Procedures for Working with MPTP
(1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine) and
MPTP Treated Animals
I.
INTRODUCTION
MPTP (1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine) is a neurotoxin used to induce
Parkinsonism symptoms in experimental models of Parkinson’s Disease (PD). MPTP
can produce irreversible neurological damage indistinguishable from PD in humans
and animals. The inappropriate handling of MPTP may result in exposure and
irreversible neurological damage to research staff.
MPTP is lipophilic which freely and rapidly crosses the blood-brain barrier. It is
metabolized to MPDP+ which is oxidized to the active metabolite MPP+. MPP+ is the
active metabolite that results in neuron cell death. Excretion of unmetabolized MPTP
occurs mainly during first day post injection while MPTP metabolites are excreted up
to four days post injection. Excretion is mainly in the urine; some has been found in
the bile. MPTP metabolites in urine are expected to be ionized and not volatile and be
absorbed by the bedding.
Exposure to staff may occur via needle sticks, aerosolized droplets, skin exposure, or
inhalation of aerosols from MPTP-contaminated bedding. Exposure potential is
greatest during preparation, administration, and when handling the animal bedding
during the first four days after administration.
The purpose of this Standard Operating Procedure (SOP) is to define the safe work
practices and appropriate medical management for staff working with MPTP in your
research laboratory. A lab-specific SOP must be approved by EH&S prior to
Institutional Animal Care and Use Committee (IACUC) approval. For questions or
assistance in completing the SOP that is specific for your laboratory, contact EH&S at
206-221-7770.
UW MPTP SOP Developed by:
Environmental Health and Safety Department
Department of Comparative Medicine
Office of Animal Welfare
Rev. 07/2005, 03/2008, 05/2010, 11/2013
Page 1 of 21
II.
PRIOR TO BEGINNING WORK WITH MPTP (All of the following procedures are required for
employees who plan to work with MPTP or enter MPTP work areas up to four days post administration and after
first cage change)
A.
Medical Management:
1. Prior to initiating work with MPTP, the Principal Investigator (PI),
, and
his/her staff must contact the Employee Health Center (EHC) -UW Campus
(UWC) at 206-685-1026 to schedule an appointment for evaluation and to
receive the post-exposure prophylaxis (PEP) of Selegiline hydrochloride. The
EHC-UWC will prescribe the Selegiline if indicated and there are no
contraindications. The EHC MPTP handout is attached in Appendix 1.
2. Selegiline is obtained prior to beginning work with MPTP. Selegiline must be
immediately available for use in room
in case of exposure. It must be
kept in the white capped container labeled “FOR MPTP USE ONLY.” Each
staff person working with MPTP must have a medical clearance and
prescription. The container must be regularly checked to ensure it is in its
proper place and the use date has not expired. If expired, contact the EHCUWC (206-685-1026) for collection or instructions for proper disposal.
3. The PI,
, must send all personnel who intend to work with MPTP to the
EHC-UWC prior to beginning work and annually thereafter for evaluation and
determination of their ability to successfully take Selegiline.
B.
Respiratory Protection: Respirators are required when working with MPTPtreated animals. You MUST be enrolled the University’s Respiratory Protection
Program prior to wearing a respirator. The PI must complete a Respirator
Request to initiate the process of respirator medical clearance, training and fit
testing: http://www.ehs.washington.edu/ohsresp/index.shtm#supervisors.
C.
Laboratory Set-up:
1. Order PRE-WEIGHED injectable form MPTP from the manufacturer. MPTP
must be purchased in hydrochloride or tartrate salt form rather than as a free
base. The chemical must be stored in a secondary container in a lock-box in
or adjacent to the fume hood. Only people who work with MPTP will have the
key to the lock-box. Post Appendix 2 on the fume hood.
2. MPTP must be entered into the chemical inventory (MyChem) system for all
laboratories and rooms where the chemical will be stored.
3. The protocol / procedures for new PIs and research staff who have not
worked with MPTP in the past should be peer reviewed by another PI familiar
with handling highly toxic chemicals.
4. It is very desirable to practice procedures using a surrogate before handling
MPTP to ensure all necessary equipment is available.
UW MPTP SOP
Rev. 07/2005, 03/2008, 05/2010, 11/2013
Page 2 of 21
5. The PI or laboratory manager must identify, in writing, specific individuals
authorized to handle MPTP and those who will be handling MPTP-treated
animals within four days post treatment.
