Zelapar (Selegiline) Oral: Uses, Side Effects, Dosages, Interactions - Verywell Health

What Is Zelapar?

Zelapar (selegiline) is a pill taken by mouth to treat Parkinson's disease in people who are already being treated with Sinemet (carbidopa and levodopa) but are not responding well enough to it. Zelapar is meant to be used in addition to Sinemet.

Selegiline is part of a drug class called monoamine oxidase inhibitors, or MAOIs. It works by inhibiting monoamine oxidase, which is an enzyme that breaks down dopamine. This leads to higher dopamine levels in the brain, which improves Parkinson's symptoms.

Selegiline is a prescription product, so you can't purchase it over the counter (OTC). You'll receive a prescription from your healthcare provider and get the medication from your pharmacy. Selegiline is also available as a transdermal patch (worn on the skin) under the brand name Emsam.

This article will focus on the oral version of selegiline.

Drug Facts

Generic Name: Selegiline
Brand Name: Zelapar
Drug Availability: Prescription
Administration Route: Oral
Therapeutic Classification: Antiparkinsonian
Available Generically: Yes
Controlled Substance: N/A
Active Ingredient: Selegiline
Dosage Form(s): Disintegrating tablet, capsule, tablet

What Is Zelapar Used For?

Zelapar is used to treat Parkinson's disease in people who are already being treated with the drug Sinemet (carbidopa and levodopa), but are not responding well enough to it or their response is decreasing. Selegiline is meant to be used in addition to Sinemet.

Parkinson's disease is a disorder in which brain cells that produce a chemical called dopamine die. This lack of dopamine causes poor movement control, shaking, stiffness, and difficulty walking.

How to Take Zelapar

It's important to note that Zelapar is the brand name for a specific form of selegiline pill known as an orally disintegrating tablet, or ODT. Selegiline is also available generically as a normal tablet swallowed whole like a regular pill. However, Zelapar is the only way to get selegiline as an ODT. There is no generic selegiline ODT.

ODTs are taken differently than regular pills. Take Zelapar in the morning before breakfast, without liquid. Avoid eating or drinking anything for five minutes before and after taking it.

Do not push Zelapar through its foil backing. Instead, peel the backing away from the blister pack and carefully remove the tablet. Immediately place it on your tongue, where it will disintegrate within seconds.

Take generic selegiline like regular pills, which means swallowing them whole with water. Generic selegiline tablets will come in a standard pill bottle, unlike Zelapar, which will come in a blister pack.

Storing Zelapar

Zelapar will come in a box of pouches that each contain 10 ODTs. Make sure to leave all the tablets in their pouches until you are ready to take a dose. Do not store pouches in areas with a lot of heat and moisture, like the bathroom.

Store Zelapar at room temperature, between 59 and 86 degrees F. Use all tablets within three months of opening the pouch.

Follow the same storage guidelines for other oral forms of selegiline in their original containers.

Off-Label Uses

Healthcare providers may prescribe selegiline for off-label uses, meaning for conditions not specifically indicated by the Food and Drug Administration (FDA).

Besides Parkinson's disease, selegiline can also be used to treat depression, panic disorders, and anxiety disorders. In addition to increasing dopamine in the body, MAOIs also boost serotonin and norepinephrine levels. These are important chemicals involved in depression and anxiety.

The form of selegiline used for these indications may be a normal tablet or a patch applied to the skin (Emsam) as opposed to the Zelapar ODT tablet.

How Long Does Zelapar Take to Work?

It may take about four to six weeks to notice the full benefit of taking Zelapar. Six weeks is the approximate time at which your healthcare provider may increase your Zelapar dose if you are tolerating the medicine and it seems to be helping your symptoms.

What Are the Side Effects of Zelapar?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider or pharmacist. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The following side effects were the most common ones reported in clinical trials.

