Safinamide

How it works

It inhibits MAO-B to increase dopamine availability and additionally modulates glutamate release through state-dependent sodium channel blockade.

Prescribing in practice

• It should not be combined with other MAO inhibitors, pethidine or potent serotonergic drugs because of the risk of serotonin syndrome and hypertensive reactions.
• Because of its retinal pharmacology it is contraindicated in patients with severe pre-existing retinal disorders such as retinitis pigmentosa or advanced diabetic retinopathy.
• As an adjunct to levodopa it may worsen dyskinesia, which can require a reduction in the levodopa dose.

Monitoring

Monitor for dyskinesia, impulse-control disorders, blood pressure changes and, in those with risk factors, ophthalmological status.

Counselling the patient

• Report any new impulsive or compulsive behaviour, such as gambling or excessive spending.
• Tell other prescribers you take safinamide before starting antidepressants or certain painkillers.
• Mention any change in vision to your clinician.

Evidence & guidelines

Safinamide's efficacy as an adjunct to levodopa in fluctuating Parkinson's disease was shown in randomised controlled trials and it is recommended as an option by NICE.