
>
> Courtney
Posted by myco on March 14, 2009, at 22:57:08
In reply to Re: ENSAM-who told me I could get this in liquid or pi » Cseagraves, posted by myco on March 14, 2009, at 22:48:47
"Zelapar" - quick dissolving lozenge. bypasses first pass mechanism. lower dosage required than oral forms and not as many GI problems compared to oral form.
> I did. Comes in pill form, liquid form and believe it or not candy-like form (i'll look up the name for you). Patch is extremely expensive at the moment. Liquid seems the most potent from what ive heard
>
> myco
>
> > Hi to all!
> >
> > I'm not sure, but did someone here tell me that I could get Emsam in pill or liquid form? Pharmacist told me that it would cost me about 560.00 per month for the patches. Can't afford that one.
> >
> > Thanks for any info.
> >
> > Courtney
>
>
Posted by Phillipa on March 15, 2009, at 0:36:14
In reply to Re: ENSAM-who told me I could get this in liquid or pi » myco, posted by myco on March 14, 2009, at 22:57:08
Oh I still like the idea of EMsam if side effects take it off or customize sizes. Which is more stimulating if anxious seligline or EMsam? Love Phillipa
Posted by Phillipa on March 15, 2009, at 0:54:01
In reply to Re: ENSAM-who told me I could get this in liquid or pi, posted by Phillipa on March 15, 2009, at 0:36:14
Wiki's new infor on EMSAM. Phillipa
Emsam
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Skeletal formula of selegilineEmsam (selegiline transdermal system) is a transdermal patch using the monoamine oxidase inhibitor (MAOI) selegiline. Selegiline, in small doses, is most commonly used in the treatment of Parkinson's disease. It is also effective in higher doses for the treatment of major depressive disorder.[1] On February 28, 2006 the FDA approved EMSAM for the treatment of major depression. [2] [3] [4]Contents [hide]
1 Inception & Development
2 Food Intake Restrictions
3 Emsam Advantages
4 Usage
5 Medication Interactions
6 Emsam Name Origin, Manufacturer & Distributor
7 External links
8 References
[edit] Inception & Development
Emsam's development was spearheaded by J. Alexander Bodkin, M.D. [5], Director of the Clinical Psychopharmacology Research Program at McLean Hospital in Belmont MA, in conjunction with Harvard Medical School. [4] [6] [7] [8] Currently, it is the only MAOI on the market used in the treatment of depression that is absorbed through the skin into the blood stream and thereby to the central nervous system.The patch "is a matrix containing three layers consisting of a backing, an... adhesive drug layer, and a release liner that is placed against the skin."[1] The primary advantage of delivering selegiline in this manner is to bypass the gastrointestinal tract and liver, specifically the small intestine, thereby limiting the chance of hypertensive crisis (very high spike in blood pressure possibly leading to stroke).[1] [9] [10]
"Despite long-standing concerns over hypertensive reactions,... (MAOIs) have grown in popularity... (and) the risk of hypertensive episodes is less than 1%."[11]
[edit] Food Intake Restrictions
The dietary problem was first discovered by a neurologist whose wife was taking an MAO inhibitor. After eating hard cheese, which is rich in tyramine, she would get severe headaches; thus, her husband's discovery of these spikes in blood pressure. For this reason, the crisis is still called the "cheese syndrome", even though other foods can cause the same problem.When an MAOI is taken orally, and an individual ingests such tyramine rich foods, the body can not properly regulate the additional tyramine. Therefore, dietary modifications are necessary. Foods containing considerable amounts of tyramine include: air dried, aged and fermented meats, sausages and salamis; pickled herring; any spoiled or improperly stored meat, poultry and fish; spoiled or improperly stored animal livers; broad bean pods (fava beans); all tap beers, and other beers that have not been pasteurized; concentrated yeast extract (such as Marmite); most soybean products (including soy sauce and tofu); aged cheeses (not processed cheese); sauerkraut; and over-the-counter supplements containing tyramine. [7] [12] [13][14][15]
[edit] Emsam Advantages
Due mainly to the availability of the newer SSRIs and SNRIs, which are viewed to have more medically benign side effects in the treatment of depression, psychopharmacologists and psychiatrists have avoided prescribing MAOIs[1][11] [16] [17] because of the possibility of hypertensive crisis. With Emsam, taken at the lowest dose of 6 mg every 24 hours, no dietary modifications are required by the FDA, and the chance of such a side effect due to diet is eliminated.[6]In addition to the lack of dietary restrictions at the 6mg/24h dose, Emsam offers[10] another benefit. It is a continuous delivery system, keeping the medication at a steady level in the body over time, although there is no evidence that this makes a difference in terms of the efficacy or side effects of this medication.[18] Generally, oral medication can not keep a steady dose in the blood stream.