Tell your healthcare provider if you notice these side effects and think they are severe or do not go away:

• Constipation
• Vomiting
• Dizziness
• Dyskinesias, which are uncontrolled and involuntary muscle movements
• Insomnia, or trouble sleeping
• Dyspnea, or shortness of breath
• Myalgia, or muscle pains
• Rash

Severe Side Effects

Contact your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you're having a medical emergency.

A hypertensive crisis, or an episode of dangerously high blood pressure, has been shown to occur in people taking selegiline who also ate foods and drinks containing high amounts of tyramine, an amino acid that aids in regulating blood pressure. These can include:

• Strong or aged cheeses
• Processed or smoked meats
• Certain types of sauce
• Alcoholic beverages like beer, red wine, and some liqueurs

If you are unsure if your diet contains foods high in tyramine, ask your healthcare provider what foods and drinks to avoid.

Other severe side effects of Zelapar include:

• Serotonin syndrome: Symptoms can include confusion, hallucinations, agitation, headache, shivering, sweating, fever, fast heart rate, nausea, and diarrhea.
• Falling asleep during daily activities: Most often this side effect happens in people who already experience regular sleepiness before starting the drug. The risk is also higher in people 65 and older.
• Hallucinations or psychotic-like behavior such as delusions, disorientation, and aggressive behavior, particularly in individuals who already have a mental health condition.
• Problems with impulse control: Possible urges may include an intense desire to gamble or spend money, increased sexual urges, binge eating, or other intense urges, and the inability to control these urges. Sometimes people with Parkinson's may not recognize these behaviors as abnormal.
• Irritation of the buccal mucosa, or mouth abnormalities: Symptoms include swallowing pain, mouth pain, areas of redness, and swelling.

Long-Term Side Effects

Zelapar may be a lifelong medication for you. Although side effects do occur, they do not seem to be significantly greater when taking Zelepar long term compared with short-term use.

Report Side Effects

Zelapar may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Zelapar Should I Take?

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For Parkinson's disease:
  • For oral dosage forms (capsules or tablets):
    • Adults—5 milligrams (mg) two times a day, taken at breakfast and lunch. Your doctor may adjust your dose as needed.
    • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (oral disintegrating tablets):
    • Adults—At first, 1.25 milligrams (mg) once a day before breakfast, for at least 6 weeks. After 6 weeks, your doctor may increase your dose to 2.5 mg once a day.
    • Children—Use and dose must be determined by your doctor.

Modifications

Certain factors or characteristics may require a treatment adjustment:

• Pregnancy: It is unknown how this drug affects pregnancies in humans. Zelapar should be used during pregnancy only if the potential benefit outweighs the potential risk to the fetus. Talk to your healthcare provider if you become pregnant or plan to become pregnant while taking it.
• Breastfeeding: It is unknown whether Zelapar is present in human milk. Because many drugs are present in human milk, caution should be exercised when giving it to people who are nursing.
• Children: The safety of Zelapar has not been established in children.
• Adults 65 and older: Not enough people 65 and older were included in the clinical trials to identify a significant difference between older and younger individuals. However, older adults did seem to have a higher risk of certain side effects, such as psychotic-like behavior, low blood pressure, and excessive sleepiness.
• Kidney problems: Let your healthcare provider know if you have kidney disease or impairment. Most likely, it will still be OK for you to take a normal dose of Zelapar. If your kidney disease is severe, this medication may not be a good choice for you. Your healthcare provider can help determine whether it is safe to take.
• Liver problems: If you have mild or moderate liver disease, you may require a lower dose of Zelapar. If your liver disease is severe, you may not be able to take this medicine. Let your healthcare provider know if you have issues with your liver.

Missed Dose

If you've forgotten to take your dose, go ahead and take it as soon as you remember. However, if it's closer to the time of your next dose, skip the missed dose and continue with your normal dosing schedule.

Do not double up doses or take two doses of Zelapar on the same day.

