Selegiline (Emsam): How This MAOI Patch Works, Diet Rules, and When Telehealth Is Enough

Last updated: August 23, 2026

Selegiline is a monoamine oxidase inhibitor. The form that treats depression is a 24-hour skin patch sold as Emsam. Oral capsules and dissolving tablets (Eldepryl, Zelapar) treat Parkinson disease with levodopa/carbidopa. They are not interchangeable with the patch. Selegiline is not a first-line antidepressant. It is not a controlled substance. The 6 mg per 24 hour patch usually does not need a tyramine diet. Higher patch strengths do. Drug interactions still apply at every dose.

This guide is educational. It is not a diagnosis and it is not a promise that any clinician will prescribe selegiline.

Looking for depression care online? Klarity Health has 2,000+ licensed providers. Many visits happen by video. Coverage varies by plan. Self-pay is also an option. See online depression treatment options or browse conditions.

TLDR

• Emsam is a selegiline transdermal system. DailyMed (setid b891bd9f, revised May 2020) lists it as an MAOI for adults with major depressive disorder. Strengths: 6, 9, and 12 mg per 24 hours. DEA schedule: none.
• MedlinePlus a607003 (patch) says apply one patch a day for 24 hours to dry, smooth skin on the upper chest, back between neck and waist, upper thigh, or outer upper arm. Do not cut patches. Avoid heating pads, saunas, hot tubs, and long direct sun on the site.
• Start and usual target: 6 mg per 24 hours. Raise by 3 mg per 24 hours no faster than every 2 weeks, max 12 mg per 24 hours. Age 65 and older: stay at 6 mg per 24 hours. See DailyMed.
• Tyramine diet: not required at 6 mg per 24 hours if you use the patch as directed. Required from day one on 9 or 12 mg per 24 hours, and for 2 weeks after you drop back to 6 mg or stop a higher dose. See DailyMed and MedlinePlus.
• Oral selegiline (MedlinePlus a697046, last revised January 15, 2022) is for Parkinson disease with levodopa/carbidopa. Capsules: usually twice a day with breakfast and lunch. Orally disintegrating tablet: once daily before breakfast; no food or drink for 5 minutes before and after. Brands: Eldepryl, Zelapar.
• StatPearls MAOIs (NBK539848) (updated December 13, 2025) lists FDA-approved MAOIs as isocarboxazid, phenelzine, selegiline, and tranylcypromine. Selective MAO-B agents such as selegiline have a lower hypertensive-crisis risk than nonselective agents, but overdose and mixed-drug use still matter.
• Boxed warning: antidepressants raised suicidal thoughts and behaviors in pediatric and young adult patients. Emsam is contraindicated under age 12 and is not recommended at ages 12 to 17. See DailyMed.
• Do not combine with SSRIs, SNRIs, clomipramine, imipramine, meperidine, tramadol, methadone, pentazocine, propoxyphene, dextromethorphan, or carbamazepine. Wait 4 to 5 half-lives (about 1 week) after most of those drugs, and at least 5 weeks after fluoxetine, before starting Emsam. Wait at least 2 weeks after stopping Emsam before starting a contraindicated drug. Also contraindicated in pheochromocytoma. See DailyMed.
• Medicare behavioral telehealth in the home is permanent. The extra in-person visit rule is waived through December 31, 2027. See HHS telehealth policy.
• Klarity Health connects you with 2,000+ licensed providers. Coverage may vary by plan. Verify benefits before you book. If you are in crisis, call or text 988.

On this page

• What selegiline is
• How it works
• Who it is for
• Emsam dosing and how to apply the patch
• Oral selegiline for Parkinson disease
• Tyramine diet
• Side effects
• Interactions and contraindications
• When telehealth is enough
• How Klarity Health fits
• FAQ

What selegiline is

Selegiline is an MAOI. The depression product is a once-daily transdermal system. DailyMed lists 6, 9, and 12 mg per 24 hour patches from Viatris Specialty LLC. Initial U.S. approval for Emsam: 2006.

