Rasagiline - Indications, Dosages, side effects

Rasagiline is a potent, selective, and irreversible inhibitor of MAO type B. It confers neuroprotective, anti-apoptotic, and anti-oxidant effects that delay the progression of neuronal degeneration.

It is used for the treatment of Parkinson disease

Rasagiline Dose in Adults

Dosage in the treatment of Parkinson disease:

Monotherapy or adjunctive therapy (not including levodopa):
- 1 mg once daily is given
- the maximum dose is 1 mg once daily
Adjunctive therapy with levodopa:
- The initial dose is 0.5 mg once daily
- It can be increased to 1 mg once daily based on response and tolerability
- The maximum dose is 1 mg once daily
When added to existing levodopa therapy, a dose reduction of levodopa might be required to avoid exacerbation of dyskinesias
Dose reduction with concomitant ciprofloxacin or other CYP1A2 inhibitors:
- The maximum dose is 0.5 mg once daily

Rasagiline Dose in Children

Not recommended for use in Children.

Rasagiline pregnancy Risk Factor: C

Animal reproduction studies have shown adverse effects.
Limited data are available on rasagiline usage during pregnancy.

Use of Rasagiline during lactation

It is unknown if rasagiline can be found in breast milk.
According to the manufacturer the decision to breastfeed while on therapy should consider the risks to infants, the benefits to breastfeeding to infants, and the benefits to mother during treatment.

Rasagiline Dose in Kidney Disease:

US Labeling
- Mild to moderate impairment
  - There is no need to adjust the dosage.
- Severe impairment
  - The manufacturer's labeling does not include any dosage adjustments.
Canadian labeling
- Mild impairment
  - There is no need to adjust the dosage.
- Moderate to severe impairment
  - It is not recommended to use

Rasagiline Dose in Liver Disease:

Mild impairment (Child–Pugh score 5-6:
- Maximum daily dose is 0.5mg
Moderate to severe impairment (Child Puugh score 7-15)
- It is not recommended.

Common Side Effects of Rasagiline Include:

Cardiovascular:
- Orthostatic Hypotension
- Hypotension
Central Nervous System:
- Headache
Gastrointestinal:
- Nausea
Neuromuscular & Skeletal:
- Dyskinesia
Miscellaneous:
- Trauma

Less Common Side Effects of Rasagiline Include:

Cardiovascular:
- Peripheral Edema
- Increased Blood Pressure
- Angina
- Bundle Branch Block
- Chest Pain
Central Nervous System:
- Dizziness
- Drowsiness
- Ataxia
- Depression
- Falling
- Abnormal Dreams
- Dystonia
- Malaise
- Paresthesia
- Insomnia
- Hallucinations
- Myasthenia
- Vertigo
- Anxiety
Dermatologic:
- Skin Rash
- Ecchymosis
- Diaphoresis
- Alopecia
- Skin Carcinoma
- Vesiculobullous Rash
Endocrine & Metabolic:
- Weight Loss
- Impotence
- Libido Decreased
Gastrointestinal:
- Constipation
- Dyspepsia
- Diarrhea
- Vomiting
- Xerostomia
- Abdominal Pain
- Anorexia
- Gastroenteritis
- Gingivitis
- Hernia
- Gastrointestinal Hemorrhage
Genitourinary:
- Hematuria
- Urinary Incontinence
Hematologic And Oncologic:
- Hemorrhage
- Leukopenia
Hepatic:
- Liver Function Tests Increased
Infection:
- Infection
Neuromuscular & Skeletal:
- Arthralgia
- Back Pain
- Neck Pain
- Tenosynovitis
- Arthritis
- Abnormal gait
- Hyperkinesias
- Hypertonia
- Neuropathy
- Weakness
Ophthalmic:
- Conjunctivitis
Renal:
- Albuminuria
Respiratory:
- Flu-Like Symptoms
- Dyspnea
- Cough
- Upper Respiratory Tract Infection
- Rhinitis
- Asthma
Miscellaneous:
- Fever
- Allergic Reaction

Contraindication to Rasagiline Include:

Use of an MAO inhibitor, including selective MAO-B inhibitors, in conjunction with MAO.
meperidine
Methadone
propoxyphene
Tramadol within 14 Days of rasagiline
Concomitant use of cyclobenzaprine or dextromethorphan with St John's wort

