Rasagiline Drug Profile

What is Rasagiline?

Rasagiline is a prescription medication that belongs to a class of drugs called monoamine oxidase type B (MAO-B) inhibitors. It is primarily used to treat Parkinson’s disease, either as a standalone treatment in early-stage disease or in combination with other medications like levodopa in more advanced stages. This oral medication helps improve motor symptoms and can reduce fluctuations in movement control.

Uses

• Early Parkinson’s disease: Used as initial therapy to help control tremor, rigidity, and bradykinesia (slowness of movement) when symptoms are mild to moderate
• Advanced Parkinson’s disease: Added to levodopa therapy to help reduce “off” periods when medication effects wear off between doses
• Motor fluctuation management: Helps smooth out the ups and downs in movement control that occur as Parkinson’s disease progresses
• Neuroprotection: May potentially slow the progression of Parkinson’s disease, though this benefit is still being studied
• Dyskinesia reduction: Can help decrease abnormal involuntary movements that sometimes develop with long-term levodopa use

How it works

Rasagiline works by blocking the enzyme monoamine oxidase type B (MAO-B), which is responsible for breaking down dopamine in the brain. By inhibiting this enzyme, rasagiline helps preserve dopamine levels in brain areas affected by Parkinson’s disease. This increased dopamine availability helps improve the communication between nerve cells that control movement and coordination.

Side effects

Common side effects:

• Headache
• Joint pain or arthralgia
• Indigestion or dyspepsia
• Depression or mood changes
• Fall or accidental injury
• Flu-like symptoms
• Conjunctivitis (pink eye)
• Dry mouth

Serious side effects requiring immediate medical attention:

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• Severe high blood pressure (hypertensive crisis)
• Hallucinations or psychotic episodes
• Sudden onset of sleep or sleep attacks
• Severe skin reactions including melanoma
• Signs of serotonin syndrome (confusion, fever, rapid heart rate)

Warnings and precautions

• Tyramine-rich foods: Patients should avoid foods high in tyramine (aged cheeses, cured meats, fermented products) as they can cause dangerous blood pressure spikes when combined with rasagiline
• Liver impairment: Dosage reduction is required in patients with mild liver problems, and the medication should not be used in moderate to severe liver disease
• Pregnancy and breastfeeding: Safety has not been established in pregnant or nursing women, and the medication should only be used if potential benefits outweigh risks
• Skin cancer monitoring: Regular skin examinations are recommended as Parkinson’s patients may have increased melanoma risk
• Mental health effects: Can worsen depression or cause hallucinations, particularly in elderly patients or those with existing psychiatric conditions

Interactions

• Antidepressants: Dangerous interactions with SSRIs, SNRIs, tricyclics, and MAO inhibitors can cause serotonin syndrome
• Meperidine (pethidine): Can cause severe reactions including coma and should be completely avoided
• Dextromethorphan: Found in cough medicines, can cause psychosis and bizarre behavior when combined with rasagiline
• St. John’s Wort: This herbal supplement can increase serotonin levels and cause dangerous interactions
• Sympathomimetics: Decongestants and stimulants can cause severe blood pressure increases
• Ciprofloxacin: This antibiotic significantly increases rasagiline blood levels and requires dose adjustment
• Tyramine-containing foods: Aged cheeses, wine, and fermented foods can cause hypertensive crisis
• Other MAO inhibitors: Combining with other MAO inhibitors can cause severe and potentially fatal reactions

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Dosage

The typical adult dosage of rasagiline is 1 mg taken once daily, with or without food. For patients taking certain medications like ciprofloxacin or those with mild liver impairment, the dose is reduced to 0.5 mg once daily. When used alongside levodopa, the same 1 mg daily dose is usually maintained. The medication should be taken at the same time each day for optimal effectiveness. Dosage adjustments should always be made under the guidance of a healthcare provider who can monitor for effectiveness and side effects.

Sources: FDA DailyMed drug labels (public domain), BNF, WHO Essential Medicines List. This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before starting or stopping any medication.

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