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MAO-B Inhibitor — Parkinson's Disease Pregnancy: Avoid — limited data

Rasagiline

Brand names: Azilect

Adult dose

Dose: 1 mg once daily
Route: Oral
Frequency: Once daily
Max: 1 mg/day
Selective, irreversible MAO-B inhibitor — increases dopamine levels in basal ganglia. Monotherapy in early Parkinson's disease or adjunct to levodopa to reduce wearing-off. Possible neuroprotective effect (debated). No tyramine dietary restriction needed (selective MAO-B does not affect MAO-A responsible for tyramine metabolism at therapeutic doses).

Paediatric dose

Route:
Not indicated in children.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Avoid in moderate–severe hepatic impairment.

Clinical pearls

  • No cheese reaction at therapeutic doses — selective MAO-B inhibition does not affect dietary tyramine metabolism (unlike non-selective MAOIs)
  • TEMPO trial: rasagiline 1 mg/day delayed PD progression when started early — suggested possible neuroprotective effect (ADAGIO trial inconclusive; benefit not confirmed)
  • Monitor skin for melanoma — association between PD and melanoma is established; rasagiline may further increase risk (mechanism unclear)

Contraindications

  • Concomitant MAOIs (other MAO-A or MAO-B inhibitors)
  • Meperidine (pethidine) — serotonin syndrome risk
  • Severe hepatic impairment

Side effects

  • Orthostatic hypotension
  • Dyskinesia (when added to levodopa)
  • Hallucinations
  • Headache
  • Serotonin syndrome (with serotonergic drugs)
  • Melanoma risk (controversial — monitor skin)

Interactions

  • MAO-A inhibitors/non-selective MAOIs (hypertensive crisis — contraindicated)
  • SSRIs/SNRIs/TCAs (serotonin syndrome — use with caution)
  • Dextromethorphan (serotonin syndrome — avoid)
  • Ciprofloxacin (CYP1A2 inhibition — doubles rasagiline exposure; max 0.5 mg/day)
  • Meperidine (pethidine) — contraindicated

Monitoring

  • Skin examination (melanoma surveillance)
  • Blood pressure (postural)
  • Dyskinesia if on levodopa

Reference: BNFc; BNF 90; NICE NG71; TEMPO Trial; ADAGIO Trial; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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