Warnings and precautions

CNS effects
- You may experience a change in your mental state or behavior.
- There have been instances of intense urges to gamble, spend money, binge-eating, increased sexual urges and/or inability to control such urges.
- These signs should be monitored.
- Consider reducing or stopping therapy if symptoms develop.
Dyskinesia
- When used in conjunction with levodopa, dysskinesia can occur.
- Side effects may be lessened by decreasing the dosage of levodopa.
Hypertension
- It can lead to hypertension exacerbation. Monitor for hypertension new-onset or not properly controlled after taking the drug.
- If blood pressure is high, medication adjustment may be necessary.
Melanoma
- Rasagaline can increase the risk of melanoma, but this has also been linked to Parkinson's disease.
- Skin checks should be performed often and routinely on patients.
Orthostatic hypotension
- Orthostatic hypotension can be caused by it, especially when combined with levodopa.
- Orthostatic hypotension is most common in the first two months of therapy, but it decreases as time goes by.
Serotonin syndrome/neuroleptic malignant Syndrome-like Reactions:
- Serotonin syndrome (SS), can be caused by concurrent antidepressant use (eg, SSRI/SNRI/TCA, tetracyclic, triazolopyridine antidepressants).
- Concomitant use of rasagiline is not recommended within two weeks (within five weeks for antidepressants such as fluoxetine).
- SS has been associated with concomitant MAO inhibitors, especially selective MAO-B inhibitors, meperidine, methadone, and propoxyphene. Rasagiline should not be administered concurrently within two weeks.
- In association with rapid dose reductions, withdrawals, or modifications to drugs that could increase central dopaminergic tone, a symptom complex similar to neuroleptic malignant (NMS), has been observed.
- It might be challenging to tell the difference between more severe NMS-like behaviours like hyperthermia and muscle rigidity and SS symptoms like tremors, myoclonus, and agitation. Both of these syndromes should be closely watched for in patients.
- The Hunter Serotonin Toxicity Criteria can be used to diagnose SS.
- If you notice any signs or symptoms, stop taking antidepressants and all concomitant medications immediately.
Somnolence
- It has happened to me that I have experienced somnolence or fallen asleep while doing daily activities (including driving motor vehicles).
- Sometimes symptoms can appear as soon as treatment is initiated. Some events may occur up to one year after rasagiline was started.
- Prior to starting therapy, think about things that could raise these risks, like concurrent use of sedatives, sleep issues, or concurrent use of medication that raises rasagiline plasma levels (eg ciprofloxacin).
- Keep an eye out for signs of lethargy and drowsiness.
- If you experience significant sleepiness during the day or fall asleep episodes, especially while driving or eating, it should be stopped.
- If more therapy is required, do so. Inform the patient to avoid driving and other risky activities.
Hepatic impairment
- Patients with mild hepatic impairment should be cautious; a reduction in dose is recommended.
- This product should not be used by patients with severe impairments or moderate to severe impairments.
Psychotic disorders
- Patients with severe psychotic disorders should not use this medication. It can worsen psychosis by increasing central dopaminergic tone.
- Rasagaline's effectiveness can be affected by many psychosis treatments that reduce central dopaminergic tone.

