Q Why did my health care professional prescribe Eldepryl® Capsules, 5mg (selegiline hydrochloride) for my Parkinson's disease?
A Your health care professional prescribed Eldepryl because it may help to control / delay the need for Sinemet®1 (levodopa/carbidopa) dose increases, while maintaining your functional ability over time. By keeping your Sinemet dose lower, Eldepryl will help to minimize Sinemet-related side effects and extend the length of time that Sinemet is effective. Eldepryl does this by slowing the loss of dopamine, an important chemical "messenger" in the brain, that is being depleted by your disease.
Q Should I expect to see an immediate improvement in my symptoms from Eldepryl treatment?
A The primary goal of Eldepryl therapy is to help you control Sinemet dose increases, while maintaining your function over time. Although Eldepryl is not primarily employed for symptom control, it may also provide improvement in your Parkinson's symptoms. For example, you may notice improvements in your tremor or your ability to dress or walk. But, not all patients who benefit from Eldepryl experience this type of immediate symptomatic improvement. Even if you do not notice an immediate improvement in your symptoms, you should continue to take Eldepryl as prescribed by your health care professional to control Sinemet dose increases and maintain function over a longer period of time.
Q How can I tell if Eldepryl is working?
A With Eldepryl, you may not need as large a dose of Sinemet or Sinemet®1 CR to control your symptoms. Eldepryl may allow your health care professional to reduce your Sinemet dose. Also, your health care professional may not need to increase your dose of Sinemet as often over the long term. A reduction in your Sinemet dose and/or a delay in the need to increase your Sinemet dose indicate Eldepryl is working and conserving your dopamine supply. (Only your health care professional should make medication dosage adjustments.) By allowing a reduction in your Sinemet dose and/or delaying Sinemet dose increases, Eldepryl helps to extend the length of time that Sinemet therapy is effective. Eldepryl also helps to minimize the "wearing-off" of the beneficial effect of Sinemet before the next Sinemet dose.
A clinical study conducted over 2 1/2 years showed that patients taking Eldepryl plus Sinemet required fewer Sinemet dose increases to maintain functional ability, compared to patients taking Sinemet alone.2
In another study conducted over a 2-year period, the Sinemet dose in patients treated with both Sinemet and Eldepryl was maintained over time when compared to patients not treated with Eldepryl and who required a doubling of their Sinemet dose.3
Q How is Eldepryl different from Sinemet or other Parkinson's medication?
A Eldepryl is the only antiparkinson's agent that has been found to slow the loss of dopamine. Eldepryl works to control Sinemet dose increases and maintain your ability to function over time. By keeping your Sinemet dose lower, Eldepryl will help to minimize Sinemet-related side effects and prolong the duration of Sinemet effectiveness.
Sinemet or Sinemet CR is prescribed to provide rapid relief of Parkinson's disease symptoms. It does this by delivering levodopa to the bloodstream which is then changed to dopamine in the brain.
Sinemet is considered dopamine "replacement" therapy. Other medications like Parlodel®4 (bromocriptine mesylate) and Permax®5 (pergolide mesylate) "mimic" dopamine by acting as dopamine "substitutes."
Q My health care professional said Eldepryl helps to extend the length of time that Sinemet is effective. What does this mean?
A It is important to remember that the effectiveness of Sinemet therapy may be limited. A "wearing off" of effectiveness ("wearing off" effect) may occur over time as the dose of Sinemet is continually increased. Therefore, your health care professional will try to keep your Sinemet dose as low as possible and delay Sinemet dose increases -- in order to prolong the length of time that Sinemet is effective and to minimize the "wearing-off" effect and other Sinemet-related side effects.
Because Eldepryl conserves your dopamine supply, Eldepryl may enable your health care professional to reduce your Sinemet dose and also control Sinemet dose increases. This is how Eldepryl helps to extend the length of time that Sinemet is effective and helps to minimize the "wearing-off" effect and other side effects associated with Sinemet therapy.
Q My health care professional said that I might experience dopamine-related side effects while taking Eldepryl and Sinemet, and that this is a positive sign that Eldepryl is working. What does this mean?
A It is important to remember that not everyone will experience side effects, but if they do occur, they are usually due to an increased amount of dopamine in your system. The appearance of dopamine-related side effects is usually an indication that Eldepryl is working to control the Sinemet dose increases by slowing the loss of dopamine. Side effects may include nausea, dizziness, or abdominal pain. Any experienced side effects should be reported to your health care professional. Dopamine-related side effects can usually be managed when your health care professional lowers your dose of Sinemet and establishes the proper dopamine level for you.
Q Why is it essential that I take 10mg of Eldepryl per day -- 5mg at breakfast and 5mg at lunch?
A 10mg of Eldepryl should be taken every day to provide the greatest therapeutic benefit. 5mg of Eldepryl should be taken at breakfast and 5mg at lunch, because some patients experience insomnia when Eldepryl is taken later in the day. Stomach upset is also minimized by taking Eldepryl with meals.
Eldepryl doses of more than 10mg per day have not been shown to increase therapeutic benefits.
Q Are there any restrictions on what I can eat while I am taking Eldepryl?
A It is generally not necessary to impose dietary restrictions when taking 10mg Eldepryl per day. However, you should not take more than 10mg per day of Eldepryl because higher doses have not been shown to increase therapeutic benefit and dietary restrictions are necessary at doses above 10mg per day.
1Sinemet and Sinemet® CR are registered trademarks of Merck & Co., Inc. and are marketed by Du Pont Pharmaceuticals.
2Adapted with permission from Sivertsen B, Dupont E, Mikkelsen B, et al. Selegiline and Ievodopa in early or moderately advanced Parkinson's disease: a double-blind controlled short- and long-term study. Acta Neurol Scand. 1989;126:147-152. ©1989 Munksgaard International Publishers Ltd., Copenhagen, Denmark. At the time of final analysis, not all patients had completed the full 30-month study.
3Adapted with permission from Myllyla VV, Sotaniemi KA, Vuorinen JA, et al. Selegiline in de novo parkinsonian patients: the Finnish study (Part II). Movement Disorders. 1993;8(suppl 1):S41-S43.
4Parlodel is a registered trademark of Novartis Inc.
5Permax is a registered trademark of Eli Lilly and Company.