WHAT IS THIS MEDICINE AND WHAT IS IT USED FOR?
Rasagiline is a monoamine oxidase type B (MAO-B) inhibitor — it works by
blocking an enzyme called MAO-B that breaks down dopamine in the brain. In
Parkinson's disease, the brain's dopamine-producing cells are progressively
lost, leading to a shortage of dopamine — the chemical messenger that controls
smooth, coordinated movement.
By blocking MAO-B, rasagiline slows the breakdown of whatever dopamine
remains, increasing its availability in the brain and helping to improve
Parkinson's symptoms.
Rasagiline is used for the treatment of Parkinson's disease in adults: as
a single treatment (monotherapy) in early Parkinson's disease to delay the need
for levodopa; or as an add-on treatment (adjunct therapy) alongside levodopa in
more advanced disease to help smooth out the wearing-off effects that occur
when levodopa's benefit fades between doses.
3. HOW TO TAKE THIS MEDICINE
The dose is 1mg once daily — one tablet taken at the same time each day.
Rasagiline can be taken with or without food. There is no dose titration — the
full 1mg dose is started from day one. Take at a consistent time each day,
ideally in the morning.
Rasagiline is a selective MAO-B inhibitor — at the recommended 1mg dose,
it primarily blocks MAO-B (which metabolises dopamine) rather than MAO-A (which
metabolises tyramine and serotonin).
This selectivity means the strict dietary tyramine restrictions that
apply to older, non-selective MAO inhibitors (like older antidepressants or
procarbazine — entry 155) are NOT required for rasagiline at 1mg. However, the
drug interaction concerns (serotonin syndrome risk with certain
antidepressants) still apply.
⚠ PATIENT TIP: Although rasagiline does not
require the full MAOI tyramine-free diet, it does interact with certain
antidepressants, opioids, and other medicines. Never start any new medicine —
including over-the-counter cold remedies containing decongestants or
prescription antidepressants — without checking with your neurologist or
pharmacist first.
4. POSSIBLE SIDE EFFECTS
|
How Common? |
Side Effects |
|
Common (as
monotherapy) |
Headache, flu-like
symptoms, joint pain, depression, and indigestion |
|
Common (as an add-on with
levodopa) |
Involuntary movements
(dyskinesia), falls, joint pain, low blood pressure on standing (orthostatic
hypotension), nausea, constipation, dry mouth |
|
Serious — Tell Your
Doctor |
Serotonin syndrome (if
combined with SSRIs, SNRIs, or certain opioids): restlessness, agitation,
rapid heart rate, tremor, muscle rigidity, confusion, high temperature — seek
emergency care immediately. Hypertensive crisis (very rare at 1mg, but
possible if dietary tyramine restriction is grossly ignored or if prohibited
medicines are taken). Impulse control disorders (as with other dopaminergic
medicines): compulsive gambling, hypersexuality, excessive spending — report
to neurologist. Hallucinations, confusion (particularly in older patients or
with levodopa combination). |
5. WHO SHOULD NOT TAKE THIS MEDICINE
Rasagiline must not be combined with other MAO inhibitors (including
moclobemide, phenelzine, tranylcypromine, selegiline, safinamide) — combination
can cause hypertensive crisis. It must not be combined with meperidine
(pethidine) — risk of fatal serotonin-like reaction. It should not be used in
severe liver disease. Use with caution with SSRIs, SNRIs, and tricyclic
antidepressants (serotonin syndrome risk). Do not use in patients taking St.
John's Wort.
⚠ SEROTONIN SYNDROME RISK: Combining rasagiline
with certain antidepressants — especially SSRIs (fluoxetine, sertraline,
citalopram), SNRIs (venlafaxine, duloxetine), and tricyclics — can trigger
serotonin syndrome: a potentially life-threatening reaction causing agitation,
tremor, rapid heart rate, and high temperature. If a switch to or from an
antidepressant is needed, a washout period is required. Discuss any
antidepressant use with your neurologist.
⚠ PETHIDINE (MEPERIDINE) IS ABSOLUTELY
CONTRAINDICATED: The combination of rasagiline with pethidine can cause a
severe, potentially fatal reaction with rigidity, hyperpyrexia (extreme fever),
and cardiovascular collapse. Always carry a card stating you take rasagiline —
in any medical emergency, ensure emergency staff know.