6. Check for proper operation of the eyewash and fume hood prior to handling
MPTP.
7. Establish procedures for make-up of 1% bleach disinfectant solution on a
daily basis.
8. Ensure receptacles and procedures for correct waste disposal (including
hazardous waste and incineration waste) are in place prior to initiation of
work.
D.
Employee Training and Notification:
1. The PI,
, must ensure his/her staff are trained on this SOP, review the
MPTP Material Safety Data Sheet / Safety Data Sheet (MSDS/SDS), the
hazards of MPTP, and the proper use of equipment (syringes, fume hood,
emergency eyewash, etc.) and personal protective equipment (PPE) prior to
beginning work. This training must be documented in Appendix 4. For
assistance, contact EH&S at 206-221-7770.
2. The following EH&S training must be taken and documented prior to
beginning work:
a. Online fume-hood training
b. Managing laboratory chemicals
c. Respirator training and fit testing
E.
III.
EH&S Notification: Notify EH&S (206-221-7770) one week prior to beginning
initial work for review of the final SOP and to check that training and pre-work
actions have been completed. After the initial EH&S SOP approval, mock-work
using surrogate materials or the first experiment may be observed by EH&S staff
to evaluate work practices and procedures. Annual reviews may be conducted by
EH&S staff.
ACCIDENTS, INJURIES, AND POTENTIAL EXPOSURES (Post these procedures in
the laboratory where the work will be conducted):
A.
In the event of a recognized percutaneous or mucous membrane exposure to
MPTP:
1. Immediately take prescribed Selegiline as directed by the EHC-UWC.
2. Initiate first aid at the worksite:
a. Contaminated skin should be washed with copious amounts of soap and
UW MPTP SOP
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Page 3 of 21
water for 15 minutes.
b. Contaminated eyes and mucous membranes should be irrigated for 15
minutes, using saline or water.
3. Go directly to the University of Washington Medical Center Emergency Room
(ER). Be sure to give your name, your exact location, and that you were
exposed to MPTP.
4. Notify the PI,
at
contact
at
as soon as possible. If he/she is not available,
.
5. Report the incident on the UW Online Accident Reporting System (OARS):
http://www.ehs.washington.edu/ohsoars/index.shtm
B.
In the event of a suspect exposure to MPTP:
1. Immediately initiate first aid at the worksite as outlined above.
2. Go directly to the University of Washington Medical Center Emergency Room
(ER). Be sure to disclose your name, your exact location, and that you may
have been exposed to MPTP. Based on the likelihood of exposure, Selegiline
may be recommended.
3. Notify the PI,
contact
at
at
as soon as possible. If he/she is not available,
.
4. Report the incident on the UW Online Accident Reporting System (OARS):
http://www.ehs.washington.edu/ohsoars/index.shtm
C.
Fume-hood alarm:
In the event the safety monitor is in alarm, lower sash until it returns to normal,
then press the reset button. If monitor continues to alarm with the sash below
18”, cover caging, stop work, and call EH&S at 206-543-9510 to assess whether
maintenance is needed. If fume-hood maintenance is required, follow
procedures outlined in section VIII, Emergency Transport of MPTP-Treated
Animals.
IV.
Spill procedures
A.
Spills inside a fume hood:
1. Close the fume hood sash.
2. Remove any contaminated PPE, wash hands for 15 minutes, and replace
PPE.
UW MPTP SOP
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3. Clean up the spill with 1% bleach solution (made daily) and paper towels.
4. Remove and replace plastic backed pads.
5. Clean all exposed surfaces with 1% fresh bleach.
6. Dispose of all clean-up materials as hazardous chemical waste as described
in Section X.
B.
Liquid Spills outside a fume hood:
1. Cordon off the area and restrict access.
2. Contact EH&S Environmental Programs (EP) at 206-543-0467 for advice as
to whether a contractor should come in and clean up the spill.
C.
Bedding spills outside a fume hood:
1. Cordon off the area and restrict access.
2. Pour 1% bleach solution on the spill, allowing the liquid to flow into the
bedding, taking care to not create dust. Allow the liquid to sit for 30 minutes.
3. Leave the room. Remove any contaminated PPE, wash hands for 15 minutes,
and replace PPE.