Oral products treat Parkinson symptoms as an add-on to levodopa/carbidopa. MedlinePlus names Eldepryl and Zelapar. Do not stack oral selegiline with the patch.

Related Klarity reads: phenelzine (Nardil), amitriptyline, trazodone, venlafaxine, bupropion, and carbamazepine (do not combine carbamazepine with Emsam).

How it works

Oral selegiline is an MAO-B inhibitor. MedlinePlus says it raises dopamine in the brain and can help levodopa last longer. At higher exposure, MAO-A in the gut and elsewhere is also blocked. That is why the 9 and 12 mg patches need a tyramine diet while the 6 mg patch usually does not.

StatPearls notes that selective MAO-B inhibitors such as selegiline carry a lower hypertensive-crisis risk than nonselective, irreversible MAOIs such as phenelzine and tranylcypromine. Selectivity is dose-dependent. Follow the label for the product you actually use.

Who it is for

Emsam: adults with major depressive disorder. DailyMed. Mayo Clinic describes the skin patch the same way.

Oral selegiline: Parkinson disease in people already on levodopa/carbidopa. MedlinePlus a697046. It may let the clinician lower the levodopa dose if nausea, stomach pain, or dizziness appear.

A licensed clinician decides after a history that covers mood, mania risk, blood pressure, pheochromocytoma, liver or kidney disease, pregnancy plans, and every medicine, cough syrup, and supplement you take. Screen for bipolar disorder before starting Emsam (DailyMed 2.4). Pregnancy: may cause fetal harm. Breastfeeding is not recommended (DailyMed 8.1, 8.2).

Emsam dosing and how to apply the patch

DailyMed:

• Apply to dry, intact skin on the upper torso (below the neck and above the waist), upper thigh, or outer upper arm once every 24 hours.
• Start and target: 6 mg per 24 hours.
• If needed, raise by 3 mg per 24 hours at intervals of no less than 2 weeks, to a maximum of 12 mg per 24 hours.
• Age 65+: 6 mg per 24 hours daily.

MedlinePlus a607003: do not cut patches. If a patch loosens, press it back. If it will not stick, discard it and apply a new one to a different site; change that new patch at the usual time. Rotate sites. Wash the old site with mild soap and water. Do not use alcohol or nail polish remover on residue.

External heat can raise drug delivery. DailyMed and MedlinePlus both warn against heating pads, electric blankets, heat lamps, saunas, hot tubs, heated water beds, and long direct sunlight on the patch.

Missed change: remove the old patch, apply a new one, stay on your usual schedule. Do not wear two patches to catch up (MedlinePlus).

Oral selegiline for Parkinson disease

MedlinePlus a697046:

• Capsule: usually twice a day with breakfast and lunch.
• Orally disintegrating tablet: once a day before breakfast. Peel the blister. Place on the tongue. Do not swallow whole. No food or drink for 5 minutes before and after. The clinician may raise the dose after six weeks. These tablets contain phenylalanine (relevant in PKU).

Do not stop Parkinson medicines suddenly. MedlinePlus lists fever, sweating, stiff muscles, and loss of consciousness as reasons to call the clinician after a sudden stop.

Too much oral selegiline can cause a dangerous blood-pressure spike. Keep the prescribed dose.

Tyramine diet

At Emsam 6 mg per 24 hours, DailyMed and MedlinePlus say you may keep a normal diet if you use the patch as directed.

At 9 or 12 mg per 24 hours, avoid tyramine-rich foods from day one. Keep avoiding them for 2 weeks after you reduce to 6 mg or stop a higher-strength patch. MedlinePlus lists smoked, aged, poorly stored, or spoiled meat, poultry, fish, or cheese; certain fruits, vegetables, and beans; alcoholic drinks; and fermented yeast products. Your clinician or a dietitian should give you a written list.

Sudden severe headache, stiff neck, chest pain, fast heartbeat, sweating, or vomiting can mark a hypertensive crisis. That is an emergency. DailyMed: stop Emsam and treat high blood pressure at once.

Side effects

DailyMed common reactions (2% or more and more than placebo): application-site reaction, headache, insomnia, diarrhea, dry mouth, dyspepsia, rash, pharyngitis, sinusitis.

