Pharmacy & Therapeutics - April 2008 - (Page 218) DRUG FORECAST Table 2 Over-the-Counter Medications Not Contraindicated For Patients Using the Selegiline Transdermal System Class Analgesics Motrin IB Caplets Example least 10 days before the procedure. If surgery is required earlier, agents such as benzodiazepines, mivacurium (Mivacron, Abbott), morphine, and codeine may be used with caution. In addition, local anesthetics containing sympa thomimetic vasoconstrictors should be avoided. Although the data do not suggest the need for a modified diet at the STS 6-mg/24-hour dose, because of the limited data available, ingesting foods and beverages containing tyramine is contraindicated for patients receiving the STS at higher doses and for up to two weeks after therapy is stopped or reduced to the 6-mg/24-hour dose.26 Table 3 presents some tyramine-rich foods and beverages to avoid, including aged or fermented meat, poultr y and fish, aged cheeses, broad bean pods, concentrated yeast extract, most soybean products, and all varieties of tap beer.57 As with other antidepressants, the concomitant use of alcohol with the STS is not recommended. Antitussive agents (in cold and Zicam Cold Remedy, Corcidin HBP Cold and Flu, cough medications) Tylenol Cold Relief, Mucinex Antihistamines, antitussive agents (in cold and cough medications) Cough and cold products Benadryl Allergy Kapseals, Claritin 24 Hour Allergy Tablets, Tavist Allergy Tablets, Zicam Cold Remedy, Corcidin HBP Cold and Flu, Tylenol Cold Relief, Mucinex Tylenol Cold Relief, Zicam Cold Remedy, Benadryl Allergy, Advil Caplets, Coricidin HBP Cold and Flu Tablets, Comtrex Maximum Strength Sore Throat Relief Liquid, Tylenol Chest Congestion Cool Burst Caplets,Vicks VapoRub, Robitussin Chest Congestion Guaifenesin Syrup USP, Mucinex Extended-Release Tablets Benadryl Allergy Kapseals, Claritin 24 Hour Allergy Tablets, Tavist Allergy Tablets cially important, because the ingredients of over-the-counter products may change, necessitating that patients check each purchase. The STS patch is also contraindicated for patients undergoing elective surgery involving general anesthesia; in this situation, the STS should be discontinued at Antihistamines phen and diphenhydramine and rep resents an alternative for patients needing the STS. Because the brand names of these medications can be similar, the pharmacist or physician can advise patients to check the contents of the product as well as the brand name for contraindicated components. This is espe- CONCLUSION The clinical data regarding the Emsam patch demonstrate both its short-term and long-term safety and ef ficacy in patients with MDD. In particular, the STS Table 3 Dietary Modifications Needed for Patients Using the Selegiline Transdermal System 9 mg and 12 mg/24 hours Class Meat, poultry, fish Foods and Beverages to Avoid Air-dried, aged, and fermented meats, sausages and salamis (cacciatore, hard salami, mortadella); pickled herring; and any spoiled or improperly stored meat, poultry and fish (e.g., foods that have undergone change in coloration or odor or have become moldy); spoiled or improperly stored animal livers Broad (fava bean) bean pods Aged cheeses All varieties of tap beer, and beers that have not been pasteurized so as to allow for ongoing fermentation Concentrated yeast extract (e.g., Marmite), sauerkraut, most soybean products (soy sauce, tofu), over-the-counter supplements containing tyramine Acceptable Foods Fresh meat, poultry, and fish, including fresh processed meats (e.g., lunch meats, hot dogs, breakfast sausage, and cooked sliced ham) Vegetables Dairy Beverages All other vegetables Processed cheeses, mozzarella, ricotta cheese, cottage cheese, yogurt As with other antidepressants, the concomitant use of alcohol is not recommended; bottled and canned beers and wines contain little or no tyramine Brewer’s yeast, baker’s yeast, soy milk, commercial chain restaurant pizzas prepared with cheeses low in tyramine Miscellaneous Note: No dietary restrictions are required for patients using the 6 mg/24-hour selegiline transdermal system (Emsam). Data from Shulman KI, Walker SE. Pychiatr Ann 2001;31:378–384.57 218 P&T® • April 2008 • Vol. 33 No. 4
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