Comprehensive medication guide to Emsam including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$60–$77.50 typical copay once prior authorization is approved; covered by approximately 88% of insurance plans. With the Emsam Savings Card (commercially insured only), copay can be reduced to as little as $20/month.
Estimated Cash Pricing
$2,678–$2,799 average retail for a 30-day supply (brand only; no generic available); as low as $2,274 with a GoodRx coupon. Commercially insured patients can reduce cost to as little as $20/month with the Emsam Savings Card from Viatris.
Medfinder Findability Score
62/100
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Emsam is the brand name for the selegiline transdermal system — a once-daily skin patch used to treat major depressive disorder (MDD) in adults and adolescents aged 12 and older. It was FDA-approved on February 27, 2006, and holds a unique distinction: it is the only transdermal antidepressant patch approved in the United States, and the only antidepressant that is not taken orally.
Emsam belongs to the monoamine oxidase inhibitor (MAOI) drug class. It is manufactured by Viatris (formerly Mylan Specialty / Somerset Pharmaceuticals) and is available in three strengths: 6 mg/24hr, 9 mg/24hr, and 12 mg/24hr. No generic version is available as of 2026.
Emsam is typically prescribed for patients who have not responded to standard antidepressants such as SSRIs or SNRIs, or who have atypical depression features including mood reactivity, hypersomnia, increased appetite, and rejection sensitivity. The American Psychiatric Association specifically recommends MAOIs for atypical and treatment-resistant depression.
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Emsam works by irreversibly inhibiting the enzyme monoamine oxidase (MAO) in the brain. MAO is responsible for breaking down key mood-regulating neurotransmitters — serotonin, norepinephrine, and dopamine. By blocking MAO, Emsam allows these chemicals to accumulate at higher levels in the brain, which produces antidepressant effects.
What makes Emsam unique among MAOIs is its transdermal delivery system. The patch delivers selegiline through the skin directly into the bloodstream, bypassing the digestive tract. At the starting dose of 6 mg/24hr, this route of delivery spares enough gastrointestinal MAO-A enzyme activity that patients do not need to follow a tyramine-restricted diet — a significant clinical advantage over oral MAOIs, which require strict dietary restrictions at all doses.
At higher doses (9 mg and 12 mg/24hr), systemic MAO inhibition is more complete, and tyramine dietary restrictions become necessary. The MAO inhibition caused by Emsam is irreversible, meaning it persists for up to 14 days after the last patch is removed — which has important implications for drug interaction safety and medication transitions.
6 mg/24hr — transdermal patch
Starting dose; no dietary restrictions required. Patch size: 20 cm² (20 mg total selegiline).
9 mg/24hr — transdermal patch
Intermediate dose; tyramine dietary restrictions required. Patch size: 30 cm² (30 mg total selegiline).
12 mg/24hr — transdermal patch
Maximum dose; tyramine dietary restrictions required. Patch size: 40 cm² (40 mg total selegiline).
Emsam is not on the FDA's official drug shortage list as of 2026, and it continues to be manufactured and distributed by Viatris. However, many patients experience significant difficulty filling their prescriptions because Emsam is a niche, brand-only specialty medication that most retail pharmacies do not stock on their shelves.
Emsam accounts for less than 1% of all antidepressant prescriptions in the US, giving retail pharmacies little incentive to carry it in inventory. Most patients fill Emsam through specialty pharmacies (CVS Specialty, Walgreens Specialty, Accredo, Optum Rx) or mail-order pharmacies designated by their insurance plan. Retail pharmacies can typically special-order Emsam within 1–3 business days.
If you're struggling to find Emsam at a pharmacy near you, medfinder can help. medfinder calls pharmacies near you to find which ones can fill your Emsam prescription and texts you the results — saving you the time and frustration of calling pharmacies yourself.
Emsam is not a controlled substance, so it can be prescribed by any licensed healthcare provider in the United States without special DEA authorization. However, due to the complexity of MAOI management — including strict drug interaction protocols and 14-day washout requirements — most prescribing occurs within psychiatric specialty practices.
Psychiatrists (most common; highest familiarity with MAOI safety protocols)
Psychiatric Nurse Practitioners (PMH-NPs)
Primary Care Physicians (PCPs) — can prescribe but often refer complex MAOI cases to psychiatry
Physician Assistants (PAs) in psychiatric practices
Neurologists (occasionally, for patients with comorbid neurological conditions)
Because Emsam is not a controlled substance, it can be prescribed via telehealth without an in-person visit. Platforms such as Talkiatry, Brightside, and Klarity Health offer psychiatric medication management via telehealth and may be able to evaluate and prescribe Emsam for appropriate patients.