4. Collect all the bedding using paper towels. Place the bedding in the container
for incineration.
5. Wipe up the spill area with paper towels. Discard paper towels as hazardous
chemical waste.
6. For further information, contact the EH&S EP at 206-543-0467 for advice as
to whether a contractor should come in and clean up the spill.
V.
PERSONAL PROTECTIVE EQUIPMENT (PPE)
A.
PPE must be worn whenever working with MPTP or MPTP-treated animals and
their waste within four days of last administration. These activities include
preparing MPTP solutions, administering MPTP to animals, entering MPTPanimal room within first four days of administration, first cage change:
 Standard vivarium scrubs
 Rear-closing disposable water-proof gown
 Disposable liquid resistant sleeve covers (wrist guards)
 Double nitrile gloves
 Chemical safety goggles or faceshield
 N95 disposable respirator
UW MPTP SOP
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B.
Cage changing: The cage changes must be done every seven days. When
possible, cage changes should not be performed for the first four days postinjection. However, protocol-specific dosing schedules may require cages to be
changed within four days post-injection. With the current dosing regimen, cages
will be changed on days 1 (prior to the first MPTP injection), and days
.
Cage changes on days
will involve MPTP-contaminated bedding.
C.
Frequent glove changes are recommended. Change gloves immediately if their
integrity has been compromised (e.g., punctured, torn) or if contaminated.
D.
Protective clothing should be changed prior to entering non- MPTP designated
areas.
E.
Remove PPE in the following order:
1. Outer gloves (place in MPTP-waste to be incinerated).
2. Put on a new pair of gloves.
3. Remove goggles/face shield. Spray goggles with 1% bleach. Wipe.
4. Sleeve covers (to non-contaminated regular trash).
5. Disposable gown (to non-contaminated regular trash).
6. N95 respirator (to non-contaminated regular trash).
7. Outer pair of gloves (to non-contaminated regular trash).
8. Exit the MPTP administration area, remove inner pair of gloves and wash
hands.
F.
Dispose of protective clothing which is not contaminated into the regular trash.
Dispose of contaminated clothing into hazardous solid waste container for
collection. When waste bags are full, remove from the waste cans, tie shut with a
label indicating either “MPTP-contaminated waste for incineration” (orange
bags), or “Uncontaminated waste” (black bags), spray with 1% bleach and leave
next to the door for disposal by Comparative Medicine staff. See Section X
(Waste) for more details.
UW MPTP SOP
Rev. 07/2005, 03/2008, 05/2010, 11/2013
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Overview of MPTP Personal Protective Equipment and Room Restrictions
Procedures
MPTP Preparation and
administration in
approved fume hood
PPE
rear closing water proof
gown,
N95 respirator,
double nitrile gloves,
disposable sleeves
covers,
chemical safety goggles
or face shield
Restrictions
Room
: restricted to
only those staff authorized
to work with MPTP.
N95 respirator,
double-gloves,
sleeves covers,
chemical safety goggles
or face shield
Standard laboratory PPE:
 lab coat,
 gloves,
Room
: restricted to
only those staff authorized
to work with MPTP.





Animal housing for one
to four days post last
injection in approved
fume hood
Animal housing after
four days post last
injection
VI.




Room
: No
restricted access
RESEARCH STAFF ONLY: MPTP PREPARATION AND ADMINISTRATION TO
ANIMALS
A.
As with all highly hazardous chemicals, two research staff must be available at all
times when working with MPTP, administering MPTP, and working with MPTPadministered animals until four days post last administration. The second person
does not have to be in the room during handling or administration but must be
readily available in the event of an emergency.
B.
During preparation and administration of MPTP: All of Room
to only those research staff authorized to work with MPTP.
C.
The approved fume hood in Room
for MPTP work is restricted to staff
authorized to work with MPTP and MPTP treated animals for a minimum of four
days after last MPTP administration. PPE must be changed prior to exiting the
room. The approved fume hood is the designated location for preparing,
administering, and housing animals.
D.
All animal procedures and housing must be performed in a centralized animal
facility. For the first four days post-injection, the door to the MPTP animal room
and the approved fume hood must be posted with the appropriate MPTP signs
so it is clear that the MPTP and treated animals are present. Appendix 2 must
be posted on the fume hood when animals administered MPTP are present.