Emsam is also valuable in the treatment of depression that is not alleviated by the more commonly used selective serotonin reuptake inhibitors (SSRIs), dual serotonin and norepinephrine reupatake inhibitors (SNRIs) and tricyclic antidepressants (TCAs).
Somewhat surprisingly, clinical trials done with MAOIs do not find that they are more effective than other antidepressants when they are tested in large groups of people. However, for certain individuals, especially individuals who have not done well on other antidepressants, a MAOI may be best. MAOIs are thought to be particularly effective in what has been called "atypical" depression. Atypical depressions are characterized by an increased need for sleep, increased appetite, and increased severity of depressive symptoms towards the end of the day.
[edit] Usage
The patch is changed once daily. There may be a reaction to the adhesive on the skin at the site of application.[6] Patients are encouraged to use an adhesive remover: usually mineral oil, Vaseline or an over-the-counter product such as dermatology recommended TRIAD brand adhesive tape remover pads. A new patch is placed on a different site. The combination of adhesive remover, and placing each patch on a new area of skin, is to discourage any dermatological reason for discontinuance of the patch.Using rubbing alcohol or hydrogen peroxide to clean the skin of oils and dirt before applying a patch can increase the likelihood of proper attachment for the duration of each 24 hour period. Immediately after applying a patch it can be helpful to use the pressure and body heat of the palm of the hand to enhance proper adhesive contact.
All of the dietary restrictions are currently required by the FDA, as a precaution, at the higher 9 mg/24h and 12 mg/24h doses of Emsam.[19]
[edit] Medication Interactions
Over-the-counter items that can not be used while on Emsam include: St. John's Wort; products containing dextromethorphan such as cough and cold preparations; decongestant medicines; and diet pills or herbal weight loss products. Caffeine and chocolate can only be consumed in small amounts.There are prescription medications that can not be taken while using Emsam, and for 2 weeks after stopping Emsam.[4] Some medications must not be taken for 1 week (or more) before an individual can start using Emsam.
Medications that can not be taken because they can cause serotonin syndrome [20] include: (SSRIs), (SNRIs), (TCAs), other MAOIs, mirtazapine, bupropion, meperidine, analgesics such as tramadol, methadone, propoxyphene, cyclobezaprine and oral selegiline.[4] The use of Emsam is contraindicated for use with sympathomimetic amines, including amphetamines as well as cold products and weight-reducing preparations that contain vasoconstrictors (e.g., pseudoephedrine, phenylephrine, phenylpropanolamine, and ephedrine). Carbamazepine and oxcarbazepine are also contraindicated.[4]
Patients taking Emsam should not undergo elective surgery requiring general anesthesia or be given local anesthesia containing sympathomimetic vasoconstrictors.[4]
[edit] Emsam Name Origin, Manufacturer & Distributor
The acronym Emsam is derived from the names Emily and Samuel. They are the children of Mel Sharoky, M.D., CEO of Emsam's manufacturer, Somerset Pharmaceuticals, Inc.,[21] The prescription medication is distributed by Bristol-Myers Squibb out of Princeton, NJ.
[edit] External links
Everything You Ever Wanted to Know about EMSAM and more.
FDA Approves Emsam (selegiline) as First Drug Patch for Depression.
