Selegiline (Selegiline Hydrochloride) - Side Effects and Adverse Reactions

ADVERSE REACTIONS

Introduction:
The number of patients who received selegiline in prospectively monitored pre-marketing studies is limited. While other sources of information about the use of selegiline are available (e.g., literature reports, foreign post-marketing reports, etc.), they do not provide the kind of information necessary to estimate the incidence of adverse events. Thus, overall incidence figures for adverse reactions associated with the use of selegiline cannot be provided. Many of the adverse reactions seen have also been reported as symptoms of dopamine excess.

Moreover, the importance and severity of various reactions reported often cannot be ascertained. One index of relative importance, however, is whether or not a reaction caused treatment discontinuation. In prospective pre-marketing studies, the following events led, in decreasing order of frequency, to discontinuation of treatment with selegiline: nausea, hallucinations, confusion, depression, loss of balance, insomnia, orthostatic hypotension, increased akinetic involuntary movements, agitation, arrhythmia, bradykinesia, chorea, delusions, hypertension, new or increased angina pectoris and syncope. Events reported only once as a cause of discontinuation are ankle edema, anxiety, burning lips/mouth, constipation, drowsiness/lethargy, dystonia, excess perspiration, increased freezing, gastrointestinal bleeding, hair loss, increased tremor, nervousness, weakness and weight loss.

Experience with selegiline obtained in parallel, placebo controlled, randomized studies provides only a limited basis for estimates of adverse reaction rates. The following reactions that occurred with greater frequency among the 49 patients assigned to selegiline as compared to the 50 patients assigned to placebo in the only parallel, placebo controlled trial performed in patients with Parkinson's disease are shown in the following Table. None of these adverse reactions led to a discontinuation of treatment.

Central Nervous System:
Motor/Coordination/Extrapyramidal : increased tremor, chorea, loss of balance, restlessness, blepharospasm, increased bradykinesia, facial grimace, falling down, heavy leg, muscle twitch*, myoclonic jerks*, stiff neck, tardive dyskinesia, dystonic symptoms, dyskinesia, involuntary movements, freezing, festination, increased apraxia, muscle cramps.

Mental Status/Behavioral/Pychiatric:   hallucinations, dizziness, confusion, anxiety, depression, drowsiness, behavior/mood change, dreams/nightmares, tiredness, delusions, disorientation, lightheadedness, impaired memory*, increased energy*, transient high*, hollow feeling, lethargy/malaise, apathy, overstimulation, vertigo, personality change, sleep disturbance, restlessness, weakness, transient irritability.

Pain/Altered Sensation: headache, back pain, leg pain, tinnitus, migraine, supraorbital pain, throat burning, generalized ache, chills, numbness of toes/fingers, taste disturbance.

Autonomic Nervous System:
dry mouth, blurred vision, sexual dysfunction.

Cardiovascular:
orthostatic hypotension, hypertension, arrhythmia, palpitations, new or increased angina pectoris, hypotension, tachycardia, peripheral edema, sinus bradycardia, syncope.

Gastrointestinal:
nausea/vomiting, constipation, weight loss, anorexia, poor appetite, dysphagia, diarrhea, heartburn, rectal bleeding, bruxism*, gastrointestinal bleeding (exacerbation of preexisting ulcer disease).

Genitourinary/Gynecologic/Endocrine:
slow urination, transient anorgasmia*, nocturia, prostatic hypertrophy, urinary hesitancy, urinary retention, decreased penile sensation*, urinary frequency.

Skin and Appendages:
increased sweating, diaphoresis, facial hair, hair loss, hematoma, rash, photosensitivity.

Miscellaneous:
asthma, diplopia, shortness of breath, speech affected.

Postmarketing Reports:
The following experiences were described in spontaneous post-marketing reports. These reports do not provide sufficient information to establish a clear causal relationship with the use of selegiline hydrochloride.

CNS: Seizure in dialyzed chronic renal failure patient on concomitant medications.

*Indicates events reported only at doses greater than 10 mg/day.

REPORTS OF SUSPECTED SELEGILINE SIDE EFFECTS / ADVERSE REACTIONS

Possible Selegiline side effects / adverse reactions in 34 year old male

Reported by a health professional (non-physician/pharmacist) from Brazil on 2011-10-14

Patient: 34 year old male

Reactions: Weight Increased, Middle Insomnia, Rapid Eye Movements Sleep Abnormal, Sleep Apnoea Syndrome, Binge Eating, Somnolence, Sleep-Related Eating Disorder

Suspect drug(s):
Amantadine HCL
    Dosage: 300 mg
    Indication: Parkinson's Disease

Selegiline
    Dosage: 10 mg
    Indication: Parkinson's Disease

Pramipexole Dihydrochloride
    Dosage: 4.5 mg
    Indication: Parkinson's Disease

Biperiden Hydrochloride TAB
    Dosage: 6 mg
    Indication: Parkinson's Disease

Possible Selegiline side effects / adverse reactions in 56 year old male

Reported by a physician from Germany on 2011-11-01

Patient: 56 year old male

Reactions: ON and OFF Phenomenon, Sleep Disorder, Hallucination, Visual, Paraesthesia

Adverse event resulted in: hospitalization

Suspect drug(s):
Levopar
    Dosage: 125 mg 3 x 1 tablet

Selegiline
    Dosage: 5 mg

Neupro
    Indication: Parkinson's Disease

Other drugs received by patient: Metformin Hydrochloride; Victoza; Amlodipine; Lantus; Ramipril; Hydrochlorothiazide; Aspirin; Ezedrol; Metformin HCL; Metformin Hydrochloride

Possible Selegiline side effects / adverse reactions in 56 year old male

Reported by a physician from Germany on 2011-11-08

Patient: 56 year old male

Reactions: ON and OFF Phenomenon, Sleep Disorder, Paraesthesia

Adverse event resulted in: hospitalization

Suspect drug(s):
Selegiline
    Dosage: 5 mg

Levopar
    Dosage: 125 mg 3 x 1 tablet

Neupro

Other drugs received by patient: Aspirin; Ezedrol; Amlodipine; Metformin Hydrochloride; Metfformin Hydrochloride; Victoza; Hydrochlorothiazide; Lantus; Metformin Hydrochloride; Ramipril