The red MPTP sign in Appendix 3 must be posted on animal housing room
UW MPTP SOP
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is restricted
door.
E.
Only trained animal husbandry and veterinary staff may enter the room up to four
days after the final administration.
F.
MPTP and MPTP solutions must be stored in labeled, tightly capped containers.
The container label must include the identity of the hazardous contents (i.e.,
MPTP) and the appropriate hazard warning (i.e., neurotoxin).
G.
MPTP, as received from the manufacturer/vendor in its original undiluted form,
must be stored in a lock box inside or adjacent to a clutter free certified and
approved chemical fume hood. Only people who work with MPTP will have the
key to the lock-box. The box will be permanently attached to the side of the fume
hood / to the wall adjacent to the fume hood. If the lock box is outside the hood,
the MPTP must be kept in a secondary container inside the lock box and while
moving it between the lock box and the fume hood.
H.
The fume hood must be posted with the red MPTP sign in Appendix 2.
I.
MPTP solutions must be prepared in a certified chemical fume hood. Appropriate
PPE must be worn, as noted in Section III. All work surfaces must be covered
with absorbent, plastic-backed, disposable absorbent pads. Make the 1% bleach
solution and prepare the fume hood with all necessary materials (pads, paper
towels, syringes, decapicones, syringe tray, etc.) prior to opening the lock box.
J.
When the lock box is adjacent to the fume hood, it is safer and more convenient
if the back-up person opens the lock box, allowing the primary investigator to
transfer the MPTP from the lock box to the fume hood.
K.
Use only needle-locking syringes or disposable syringe-needle units (i.e., needle
is integral to the syringe). Used disposable needles must not be bent, sheared,
broken, recapped, removed from disposable syringes, or otherwise manipulated
before disposal. Never leave the tip exposed on work surface. After each
injection, immediately place the syringe-needle unit in a sharps disposal
container located in the fume hood or approved containment.
L.
Disposable labware should be used when preparing MPTP solutions. If nondisposable glassware is used, it must be triple rinsed in 1% bleach solution prior
to washing. The rinsate must be collected and disposed by EH&S as hazardous
chemical waste (see section X: MPTP Waste).
M.
When all work with MPTP is complete, place th MPTP vial in the lock
box/secondary container. Change outer gloves, then spray the exterior surface
with 1% bleach and wipe down. Carefully remove all absorbent pads and dispose
as hazardous chemical waste. Wipe all surfaces with a 1% bleach solution and
double bag the wipes or paper towels and discard with regular garbage. TURN
THE HOOD LIGHT OFF.
UW MPTP SOP
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N.
Tie the MPTP-contaminated waste bag closed, spray down the exterior surface
with 1% bleach, then place in a second bag labeled as hazardous chemical
waste. Tie the second bag closed and leave in the room for disposal.
O.
Change the non-contaminated waste bag. Tie the full non-contaminated waste
bag closed and leave in the room for disposal.
P.
Remove PPEinto the non-contaminated waste located next to the door, and exit
the room.
Q.
If emergency maintenance must be done during the first four days after the
injection, stop all work and decontaminate the area. Ensure that all concentrated
and dilute concentrations of MPTP are closed and properly stored. Please escort
the worker into the space and remain in the room during the entire maintenance.
If work needs to be done in the fume hood, the animals should be moved to
another fume hood following the procedures outlined below. The sign should
remain on the door and fume hood to inform other staff of the MPTP and MPTPtreated animals. After the four days post injection, no extra PPE is required in
this space and any requirements for escorts will be determined by the
Department of Comparative Medicine staff.
VII. TRANSPORTING MPTP
A.
MPTP containers must be transported between rooms using the following
method:
1. MPTP solutions must always be transported in a labeled, sealed, primary
container within a sealed, leakproof, unbreakable secondary container.
2. The primary container must be placed inside a secondary container lined with
a plastic-backed pad or other absorbent material.
3. If a spill does occur outside the lab, follow the spill procedures above; cordon
off the area and restrict access until all of the MPTP has been cleaned up.
4. The secondary container must be cleaned with 1% bleach solution after each
use.
5. All PPE must be removed prior to leaving the designated area.
6. PPE must be put on prior to handling the MPTP container in the new space.
B.
All locations where MPTP will be stored must be entered in MyChem.