MedlinePlus patch also lists redness at the site. Serious symptoms that need same-day medical contact include severe headache, chest pain, confusion, stiff neck, and signs of serotonin syndrome (agitation, high fever, twitching).

Oral selegiline common effects (MedlinePlus): dizziness, dry mouth, nausea, insomnia, unusual dreams, constipation or diarrhea, mouth sores with the dissolving tablet. Parkinson disease itself is linked to a higher melanoma risk; MedlinePlus says there is not enough information to say whether selegiline adds to that risk. Ask about skin checks.

Boxed warning applies to the antidepressant patch: watch for new or worse depression, agitation, or suicidal thinking, especially in young adults. Children under 12 must not use Emsam. Ages 12 to 17: not recommended (DailyMed).

Interactions and contraindications

DailyMed contraindications:

• SSRIs, SNRIs, clomipramine, imipramine
• Meperidine, tramadol, methadone, pentazocine, propoxyphene
• Dextromethorphan
• Carbamazepine
• Age under 12
• Pheochromocytoma

Washouts: after a contraindicated drug, wait 4 to 5 half-lives (about one week) before Emsam; after fluoxetine, wait at least 5 weeks. After Emsam, wait at least 2 weeks before a contraindicated drug.

Monitor blood pressure if Emsam is used with buspirone, amphetamines, or cold/weight-loss products that contain pseudoephedrine, phenylephrine, phenylpropanolamine, or ephedrine (DailyMed 5.3).

MedlinePlus also flags St. John’s wort, other MAOIs (including oral selegiline, phenelzine, tranylcypromine, isocarboxazid), mirtazapine, cyclobenzaprine, oxcarbazepine, and bupropion as items to review before you start.

Related Klarity MAOI and interaction reads: phenelzine and oxcarbazepine.

When telehealth is enough

A video visit can often continue a stable adult already on Emsam 6 mg who knows site rotation, heat rules, and the interaction list. New starts need a full medication review, bipolar screen, and a plan for what to do if the patch falls off or a headache hits.

Telehealth is not enough for hypertensive crisis, suspected serotonin syndrome, overdose, or a first manic switch. Oral Parkinson care still needs the neurologist who manages levodopa.

Medicare patients can permanently receive behavioral telehealth in the home. The extra in-person visit rule is waived through December 31, 2027 (HHS).

How Klarity Health fits

Klarity Health connects adults with 2,000+ licensed providers for online depression and anxiety care. A visit can cover history, current medicines, and whether an MAOI is even on the table. Many people stay on an SSRI, SNRI, or other first-line option. Coverage may vary by plan. Verify benefits before you book. Self-pay is also an option.

See online depression treatment · Browse conditions

Disclaimer: Insurance coverage varies by plan. This article does not state that any plan covers selegiline, Emsam, or a Klarity visit. Confirm benefits with your insurer. This is not medical advice. If you are in crisis, call or text 988.

FAQ

Is selegiline the same as Emsam?

Emsam is the selegiline patch for adult major depression. Oral selegiline (Eldepryl, Zelapar) is labeled for Parkinson disease with levodopa/carbidopa. Same generic name, different products and rules.

Do I need a tyramine diet on Emsam?

Not at 6 mg per 24 hours if you use the patch as directed. Yes at 9 or 12 mg per 24 hours, and for 2 weeks after you leave those doses (DailyMed, MedlinePlus).

Is selegiline a controlled substance?

DailyMed lists DEA Schedule: None for Emsam.

Can I start Emsam right after I stop Prozac?

No. DailyMed requires at least 5 weeks after fluoxetine because of its long half-life.

Can a telehealth clinician prescribe selegiline?

A licensed clinician licensed in your state can discuss it after a full review. Many clinicians reserve MAOIs for people who have already tried other antidepressants. No article can promise a prescription.

What if I get a sudden severe headache on the patch?

Treat it as an emergency. Hypertensive crisis is possible, especially on higher doses or with the wrong food or drug. Stop the patch and get urgent care (DailyMed).