Overdose: What Happens If I Take Too Much Zelapar?

Clinical information about overdosing on selegiline is limited, but the signs and symptoms of an overdose may be similar to overdoses of other MAOI drugs.

You may not see any signs of toxicity after taking too much selegiline for about 12 hours and potentially up to one day. However, overdosage can be fatal, so get medical help quickly.

Signs and symptoms of an overdose may include:

• Drowsiness
• Dizziness
• Irritability or agitation
• Severe headache
• Hallucinations
• Trismus (also known as lockjaw, or trouble opening your jaw as wide as you normally can)
• Convulsions
• Fast or irregular heartbeat
• High or low blood pressure
• Trouble breathing
• Cool or clammy skin

What Happens If I Overdose on Zelapar?

If you think you or someone else may have overdosed on Zelapar, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Zelapar, call 911 immediately.

Precautions

It is very important that your doctor check your progress at regular visits to allow for changes in your dose. Blood tests may be needed to check for any unwanted effects.

Do not take selegiline if you have used narcotic pain medicines (including meperidine, methadone, tramadol, Demerol®, Dolophine®, Ultram®) or an MAO inhibitor (MAOI) (eg, isocarboxazid, linezolid, phenelzine, tranylcypromine, Marplan®, Nardil®, Parnate®, Zyvox®) within the past 14 days. If you do, you may develop agitation, confusion, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, or severe seizures.

Do not take cyclobenzaprine, dextromethorphan (Robitussin®, Pediacare®), propoxyphene (Darvon®), or St. John's wort while you are using this medicine. Using these medicines together can cause unwanted effects.

Selegiline may cause a condition called serotonin syndrome when used together with certain MAO inhibitors (eg, phenelzine, rasagiline, tranylcypromine) and medicines to treat depression (eg, amitriptyline, doxepin, fluoxetine, fluvoxamine, nortriptyline, paroxetine, sertraline, Elavil®, Luvox®, Pamelor®, Paxil®, Prozac®, or Zoloft®). Check with your doctor right away if you have anxiety, restlessness, fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, seeing or hearing things that are not there.

When selegiline is taken at doses of 10 mg or less per day for the treatment of Parkinson's disease, there are no restrictions on food or beverages you eat or drink. However, the chance exists that dangerous reactions, including sudden high blood pressure, may occur if doses higher than those used for Parkinson's disease are taken with certain foods, beverages, or other medicines. These foods, beverages, and medicines include:

• Foods that have a high tyramine content (most common in foods that are aged or fermented to increase their flavor), such as cheeses, fava or broad bean pods, yeast or meat extracts, smoked or pickled meat, poultry, or fish, fermented sausage (bologna, pepperoni, salami, summer sausage) or other fermented meat, sauerkraut, or any overripe fruit. If a list of these foods and beverages is not given to you, ask your doctor to provide one.
• Alcoholic beverages or alcohol-free or reduced-alcohol beer and wine.
• Large amounts of caffeine-containing food or beverages such as coffee, tea, cola, or chocolate.
• Any other medicine unless approved or prescribed by your doctor. This especially includes nonprescription (over-the-counter [OTC]) medicine, such as that for colds (including nose drops or sprays), cough, asthma, hay fever, and appetite control, "keep awake" products, or products that make you sleepy.

Also, for at least 2 weeks after you stop taking this medicine, these foods, beverages, and other medicines may continue to react with selegiline if it was taken in doses higher than those usually used for Parkinson's disease.

Check with your doctor or hospital emergency room immediately if severe headache, stiff neck, chest pains, fast heartbeat, or nausea and vomiting occur while you are taking this medicine. These may be symptoms of a serious side effect that should have a doctor's attention.

This medicine may make you drowsy. It may even cause you to fall asleep without warning while you drive, talk, or eat. Do not drive or do anything that could be dangerous until you know how this medicine affects you.

Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position. Getting up slowly may help. If the problem continues or gets worse, check with your doctor.