UW MPTP SOP
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VIII. EMERGENCY TRANSPORT OF MPTP-TREATED ANIMALS
A.
In the event of an emergency requiring the treated animals be moved before the
first cage change, contact EH&S (206-221-7770) and the Office of Animal
Welfare.
B.
A new fume hood and room for procedures and animal housing must be
approved by the Office of Animal Welfare and EH&S.
C.
in a fume hood, prepare animals for transport:
1. Secure the cage tops to the cage bottoms with tape.
2. Wipe down the cages with 1% fresh bleach solution made daily.
3. Pack up to four cages in the transport box. Transport boxes may be obtained
from the Department of Comparative Medicine.
4. Secure the transport lid using the snaps.
5. Carefully transport the animals to the new fume hood or animal housing room.
6. Ensure no cage has opened during transport.
7. Remove cages from the transport box into the chemical fume hood.
IX.
ANIMAL HOUSING
Research staff will be responsible for changing the animal cages during the course of
the experiments and for the final cage change four days after the last injection. The
Department of Comparative Medicine staff will ONLY care for the animals if there is a
sick animal, flooded cage, or other special circumstances.
A.
Animals will be housed in room
centralized animal facility.
B.
The animals will be housed in disposable cages; all bedding will remain in the
cages and be disposed of at the same time/re-useable cages.
C.
For the first four days post-injection, the fume hood in room
is the
designated location for preparing, administering, and housing animals. The door
to each MPTP-animal room must be posted in such a manner that it is clear that
the fume hood contains MPTP-treated animals. The fume hood may only be
used for the MPTP work (preparing, administering MPTP and housing animals).
Post the sign in Appendix 2 on the chemical fume hood .
D.
The animal cages must also be properly labeled with cage cards stating “MPTP –
neurotoxin.”
UW MPTP SOP
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Page 10 of 21
, where the fume hood is located in a
E.
For the first four days post-injection, cover the cages with filter bonnets. Place
the cages in a certified chemical fume hood. Ensure the lids are secured to the
cage.
F.
No animal husbandry staff is allowed in the animal housing room during the
animal procedures.
G.
When possible, cage changes should not be performed for the first four days
post-injection. However, protocol-specific dosing schedules may require cages
to be changed within four days post-injection.
H.
Four days after the final MPTP injection, the animals may be transferred to clean,
standard caging and the MPTP door signs and cage tags may be removed.
1. Cage change should be performed wearing appropriate PPE (section V) and
in a chemical fume hood. Work atop absorbent pads. The fume hood should
be wiped down with 1% bleach solution and water after use.
2. Dirty reusable cages and reusable racks should be wiped down with 1%
bleach solution for 10 minutes, rinsed with water, and covered with a full
drape.
3. Dispose of bedding by misting the bedding with minimum 1% bleach solution,
carefully place bedding into plastic bag, then into incineration container.
Alternatively, bedding may be completely saturated with 1% bleach solution,
allowed to sit for 10 minutes, and then double bagged and disposed with
regular trash.
4. Reusable caging, cage racks and reusable water bottles can be sprayed with
1% bleach solution, allowed to sit for 10 minutes, wiped down with paper
towels and then bagged for transport to facility cage wash. Any extra water in
the water bottle should have 1% bleach added and allowed to sit for 10
minutes.
I.
X.
The use of special PPE is not required after the animals have been transferred to
clean cages (after four days post-injection).
MPTP WASTE
A.
Unused concentrated MPTP (including empty vials) waste is managed as
hazardous chemical waste through EH&S. See
http://www.ehs.washington.edu/epowaste/chemwaste.shtm
B.
Spill cleanup materials, soiled PPE, and absorbent pads contaminated with
MPTP should be double bagged and managed as hazardous chemical waste
through EH&S as above.
UW MPTP SOP
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Page 11 of 21
C.
Grossly contaminated solids can be decontaminated with 0.1 N hydrochloric acid
or 1% bleach. After decontamination, the solids can be disposed with regular
garbage or reused. The liquid waste containing dilute MPTP and decontaminant
should be managed as hazardous chemical waste through EH&S.
D.
All other solid waste, including gowns and gloves, believed not to have contact
with MPTP can be double bagged and discarded with regular garbage.
E.
Animal bedding: Bedding from first change (four days after last administration)
must be incinerated. Complete the UW Biomedical Waste Account Request
Form to arrange for proper containers and pick-up. Specify that pick-up is for
incineration. Bedding from subsequent cage changes can be double bagged
and discarded with regular garbage.