⚠ IMPULSE CONTROL DISORDERS: Dopaminergic
treatments for Parkinson's can cause compulsive behaviours. Patients and carers
should monitor for out-of-character urges to gamble, spend, eat, or seek sexual
activity. These are side effects — not character flaws — and must be reported
to the neurologist.
6. MEDICINES THAT INTERACT WITH THIS TREATMENT
Absolute contraindications: other MAO inhibitors (at least 14-day washout
required between rasagiline and a non-selective MAOI), meperidine/pethidine
(fatal interaction). Serious cautions: SSRIs, SNRIs, tricyclic antidepressants
(serotonin syndrome risk — 14-day washout from rasagiline before starting
these, and 14 days off antidepressants before starting rasagiline for most
agents; fluoxetine requires a 5-week washout before rasagiline).
Sympathomimetics (adrenaline-like decongestants such as pseudoephedrine,
phenylephrine): increased blood pressure risk.
Ciprofloxacin: inhibits CYP1A2, which metabolises rasagiline — can double
rasagiline plasma levels; reduce dose to 0.5mg if used concurrently or avoid.
Fluvoxamine: similar CYP1A2 inhibition — avoid. St. John's Wort: avoid.
Alcohol: increases CNS depression.
7. HOW TO STORE THIS MEDICINE
Store below 25°C. Keep in original packaging away from moisture and
light. Keep out of reach of children.
8. PRESCRIPTION REQUIREMENT
|
Field |
Details |
|
Status |
Prescription Only
Medicine (POM) — Specialist (neurology) prescription required for initiation;
may be managed by GP long-term |
9. GUIDANCE FOR PATIENTS & CAREGIVERS
Take one tablet every morning at the same time, with or without food. You
do not need to follow a tyramine-free diet with rasagiline at the standard 1mg
dose — but you must tell every doctor, pharmacist, and nurse that you take it
before any new medicine is prescribed.
This is especially important before anyone prescribes an antidepressant
or gives you a painkiller injection (particularly pethidine). Carry a medicine
alert card. Watch for and report any unusual compulsive behaviours to your
neurologist — gambling, spending, sexual urges, or binge eating that seems out
of character. Tell your neurologist if antidepressants are being considered — a
careful planned switch is required.
10. PHARMACIST & PRESCRIBER NOTES
|
Field |
Details |
|
Clinical Dispensing
Notes |
Selective MAO-B
inhibitor — at 1mg, tyramine dietary restriction is not required (unlike
non-selective MAOIs), but drug interactions remain critical.
Pethidine/meperidine: absolute contraindication — potentially fatal
serotonin-like syndrome. SSRI/SNRI/TCA: serotonin syndrome risk — washout
periods required before initiating antidepressants (14 days off rasagiline;
fluoxetine requires 5-week washout before rasagiline can restart). CYP1A2
inhibitors (ciprofloxacin, fluvoxamine): significantly increase rasagiline
exposure — dose reduction or avoidance. St. John's Wort: avoid.
Sympathomimetics (OTC decongestants): elevated BP risk — advise
decongestant-free products for colds. Impulse control disorder counselling
for patient AND carer. Hallucination risk — especially in elderly and those
on concurrent levodopa. No dose titration required. Carry MAO inhibitor
warning card. |
11. FREQUENTLY ASKED QUESTIONS
Q: Do I need to avoid certain foods like with older MAO inhibitors?
No — rasagiline at the standard 1mg dose is selective for MAO-B and does
not significantly block MAO-A, which is the enzyme responsible for breaking
down tyramine in food. Unlike older non-selective MAO inhibitors (or high-dose
rasagiline), you do not need to follow a tyramine-free diet. However, drug
interactions still require careful attention.
Q: Can I take antidepressants alongside rasagiline?
With great care and only under a neurologist's guidance. Combining rasagiline
with SSRIs, SNRIs, or tricyclic antidepressants risks serotonin syndrome — a
potentially serious reaction. If you need an antidepressant, your neurologist
will plan a careful transition with appropriate washout periods between
medicines.
Q: What should I do if I need a cold remedy?
Many over-the-counter cold and flu remedies contain decongestants like
pseudoephedrine or phenylephrine, which can raise blood pressure when combined
with MAO inhibitors. Ask your pharmacist for a decongestant-free product — one
that only contains paracetamol, for example.
Q: Will rasagiline ever need to be increased?
Rasagiline is used at a fixed 1mg once-daily dose — there is no
escalation. If Parkinson's symptoms progress, your neurologist may add levodopa
or adjust other medicines rather than increasing the rasagiline dose.