Andrew Bridges, Associated Press (2006). "Skin patch for mood disorders approved". The Boston Globe March 01, 2006
Bodkin JA, Amsterdam JD (Nov 2002). "Transdermal selegiline in major depression: a double-blind, placebo-controlled, parallel-group study in outpatients". Am J Psychiatry 159 (11): 186975. doi:10.1176/appi.ajp.159.11.1869. PMID 12411221. http://www.ajp.psychiatryonline.org/cgi/content/full/159/11/1869.
Bristol-Myers Squibb Company EMSAM information for U.S. residents only.
Hitti, Miranda (reviewed bt Chang, M.D. Louise) (2006-02-28). "FDA OKs Patch to Treat Depression, Using EMSAM in Lower Doses May Avoid Concerns About Drug Interactions" ([dead link] Scholar search). Medicine Net.com :WebMD, Inc.. http://www.medicinenet.com/script/main/art.asp?articlekey=60223.
Tong TG, Saklad SR (1994). "What foods you should avoid on MAOIs" (MAO-I's Dietary Restrictions)
Walker SE, Shulman KI, Tailor SA, Gardner D (Oct 1996). "Tyramine content of previously restricted foods in monoamine oxidase inhibitor diets". J Clin Psychopharmacol 16 (5): 3838. doi:10.1097/00004714-199610000-00007. PMID 8889911. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0271-0749&volume=16&issue=5&spage=383.
William J. Cromie (November 7, 2002). "Bodkin is patching up depression". Harvard University Gazette (photo of Dr. Bodkin displaying patch.)
Feiger AD, Rickels K, Rynn MA, Zimbroff DL, Robinson DS (Sep 2006). "Selegiline transdermal system for the treatment of major depressive disorder: an 8-week, double-blind, placebo-controlled, flexible-dose titration trial". J Clin Psychiatry 67 (9): 135461. PMID 17017821. http://article.psychiatrist.com/?ContentType=START&ID=10002718.
Patkar AA, Pae CU, Zarzar M (Jun 2007). "Transdermal selegiline". Drugs Today 43 (6): 36177. doi:10.1358/dot.2006.43.6.1050794 (inactive 2008-12-15). PMID 17612708.
NIH Medication Information: EMSAM.
NIH Medline Information: Serotonin Syndrome
Posted by desolationrower on March 15, 2009, at 2:31:17
In reply to Re: ENSAM-who told me I could get this in liquid or pi, posted by Phillipa on March 15, 2009, at 0:54:01
oral selegiline might be slightly more physically acitvating than emsam/sublingual because you get some l-methamp. its pretty small amount though, probably not worth the bother of the extra risk of tyramine with the oral.
-d/r
Posted by softheprairie on March 16, 2009, at 5:20:45
In reply to ENSAM-who told me I could get this in liquid or pi, posted by Cseagraves on March 14, 2009, at 20:14:37
I took Emsam in around 2007. I was getting a bit of depression help from the medication, but had various troubles with the patch format -- pain to remove, not sticking well -> feeling I wasn't getting all of the active ingredient I should, it was on my mind all the time and bothersome in a way I don't know how to describe. Along with my psychiatrist, I looked into selegiline in other forms. I ended up going with Zelapar ODT (orally disintegrating tablets) for several months, and we really upped the dose to try to get me to relief. If I recall corectly, I got up to 12 or more tablets a day, with each tablet being 1.25 mg (I'm just going by memory on this) (the normal dose in Parkinson's disease treatment, which is Zelapar's official FDA indication, is 1 or 2 of those tablets a day). While I got some benefit, it wasn't enough to offset the downside of the lifestyle restrictions (diet and inability to take some other meds I sometimes want), so I weaned off of it and tried a med of a differnt class (desipramine, a TCA, which, in combination with other things has been my best or 2nd best combo yet). Anyways, if things are the same now as about 1-2 years ago: I have some awful news. The Zelapar cost my insurance even more than Emsam! I'm thinking in the $800 to 1000/month range for the high dose I got to. The makers of Emsam and Zelapar are able to get away with highway robbery for now, as no generic of the patch nor orally disintegrating tablet forms are allowed to be sold in the US. Others have talked about the swallowed pill form, which is cheaper, but I have no experience with that and can't say much there. In my limited understanding, the swallowed form gets digested in the gut and has trouble getting to the brain to be psychoactive, which is why there is a market for the exorbitantly priced patch and ODT forms. But, maybe with a high enough dose, some of the swallowed kind can make it to the brain sufficiently to help some people.