F.
Animal carcasses: Carcasses that have received MPTP within the last four days
must be incinerated. Complete the UW Recycling and Solid Waste Biomedical
Waste Account Request Form to arrange for proper containers to be delivered
and pick-up. Specify that pick-up is for incineration. Carcasses that have not
received MPTP in the past four days can be double bagged and discarded with
regular garbage.
G.
Sharps are collected in an appropriate sharps container, and picked up by the
UW biomedical waste contractor for incineration.
Principal Investigator Signature:
Date:
References:
1. Kopin, I.J. 1987. MPTP: An industrial chemical and contaminant of illicit narcotics stimulates a new era in research on
Parkinson’s disease. Environmental Health Perspectives. 75, 45-51.
2. National Institutes of Health (NIH), Office of Research Services, Division of Occupational Health and Safety:
Procedures for Working with MPTP or MPTP-Treated Animals.
http://dohs.ors.od.nih.gov/pdf/Procedures_for_Working_with_MPTP_or_MPTP_Treated_Animals_july%202006.pdf
3. Przedborski, Serge, Jackson-Lewis , V., Naini, A.b., Jakowec , M., Petzinger , G., Miller, R., Akram , M. 2001. The
parkinsonian toxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP): A technical review of its utility and safety.
Journal of Neurochemistry. 76, 1265-1274.
4. Yang, S.C., Markey, S.P., Bankiewiez, K.S., London, W.T., Lunn, G. 1988. Recommended safe practices for using the
neurotoxin MPTP in animal experiments. Laboratory Animal Science. 38, 563-567.
UW MPTP SOP
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Page 12 of 21
Appendix 1: Employee Health Center (EHC) MPTP Handout
MPTP Research Group
Campus Health Services- UW
Hall Health
206-685-1026
Background: MPTP (1-methyl-4-phenyl-1,2,5,6 tetrahydropyridine) and its analogues (ie.,
2’-CH2-MPTP or 2’-NH2-MPTP) are neurotoxins used in animal models to simulate
Parkinson’s syndrome. Low dose exposure (ie. 0.1mg/kg body weight) may cause
irreversible neurological damage to dopamine neurons (exposure may result in Parkinson’s
disease-like syndrome).
Definition of Exposure:
 Skin puncture with materials contaminated with MPTP or analogues
 Ingestion of MPTP or analogues
 Mucous membrane exposure (ie nose, eyes, mouth)
 Inhalation of MPTP or analogues powder
 Cutaneous exposure if skin is broken (i.e. wound)
Immediate Post-Exposure actions:
 Follow EH&S OHS
 Post exposure prophylaxis: initiate immediately following exposure
1. Treatment for significant exposures to MPTP is four (4) selegiline (Eldepryl) 5 mg
capsules p.o. immediately. The employee should immediately initiate first aid at the
worksite by washing the contaminated skin with copious amounts of soap and water
for 15 minutes. Eyes and mucous membranes should be irrigated for 15 minutes
with water or normal saline.
2. Alternate treatment for significant exposures to MPTP analogues (e.g. 2’-CH2-MPTP
or 2’=NH2-MPTP) is phenelzine sulfate (Nardil) 15 mg, four tablets p.o.
3. Report to UWMC or Harborview Emergency Room for medical examination,
assessment, and further treatment as needed.
NOTE: treat percutaneous exposures as low as 0.001mg/kg. Treat
ingestion/mucosal exposures and inhalation exposures as low as 0.1mg/kg.
Consider treatment for any exposure especially if there is any burning or irritation at
the site of exposure.
Ongoing Post-Exposure treatment:
 Selegiline 5 mg, #18, three (3) tablets twice each day for significant exposure
to MPTP
 Phenelzine sulfate 15 mg, #12, two (2) tablets twice each day is given for
significant exposures to MPTP analogues (2’-CH2-MPTP or 2’-NH2-MPTP)
 Follow up with EHC-UW and possible referral to neurologist
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Rev. 07/2005, 03/2008, 05/2010, 11/2013
Page 13 of 21
Per: Occupational Medical Service, DOHS National Institutes of Health 05/2008
http://dohs.ors.od.nih.gov/pdf/Procedures_for_Working_with_MPTP_or_MPTP_Treated_Animals.pdf
Selegiline U.S. BRAND NAME- Eldepryl
PHARMACOLOGIC CATEGORY
Antidepressant, Monoamine Oxidase Inhibitor
Anti-Parkinson's Agent, MAO Type B Inhibitor
REASONS NOT TO TAKE THIS MEDICINE



If you have an allergy to selegiline or any other part of this medicine
If you are taking meperidine
If you have taken isocarboxazid, phenelzine, or tranylcypromine in the last 14 days.
Monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine) must be
stopped 14 days before this medicine is started. Taking the two together could cause
dangerously high blood pressure.
How is it best taken?
Avoid eating foods such as aged cheeses and meats, soy sauce, soy bean including paste, Miso
soup, Italian green beans (fava beans), snowpea or broad bean pods, sauerkraut, kimchee,
concentrated yeast extracts (Marmite), wine, beer including alcohol-free beer.
Take this medicine with food.
What do I do if I miss a dose? (This does not apply to patients in the hospital): Take a missed
dose as soon as possible. If it is almost time for the next dose, skip the missed dose and return
to your regular schedule.
Do not take a double dose or extra doses.
Do not change dose or stop medicine. Talk with healthcare provider.
What are the precautions when taking this medicine?
If you are taking a high dose (10 mg per day) of this medicine, avoid aged meats and cheeses,
soy sauce, certain beans, sauerkraut, beer, concentrated yeast extracts, and others. Talk with
healthcare provider.
Check medicines with healthcare provider. This medicine may not mix well with other
medicines.
If you are taking this medicine and have high blood pressure, talk with healthcare provider
before using over-the-counter products that may increase blood pressure. These include cough
or cold remedies, diet pills, stimulants, ibuprofen or like products, and certain natural products
or supplements.
Avoid alcohol (includes wine, beer, and liquor).
UW MPTP SOP
Rev. 07/2005, 03/2008, 05/2010, 11/2013
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Tell healthcare provider if you are pregnant or plan on getting pregnant or if you are breastfeeding.
What are some possible side effects of this medicine?
Feeling lightheaded, sleepy, having blurred vision, or a change in thinking clearly. Avoid
driving, doing other tasks or activities that require you to be alert or have clear vision until you
see how this medicine affects you.
Nausea or vomiting. Small frequent meals, frequent mouth care, sucking hard, sugar-free
candy, or chewing sugar-free gum may help.
PH ENELZINE- US BRAND NAME NARDIL
PHARMACOLOGIC CATEGORY
Antidepressant, Monoamine Oxidase Inhibitor
REASONS NOT TO TAKE THIS MEDICINE
If you have an allergy to phenelzine or any other part of this medicine.
If you have any of the following conditions: Liver disease, pheochromocytoma, severely
weakened heart, or uncontrolled high blood pressure.
If you are taking any of these medicines: Citalopram, fluvoxamine, paroxetine, or sertraline
(SSRI antidepressants). Do not use within two weeks of other antidepressants.
Fluoxetine should be stopped for at least five weeks before starting this medicine.
How is it best taken?
Follow diet instructions. Certain foods and drinks taken with this medicine can cause very
dangerous reactions such as sudden high blood pressure. To prevent these problems, get a list
of foods to avoid from a nutritionist.
Avoid eating foods such as aged cheeses and meats, soy sauce, soy bean including paste, Miso
soup, Italian green beans (fava beans), snowpea or broad bean pods, sauerkraut, kimchee,
concentrated yeast extracts (Marmite), wine, beer including alcohol-free beer.
If medicine is stopped, follow diet for at least two more weeks.
What do I do if I miss a dose? (does not apply to patients in the hospital) Take a missed dose
as soon as possible. If it is almost time for the next dose, skip the missed dose and return to
your regular schedule.
Do not take a double dose or extra doses.
Do not change dose or stop medicine. Talk with healthcare provider.
UW MPTP SOP
Rev. 07/2005, 03/2008, 05/2010, 11/2013
Page 15 of 21
What are the precautions when taking this medicine?
If you have a weakened heart, talk with healthcare provider.
Fluoxetine should be stopped for five weeks before starting this medicine.
You may not be alert. Avoid driving, doing other tasks or activities until you see how this
medicine affects you.
