Transdermal Selegiline conversion to oral???

[julia403]

I am currently a pharmacy student working in the psych ward at the veteran's hospital. We have been trying to figure out whether there is a conversion method for switching a patient from the transdermal selegiline patch (EMSAM) 6mg/day to an oral formulation. So far we've had no luck (the manufacturer's website doesn't give a phone number for drug info... as if they don't want us to call!). Just wondering if any of you have run into this before & whether you found any helpful resources on the topic?

Thanks in advance.

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[TherapistDave]

All I know of that we prescribe to patients are Lexapro and Zoloft🙂, but I have no idea how that transfer would be for your patients. I am sure if you look up some studies you will see any correlative effects on clients who have switched the kind of MAOs they were taking, but I have yet to actually search for an article as such. Many of your student article searches that you utilize for research papers would have what you are looking for.

Also, Abilify and Risperidol might be worth looking into for anxiolytic purposes, but that all depends on the population you are serving. I know that we have had a couple clients come off of the patch, and from what I recall, they seemed to do well with the transition; just be mindful of the half-life with what you have them on; but you probably already knowa all of that.

 

[Therapist4Chnge]

*moving to pharmacy*

Right now my brain is turned off, so I'll let the pharms answer this.....this should be right in their wheel-house. Just as an aside, we don't give specific medical advice on the forum, but a general question about conversions is fine.

-t

ps. As a slight tangent, I thought I heard a rumor that they stopped producing the patch? I think it is a worthwhile method...but why start with an MAOI? I never quite understood that.

 

[Caverject]

I am currently a pharmacy student working in the psych ward at the veteran's hospital. We have been trying to figure out whether there is a conversion method for switching a patient from the transdermal selegiline patch (EMSAM) 6mg/day to an oral formulation. So far we've had no luck (the manufacturer's website doesn't give a phone number for drug info... as if they don't want us to call!). Just wondering if any of you have run into this before & whether you found any helpful resources on the topic?

Thanks in advance.

I take it you haven't taken Drug Information yet? In that course, you will learn that the Facts and Comparisons book has the phone number to every drug mfg in the country.

There doesn't appear to be a published conversion guide...but with any knowledge about PK, you should be able to figure it out on your own. good luck

 

[sdn1977]

EMSAM has been a bust. The dose is too low to be therapeutic for many folks.

Why would you need to convert when someone is admitted to a psych ward? One would think they'd be unstable....so everything is up for adjustment.

You start conservatively & move up or down depending on the cllnical situation.

The more appropriate concern is if it is possible to convert a po dose to a transdermal application - which is often not possible to EMSAM.

 

[BMBiology]

Have you done a pubmed search? Here's the infor on the company:

Somerset Pharmaceuticals Inc.
Tampa, FL 33607
813-288-0040
www.somersetpharm.com

You may also want to contact Bristol-Myers Squibb since Bristol has distribution rights to Emsam in the U.S.

Even if there's a conversion method, I doubt they will tell you.

 

[Caverject]

Why would you need to convert when someone is admitted to a psych ward?

Did you not see that she works for the VA? They do their own thing there...

 

[BMBiology]

The VA is probably looking for ways to save money.

 

[sdn1977]

The VA is probably looking for ways to save money.

Nah Caverject - I didn't catch that......oops😳

But - they're not gonna save money on Emsam!! The dose will be too low for most vets on a psych ward & generic selegiline is waaaay cheaper than EMSAM.


But - its govt money - I've gotta give Zoloft rather than sertraline for my MediCal pts - go figure!!!

 

[All4MyDaughter]

But - they're not gonna save money on Emsam!! The dose will be too low for most vets on a psych ward & generic selegiline is waaaay cheaper than EMSAM.

It sounds to me like the VA is moving the veteran OFF the EMSAM to something cheaper to save money. From the OP:

from the transdermal selegiline patch (EMSAM) 6mg/day to an oral formulation.

The VA is probably looking for ways to save money.

Yep.

Did you not see that she works for the VA? They do their own thing there...

That's the truth. I've seen it in action.

 

[julia403]

Thanks for the replies, I don't think there is any official conversion guide for ENSAM to Eldepryl. I looked, I tried. In fact, when looking thru the Pkinetics to figure out an answer to my own question, I ended up finding every reason not to switch (risk of hypertension with PO doses high enough to treat depression, amphetamine metabolites which could potentially alter behavior, necessity of tyramine free diet, every problem you wouldn't want for a psych patient). When I told the Dr., he agreed that switching might be more trouble than it's worth.

And ya'll are right, the VA's formulary is just weird, I dont think I'll ever figure out their logic, but they seem to think it works just fine.🙄

 

[ZpackSux]

And ya'll are right, the VA's formulary is just weird, I dont think I'll ever figure out their logic, but they seem to think it works just fine.🙄

Simple logic... cheaper and more rebates.