No. Emsam (selegiline transdermal system) is not a controlled substance. It has no DEA scheduling. This means it can be prescribed by any licensed healthcare provider — including via telehealth — without special prescribing authorization. Prescriptions can be refilled without the restrictions that apply to Schedule II or III controlled substances.
While Emsam is not a controlled substance, it does carry significant safety requirements due to its MAOI mechanism of action. It has a black box warning for suicidal thoughts and behaviors in pediatric and young adult patients (a warning shared by all antidepressants), and it has strict drug interaction contraindications. It is contraindicated in patients under 12 years of age.
The most commonly reported side effects of Emsam include:
Application site reactions (redness, itching, rash) — approximately 24% of patients
Insomnia — 8–18% of patients
Headache
Dizziness and orthostatic hypotension (low BP when standing)
Dry mouth
Nervousness and abnormal dreams
Diarrhea
Hypertensive crisis (dangerous BP spike, especially at 9/12 mg doses with tyramine-containing foods)
Serotonin syndrome (when combined with serotonergic drugs)
Suicidal thoughts or behaviors (Black Box Warning — monitor in first weeks)
Manic or hypomanic episodes (especially in undiagnosed bipolar disorder)
Severe allergic reactions
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Phenelzine (Nardil)
Oral non-selective MAOI; particularly effective for atypical depression. Generic available, significantly more affordable. Requires strict tyramine dietary restrictions at all doses.
Tranylcypromine (Parnate)
Oral non-selective MAOI with stimulating properties; often used for treatment-resistant depression with fatigue. Generic available. Strict dietary restrictions required.
Isocarboxazid (Marplan)
Oral non-selective MAOI; FDA-approved for depression unresponsive to other treatments. Dietary restrictions required. Less commonly used than Nardil or Parnate.
Vortioxetine (Trintellix)
Novel multimodal antidepressant with a different mechanism from MAOIs. Used for treatment-resistant MDD. Requires a 2-week washout after stopping Emsam before starting. Generally well tolerated.
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SSRIs (fluoxetine, sertraline, escitalopram, etc.)
majorRisk of serotonin syndrome. Strictly contraindicated. Wait 5 weeks after stopping fluoxetine, or 2 weeks after other SSRIs before starting Emsam.
SNRIs (venlafaxine, duloxetine, desvenlafaxine)
majorRisk of serotonin syndrome. Strictly contraindicated. Require 2-week washout before starting Emsam.
TCAs (amitriptyline, nortriptyline, clomipramine)
majorRisk of serotonin syndrome. Strictly contraindicated. Require 2-week washout before starting Emsam.
Carbamazepine (Tegretol)
majorParadoxically increases selegiline blood levels approximately 2-fold, raising risk of hypertensive crisis at any Emsam dose. Strictly contraindicated.
Bupropion (Wellbutrin)
majorRisk of hypertensive reactions via additive dopaminergic/noradrenergic effects. Contraindicated. Wait 2 weeks after stopping Emsam.
Opioids: meperidine, tramadol, methadone
majorRisk of serotonin syndrome or opioid toxicity. Contraindicated. If pain management needed, non-serotonergic opioids may be used with extreme caution.
Amphetamines/stimulants (Adderall, Ritalin, Vyvanse)
majorRisk of acute hypertensive episode. Contraindicated.
Dextromethorphan (DXM, in OTC cough products)
majorRisk of serotonin syndrome. Contraindicated. Avoid all OTC products containing DXM while on Emsam.
Sympathomimetics (pseudoephedrine, phenylephrine)
moderateMay cause significant blood pressure increases. Monitor BP carefully if used with Emsam.
St. John's Wort
majorRisk of serotonin syndrome. Avoid during Emsam therapy.
Emsam occupies a unique and important position in the antidepressant landscape. For patients with treatment-resistant or atypical depression who have not responded to SSRIs, SNRIs, or other first-line agents, it offers a genuinely different mechanism of action — and the convenience of a once-daily patch without oral medication, with no dietary restrictions at the starting dose.
The main challenges are cost, access, and the complexity of MAOI management. The retail price exceeds $2,600/month without assistance, but significant savings are available through the Viatris Savings Card (commercially insured) and patient assistance programs. Availability at retail pharmacies is limited, but specialty pharmacy and mail-order channels are reliable.
If you've been prescribed Emsam and are having trouble filling it, medfinder can help you locate a pharmacy near you that has it in stock. medfinder calls pharmacies on your behalf and texts you the results — making the search for this specialty medication much simpler.
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