Perhaps you could apply to the maker of Emsam if they have a patient assistance program to send it to your prescriber's office for free? That is how I am currently getting one of my meds.
(The maker of Zelapar probably wouldn't agree to give it to someone where the prescriber's directions are to take a does so many times higher than officially approved for in Parkinson's.)
Posted by myco on March 16, 2009, at 10:41:13
In reply to warning on Zelapar cost » Cseagraves, posted by softheprairie on March 16, 2009, at 5:20:45
Sounds like wasnt the right med for you or you could have augmented with something to avoid a massive dose
> I took Emsam in around 2007. I was getting a bit of depression help from the medication, but had various troubles with the patch format -- pain to remove, not sticking well -> feeling I wasn't getting all of the active ingredient I should, it was on my mind all the time and bothersome in a way I don't know how to describe. Along with my psychiatrist, I looked into selegiline in other forms. I ended up going with Zelapar ODT (orally disintegrating tablets) for several months, and we really upped the dose to try to get me to relief. If I recall corectly, I got up to 12 or more tablets a day, with each tablet being 1.25 mg (I'm just going by memory on this) (the normal dose in Parkinson's disease treatment, which is Zelapar's official FDA indication, is 1 or 2 of those tablets a day). While I got some benefit, it wasn't enough to offset the downside of the lifestyle restrictions (diet and inability to take some other meds I sometimes want), so I weaned off of it and tried a med of a differnt class (desipramine, a TCA, which, in combination with other things has been my best or 2nd best combo yet). Anyways, if things are the same now as about 1-2 years ago: I have some awful news. The Zelapar cost my insurance even more than Emsam! I'm thinking in the $800 to 1000/month range for the high dose I got to. The makers of Emsam and Zelapar are able to get away with highway robbery for now, as no generic of the patch nor orally disintegrating tablet forms are allowed to be sold in the US. Others have talked about the swallowed pill form, which is cheaper, but I have no experience with that and can't say much there. In my limited understanding, the swallowed form gets digested in the gut and has trouble getting to the brain to be psychoactive, which is why there is a market for the exorbitantly priced patch and ODT forms. But, maybe with a high enough dose, some of the swallowed kind can make it to the brain sufficiently to help some people.
>
> Perhaps you could apply to the maker of Emsam if they have a patient assistance program to send it to your prescriber's office for free? That is how I am currently getting one of my meds.
> (The maker of Zelapar probably wouldn't agree to give it to someone where the prescriber's directions are to take a does so many times higher than officially approved for in Parkinson's.)
Posted by desolationrower on March 17, 2009, at 0:51:36
In reply to Re: warning on Zelapar cost » softheprairie, posted by myco on March 16, 2009, at 10:41:13
i used pretty high dose of the regular pill sublingually and cost me less than 25$ a month...
-d/r
Posted by gigantor on August 22, 2013, at 23:18:30
In reply to Re: ENSAM-who told me I could get this in liquid or pi » myco, posted by myco on March 14, 2009, at 22:57:08
Yes, Zelapar requires a smaller dose than a tablet but how does Zelapar compare to Emsam, which also needs a smaller dose transdermally than via pill? Since they are three different delivery systems, are I don't think they'd have the same dosing/absorption as each other. Making a cheaper 1.5 Zelapar lozenge more expensive overall if you have to take the dosing equivalent to match Emsam (6, 9, 12 mg).
> "Zelapar" - quick dissolving lozenge. bypasses first pass mechanism. lower dosage required than oral forms and not as many GI problems compared to oral form.
This is the end of the thread.
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