Why Do Doctors Prescribe Rasagiline?

March 10, 2020
Doctors prescribe Rasagiline for the treatment of Parkinson's disease. It can be used in adjunctive therapy with Levodopa or on its own. In this article, discover how it’s administered and its contraindications.

Doctors prescribe Rasagiline for the treatment of Parkinson’s disease. Typically, it can be used in adjunctive therapy with Levodopa, a precursor of dopamine that used to be the treatment of choice for Parkinson’s disease. However, doctors also prescribe it on its own without Levodopa.

Parkinson’s disease is a type of movement disorder that occurs when the neurons don’t produce enough of a chemical that’s extremely important for the brain, known as dopamine. Below, we’ll explain how Rasagiline can help.

How Rasagiline works

This drug is a selective inhibitor of MAO-B. The inhibition of MAO-B protects dopamine from extraneuronal degradation. Therefore, it increases its concentration in the brain. Initially, doctors prescribed it along with levodopa. Nowadays, they prescribe both drugs in combination in cases of patients with motor fluctuations at the end of the dose.

A doctor writing a prescription.
This drug is a selective inhibitor of MAO-B. Therefore, it protects dopamine from degradation.

How doctors prescribe Rasagiline: Dosage and administration

Overall, the common form of administration is oral, at a dose of 1 mg every 24 hours, on its own or in combination with Levodopa. The patient can take it with or without food. Also, doctors don’t need to modify the dose in elderly patients.

Experts don’t recommend Rasagiline to minors. This is because there isn’t enough data on its safety and efficacy in children and adolescents.

You may want to read: Rasagiline and its Use in Parkinson’s Disease

Contraindications of Rasagiline

Doctors shouldn’t prescribe Rasagiline in the following conditions:

  • First, if there’s a hypersensitivity to the active substance or any of the excipients.
  • Also, if the patient is already being treated with monoamine oxidase (MAO). This includes if the patient is taking medicines and natural products not subject to medical prescription, such as St. John’s wort. A patient needs to take a 14-day break from the moment they discontinue using rasagiline to begin treatment with MAO inhibitors or pethidine.
  • Finally, in patients with acute or chronic liver failure. Also, patients with mild liver failure must take special precautions when they start treatment with Rasagiline. However, if liver failure progresses from mild to acute, they need to discontinue treatment.

Interaction with other drugs and other forms of interaction

As we mentioned above, taking Rasagiline with other MAO inhibitors or antidepressants is contraindicated. These include:

  • Natural antidepressants, such as St. John’s wort
  • SSRIs–selective serotonin reuptake inhibitors
  • SNRIs–serotonin-norepinephrine reuptake inhibitors
    Tricyclic and tetracyclic antidepressants

Also, experts advise against taking it along with sympathomimetic drugs, such as those found in nasal and oral decongestants, or in cold medications that contain ephedrine or pseudoephedrine.

A sick woman in bed with pills next to her.
Rasagiline is contraindicated with other MAO inhibitors or antidepressants.

In this regard, enzyme cytochrome P450 (CYP450) plays a role in the metabolism of most drugs. In fact, in vitro metabolism studies indicate that the isozyme of cytochrome P450 1A2 (CYP1A2) is the main enzyme responsible for the metabolism of rasagiline. Therefore, co-administration of Rasagiline and Ciprofloxacin, a CYP1A2 inhibitor, may affect plasma concentrations of Rasagiline. Thus, patients should take it with caution.

Furthermore, there’s a risk that the plasma levels of Rasagiline in patients who smoke could be decreased, due to the induction of the metabolizing enzyme CYP1A2.

This article may also interest you: Antidepressants and their Contraindications

Possible side effects

Overall, here are the most common side effects of this drug:

  • Flu or infections caused by the influenza virus
  • Skin carcinoma.
  • Leukopenia
  • Allergy, rhinitis, or conjunctivitis
  • Decreased appetite
  • Depression and hallucinations
  • Headaches
  • Vertigo
  • Angina pectoris
  • Dermatitis
  • Flatulence
  • Urgent urination
  • Fever or malaise
  • Musculoskeletal pain, cervical pain, and arthritis

Can doctors prescribe rasagiline to pregnant women?

Currently, there are no clinical data on exposure to rasagiline during pregnancy. However, studies in animals don’t indicate direct or indirect harmful effects on pregnancy. Also, this includes embryo-fetal development, birth, and postnatal development.

Nevertheless, pregnant women who take it should be careful. Also, Rasagiline may interfere with breastfeeding. According to experimental data, this drug inhibits prolactin secretion. However, it’s unknown whether rasagiline is excreted in breast milk. Therefore, medical professionals should take precautions when they prescribe it to lactating women.

  • Agencia Española del Medicamento (2019). Centro de información del medicamento. Ficha técnica. Rasagilina. Disponible en: https://cima.aemps.es/cima/dochtml/ft/80346/FT_80346.html
  • Jiang DQ, Wang HK, Wang Y, et al (2019). Rasagiline combined with levodopa therapy versus levodopa monotherapy for patients with Parkinson’s disease: a systematic review. Neurol Sci. doi: 10.1007/s10072-019-04050-8. [Epub ahead of print]. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/3144657

  • Rang HP, Dale MM (2012). Farmacología 7ª edición. Enfermedades neurodegenerativas, 39: 488