Rasagiline

How it works

By selectively and irreversibly inhibiting MAO-B, it reduces the breakdown of dopamine in the brain, thereby enhancing dopaminergic transmission.

Prescribing in practice

• It should not be combined with pethidine, and concurrent use with other MAO inhibitors or sympathomimetics carries a risk of serotonin syndrome or hypertensive reactions, so combinations must be reviewed carefully.
• When used as an adjunct to levodopa it can increase dopaminergic adverse effects such as dyskinesia, which may require a reduction in the levodopa dose.
• Caution is needed in hepatic impairment, as systemic exposure is increased.

Monitoring

Monitor for dopaminergic effects, dyskinesia, impulse-control behaviours and any features suggestive of serotonin toxicity when combined with serotonergic drugs.

Counselling the patient

• Report any new gambling, compulsive shopping, hypersexuality or binge-eating behaviour, as impulse-control disorders can occur with dopaminergic therapy.
• Tell any prescriber you take rasagiline before starting new medicines, particularly antidepressants and certain painkillers.
• Daytime sleepiness and sudden onset of sleep can occur, which may affect driving.

Evidence & guidelines

Rasagiline's efficacy in early and adjunctive Parkinson's disease was demonstrated in randomised trials including the TEMPO and PRESTO studies, and it is recommended as a treatment option by NICE.