Do not use over-the-counter medicines containing dextromethorphan or pseudoephedrine.
Avoid alcohol (includes wine, beer, and liquor).
Avoid caffeine (for example, tea, coffee, cola) and chocolate intake.
Tell healthcare provider if you are pregnant or plan on getting pregnant.
What are some possible side effects of this medicine?
Feeling lightheaded, sleepy, having blurred vision, or a change in thinking clearly. Avoid
driving, doing other tasks or activities that require you to be alert or have clear vision until you
see how this medicine affects you.
Feeling dizzy. Rise slowly over several minutes from sitting or lying position. Be careful
climbing.
Headache
Constipation. More liquids, regular exercise, or a fiber-containing diet may help. Talk with
healthcare provider about a stool softener or laxative.
Inability to sleep
High blood pressure can rarely occur.
REASONS TO CALL HEALTHCARE PROVIDER IMMEDIATELY WHILE TAKING SELEGILINE OR
PHENYLZINE
Signs of a life-threatening reaction. These include wheezing; chest tightness; fever; itching;
bad cough; blue skin color; fits; or swelling of face, lips, tongue, or throat.
If you are planning to harm yourself or the desire to harm yourself increases.
Chest pain or pressure, fast heartbeat, or passing out
Confusion; very nervous; anger with sweating, shivering, stiffness, or shaking
Severe nausea or vomiting
Any rash
UW MPTP SOP
Rev. 07/2005, 03/2008, 05/2010, 11/2013
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No improvement in condition or feeling worse
How should I store these medicines?
Store at room temperature.
Protect from moisture. Do not store in a bathroom or kitchen.
Reference: Up-to-date; accessed 6/29/06
Information for the Patient:
All patients, should be warned that the following foods, beverages and medications (Table II
and III) must be avoided while taking selegiline or phenelzine, and for two weeks after
discontinuing use.
------------------------------------------------------------------Table II
Foods and Beverages to Avoid During Phenelzine Therapy
Meat and Fish:
Pickled herring, liver, dry sausage
(including Genoa salami, hard salami,
pepperoni, and Lebanon bologna)
Vegetables:
Broad bean pods (fava beans)
Dairy Products:
Cheese (cottage cheese and cream cheese
are allowed), yogurt
Beverages:
Beer and wine, alcohol-free and reduced-alcohol
beer and wine products
Miscellaneous:
Yeast extract (including brewer's yeast in
large quantities), excessive amounts of
chocolate or caffeine
------------------------------------------------------------------Patients being treated with selegiline or phenelzine should also avoid any spoiled or improperly
refrigerated, handled or stored protein-rich
foods such as meats, fish and dairy products, including foods that
may have undergone protein breakdown by aging, pickling,
fermentation, or smoking to improve flavor.
------------------------------------------------------------Table III
OTC Medications to Avoid During Phenelzine Therapy
1. Cold and cough preparations (including those containing
dextromethorphan)
2. Nasal decongestants (tablets, drops or spray)
3. Hay-fever medications
4. Sinus medications
5. Asthma inhalant medications
UW MPTP SOP
Rev. 07/2005, 03/2008, 05/2010, 11/2013
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6. Antiappetite medicines
7. Weight-reducing preparations
8. L-tryptophan containing preparations
------------------------------------------------------------Last revised Marguerite McCadden, ARNP 05/09/2008
UW MPTP SOP
Rev. 07/2005, 03/2008, 05/2010, 11/2013
Page 18 of 21
Appendix 2: Post on fume hood
MPTP
NEUROTOXIN
&
MPTP-TREATED LIVE
ANIMALS
UW MPTP SOP
Rev. 07/2005, 03/2008, 05/2010, 11/2013
Page 19 of 21
Appendix 3: Post on lab door until 4 days post last administration
MPTP
NEUROTOXIN
ENTRY RESTRICTED TO
AUTHORIZED* PERSONNEL
*EH&S approved SOP, enrollment in respirator program, proper PPE, prescription
selegeline in lab, documented training on SOP.
UW MPTP SOP
Rev. 07/2005, 03/2008, 05/2010, 11/2013
Page 20 of 21
Appendix 4: Documentation of MPTP SOP Training
Name
UW MPTP SOP
Rev. 07/2005, 03/2008, 05/2010, 11/2013
MPTP SOP
Training Date
Page 21 of 21
Signature