Xadago, a Drug for Parkinson's Disease

Xadago is a drug used in combination with levodopa to treat Parkinson's disease. In the face of such a difficult pathology, another therapeutic option is always useful.

Reviewed and approved by the pharmacist Franciele Rohor de Souza.

Written by Editorial Team

Last update: 27 November, 2022

Xadago is a drug whose active ingredient is safinamide. This drug is used as an adjunctive therapy for the treatment of Parkinson’s disease , being used for episodes when difficulty in movement is experienced, known as off episodes.

Xadago acts by increasing the level of the neurotransmitter dopamine in the brain. Dopamine is a substance involved in the control of movement. In people with Parkinson’s disease, dopamine is at lower levels than in unaffected people.

How does Xadago work?

Safinamide, Xadago’s main active ingredient, reversibly and specifically inhibits MAO-B. However, Xadago also has other mechanisms of action such as the following:

• It’s a calcium channel antagonist
• It inhibits dopamine reuptake
• It works as an antagonist in the release of glutamate

This drug is the only one with a dual mechanism of action for Parkinson’s disease. For this reason, it influences the control of symptoms and motor disturbances when the pathology is in the intermediate or advanced stages. It’s in those periods when there are movement fluctuations.

Currently there are other MAO-B inhibitors for the treatment of Parkinson’s disease, but they don’t have the other mechanisms of action that safinamide has.

What is it used for?

This drug is recommended for the treatment of Parkinson’s disease as an add-on therapy. It’s added to a stable dose of levodopa alone or in combination with other antiparkinsonian drugs.

Its ideal use is among patients going through the middle or advanced stages of the disease, and who experience fluctuations of movement. Apart from Xadago, the pharmacological options for these people today are:

• MAO-B inhibitors, such as selegiline or rasagiline
• Levodopa with a LAAD inhibitor
• COMT inhibitors, such as entacapone

How is Xadago taken?

The recommended starting dose of Xadago is one 50-milligram tablet; however, this dose can be increased to one 100-milligram tablet once daily.

It doesn’t need to be taken separately from food, and its effect is experienced two to three weeks after the start of therapy.

When on treatment with Xadago, before starting to take any other drug, you should consult a specialist, especially if you’re taking any of the following groups of drugs:

• Other MAO inhibitors
• Anti-influenza drugs containing dextromethorphan, ephedrine, or pseudoephedrine
• Selective serotonin reuptake inhibitors (SSRIs) used for anxiety disorders
• Serotonin and norepinephrine reuptake inhibitor (SNRI) drugs used for depression

Possible adverse effects

In several studies carried out in patients with mid to advanced stage Parkinson’s disease, taking safinamide as adjunctive treatment to levodopa, the following adverse effects were observed as frequent:

• Insomnia
• Difficulty in controlling the execution of voluntary movements
• Feeling sleepy
• Dizziness and headaches

Rare adverse effects included urine infections, anemia, low white blood cell count, red blood cell disturbances, poor appetite, high cholesterol and blood sugar levels. There were also hallucinations and dreams with nightmares or feelings of fear.

Finally, rare, low-frequency adverse effects may appear, such as nasal allergy, oral infections, abrupt weight loss, increased potassium levels in the blood, disorientation, or visual disturbances.

A difficult illness to treat

Parkinson’s disease is a difficult disease to deal with. For patients, daily life is complicated, and for the healthcare team, access to the therapies that the patient really requires is a problem.

Xadago can be a therapeutic alternative in patients in the middle or advanced stages of the disease who are affected by fluctuating movement problems. It is used on its own, but rather in combination with levodopa or other dopaminergics.