Check with your doctor right away if you have pain when swallowing, pain in the mouth, redness, swelling, or sores in your mouth while receiving this medicine.

Selegiline may cause dryness of the mouth. For temporary relief, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

Some people who have used this medicine had unusual changes in their behavior. Talk with your doctor if you start having unusual urges, such as gambling urges, binge or compulsive eating, compulsive shopping, or sexual urges while using this medicine.

Do not stop taking this medicine without first checking with your doctor. Your doctor may want you to reduce gradually the amount you are taking before stopping completely.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn't Take Zelapar?

You shouldn't take Zelapar if you have any of the following conditions, as they all can be worsened by taking MAOI drugs like selegiline:

• An active peptic or duodenal ulcer, which is a sore on the lining of your stomach or intestines
• An extrapyramidal disorder such as a severe tremor (shakiness)
• Tardive dyskinesia, including involuntary movements in the face like grimacing or eye blinking
• Severe psychosis or dementia
• Severe liver or kidney disease
• Severe heart disease like arterial hypertension (high blood pressure of the arteries), narrow-angle glaucoma (high pressure inside your eye), or abnormal heart rhythms

What Other Medications Interact With Zelapar?

Zelapar has significant interactions with a few other medications. The interactions can be severe enough that taking these drugs while on selegiline is contraindicated, meaning it should always be avoided and is known to be unsafe.

Do not take Zelepar with any of the following drugs. Instead, allow 14 days to pass between stopping Zelepar and starting these medications:

• Demerol (meperidine), a narcotic painkiller
• Conzip or Qdolo (tramadol), a narcotic painkiller
• Methadose (methadone), a narcotic used as a painkiller and to treat narcotic drug addiction
• Other MAOI drugs, such as Marplan (isocarboxazid) and Nardil (phenelzine)
• Saint-John's-wort, an herbal supplement
• Amrix (cyclobenzaprine), a muscle relaxer
• Dextromethorphan, a drug used to treat cough

Always make sure your healthcare provider is aware of any other prescription and OTC medications, vitamins, or herbal supplements you take.

What Medications Are Similar to Zelapar?

Other medications in the MAOI class of drugs include:

• Azilect (rasagiline)
• Parnate (tranylcypromine), which is more commonly used for depression
• Marplan (isocarboxazid)
• Nardil (phenelzine)

This is not a list of drugs recommended to take with Zelapar. In fact, you should not take these drugs together. Talk to your pharmacist or healthcare provider if you have questions.

Frequently Asked Questions

• Zelapar is used to treat symptoms of Parkinson's disease. It is used in combination with a drug called Sinemet (carbidopa and levodopa) in individuals who already take Sinemet but are not responding to it well enough.

• Zelapar works by inhibiting the protein that breaks down dopamine, leading to more dopamine in your system. Dopamine is a chemical in your body that helps reduce Parkinson's disease symptoms.

• You should not take the narcotic drugs meperidine, methadone, or tramadol with Zelapar. Other MAOI drugs should also be avoided, as well as the cough suppressant dextromethorphan and the muscle relaxer cyclobenzaprine. Ask your healthcare provider or pharmacist for a complete list of drug interactions with Zelepar.

How Can I Stay Healthy While Taking Zelapar?

Any disease that interrupts your daily activities and causes you to feel a loss of control can be life-changing. Conditions like Parkinson's disease that affect motor control can understandably bring feelings of anxiety, depression, or both.

Educate yourself as much as possible about Parkinson's disease and encourage your loved ones to do the same, as there are some manifestations of the condition that many people don't know about. Understanding and anticipating the emotional and behavioral changes will help you and your caregivers be more prepared to cope with them.

The good news is that medications are available to help improve symptoms for many people, and add-on medicines like Zelapar can provide even more relief. In addition to your medication, try exercising regularly to enhance physical stability and maintain a healthy diet.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.