The Pharmaceutical Journal
Vol 269 No 7209 p150
3 August 2002

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Patients with Parkinson's disease should not be started on selegiline

The use of selegiline, either alone in early stage Parkinson's disease (PD) or in combination with levodopa for more advanced disease, is not justified in new patients, concludes a review in Prescrire International this month.

Six years ago, a review in the same journal reserved judgement on selegiline but the latest review concludes that, on the basis of newly published data, selegiline is "not acceptable".

The reviewers say the efficacy of selegiline is at best only moderate. Although it delays the need for levodopa therapy by a few months and reduces levodopa requirements, it has no tangible effect on the course of the disease.

In addition, results from a large clinical trial and an epidemiological study suggest that selegiline may cause an increase in mortality, possibly linked to its cardiovascular side effects, although the reviewers acknowledge that it is difficult to draw firm conclusions from the available mortality data. The reviewers conclude that there is no justification for starting new patients on selegiline and that patients already taking selegiline should only continue to do so if they feel a clear benefit from it and are free from risk factors associated with early mortality, especially cardiovascular disease (2002;11:108).