Rasagilinesv: Drug Interaction

Risk Factor C (Monitor therapy)
Abiraterone Acetate	May increase the serum concentration of CYP1A2 Substrates (High risk with Inhibitors).
Alfuzosin	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Altretamine	May enhance the orthostatic hypotensive effect of Monoamine Oxidase Inhibitors.
Amifampridine	Agents With Seizure Threshold Lowering Potential may enhance the neuroexcitatory and/or seizure-potentiating effect of Amifampridine.
Antiemetics (5HT3 Antagonists)	Could make serotonin modulators' serotonergic effects stronger. Serotonin syndrome might occur from this.
Antipsychotic Agents	Serotonin modulators might make antipsychotic drugs more harmful or toxic. Serotonin modulators, in particular, may enhance dopamine blockade, potentially raising the risk for neuroleptic malignant syndrome. Serotonin modulators' serotonergic effects may be strengthened by antipsychotic drugs. Serotonin syndrome might occur from this.
Antipsychotic Agents (Second Generation [Atypical])	Antipsychotic drugs' hypotensive effects may be enhanced by blood pressure-lowering medications (Second Generation [Atypical]).
Barbiturates	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Benperidol	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Beta2-Agonists	Beta2Agonists may have a more negative or toxic effect when combined with monoamine oxidase inhibitors.
Betahistine	The serum concentration of betahistine may rise in response to monoamine oxidase inhibitors.
Blood Glucose Lowering Agents	Blood Glucose Lowering Agents' hypoglycemic effects may be strengthened by monoamine oxidase inhibitors.
Blood Pressure Lowering Agents	May increase the hypotensive effects of agents associated with hypotension.
Brimonidine (Ophthalmic)	Monoamine Oxidase Inhibitors might make brimonidine more harmful or poisonous (Ophthalmic). Brimonidine serum levels may rise in response to monoamine oxidase inhibitors (Ophthalmic).
Brimonidine (Topical)	Monoamine Oxidase Inhibitors might make brimonidine more harmful or poisonous (Topical). Brimonidine serum levels may rise in response to monoamine oxidase inhibitors (Topical).
Brimonidine (Topical)	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Broccoli	May decrease the serum concentration of CYP1A2 Substrates (High risk with Inducers).
Cannabis	May decrease the serum concentration of CYP1A2 Substrates (High risk with Inducers).
Cerebrolysin	May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.
Chlorphenesin Carbamate	May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.
Codeine	Monoamine Oxidase Inhibitors might make codeine more harmful or poisonous.
CYP1A2 Inducers (Moderate)	May decrease the serum concentration of CYP1A2 Substrates (High risk with Inducers).
Cyproterone	May decrease the serum concentration of CYP1A2 Substrates (High risk with Inducers).
Diazoxide	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Dihydrocodeine	The serotonergic effects of monoamine oxidase inhibitors may be enhanced. Serotonin syndrome might occur from this.
Domperidone	Monoamine Oxidase Inhibitors may intensify Domperidone's negative/toxic effects. Monoamine Oxidase Inhibitors may lessen Domperidone's therapeutic efficacy. Monoamine Oxidase Inhibitors' therapeutic effects may be lessened by dolperidone.
Doxapram	Doxapram's hypertensive effect may be strengthened by monoamine oxidase inhibitors.
EPINEPHrine (Nasal)	Epinephrine's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors (Nasal).
Epinephrine (Racemic)	Epinephrine's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors (Racemic).
EPINEPHrine (Systemic)	Epinephrine's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors (Systemic).
Esketamine	The hypertensive effects of monoamine oxidase inhibitors might be enhanced.
Herbs (Hypotensive Properties)	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Hypotension-Associated Agents	Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents.
Lormetazepam	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Metaraminol	Metaraminol's hypertensive effect may be strengthened by monoamine oxidase inhibitors.
Metaxalone	Could make serotonin modulators' serotonergic effects stronger. Serotonin syndrome might occur from this.
Metoclopramide	Serotonin modulators may intensify Metoclopramide's harmful or hazardous effects. These could appear as signs of neuroleptic malignant syndrome or serotonin syndrome.
Molsidomine	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Naftopidil	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nicergoline	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Nicorandil	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Nitroprusside	Nitroprusside's hypotensive impact may be strengthened by blood pressure-lowering medications.
Norepinephrine	Monoamine Oxidase Inhibitors may increase Norepinephrine's ability to raise blood pressure.
Obeticholic Acid	May increase the serum concentration of CYP1A2 Substrates (High risk with Inhibitors).
Opioid Agonists	May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Peginterferon Alfa-2b	May increase the serum concentration of CYP1A2 Substrates (High risk with Inhibitors).
Pentoxifylline	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Phosphodiesterase 5 Inhibitors	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Pipamperone [INT]	May reduce the therapeutic impact of Parkinson's drugs (Monoamine Oxidase Inhibitor). Pipamperone [INTtherapeutic ]'s impact may be reduced by anti-Parkinson drugs (monoamine oxidase inhibitors).
Prostacyclin Analogues	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Quinagolide	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Teriflunomide	May decrease the serum concentration of CYP1A2 Substrates (High risk with Inducers).
Risk Factor D (Consider therapy modification)
Amifostine	Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered.
Benzhydrocodone	The serotonergic effects of monoamine oxidase inhibitors may be enhanced. The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
COMT Inhibitors	Serotonin syndrome might occur from this. Treatment: Patients on monoamine oxidase inhibitors (MAOIs) or those who have stopped taking MAOIs within 14 days shouldn't use benzhydrocodone.
CYP1A2 Inhibitors (Moderate)	May raise the level of Rasagiline in the serum. Treatment: Patients on mild CYP1A2 inhibitors should have their daily dose of rasagiline limited to 0.5 mg.
DOPamine	DOPamine's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors. Treatment: Patients who are taking (or have recently taken) monoamine oxidase inhibitors should start dopamine at no more than one-tenth (1/10) of the typical dose. Keep an eye out for a heightened hypertensive reaction to dopamine.
HYDROcodone	Monoamine Oxidase Inhibitors could make the harmful or hazardous effect worse.
Iohexol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iohexol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Iomeprol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iomeprol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iomeprol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Iopamidol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iopamidol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Levodopa-Containing Products	The negative or hazardous effects of monoamine oxidase inhibitors can be increased. The emergence of hypertensive responses when levodopa is combined with nonselective MAOI is of special concern. Treatment: It is not advised to take levodopa and nonselective MAO inhibitors (MAOIs) together.
Lithium	Levodopa should be started at least two weeks after stopping the nonselective MAOI. Observe patients who are on levodopa with a selective MAOI. Monoamine Oxidase Inhibitors might make lithium's harmful/toxic effects worse. Management: Use extreme caution when using this combo. When combination treatment is therapeutically necessary, keep a vigilant eye out for any symptoms of serotonin syndrome or toxicity.
Obinutuzumab	The hypotensive effects of blood pressure-lowering medications may be strengthened. Management: Take into account temporarily stopping blood pressure-lowering drugs starting 12 hours before the start of the obinutuzumab infusion and lasting until 1 hour after it.
OxyCODONE	May enhance the serotonergic effect of Monoamine Oxidase Inhibitors. This could result in serotonin syndrome. Management: Seek alternatives when possible. Avoid use of oxycodone/naltrexone during and within 14 days after monoamine oxidase inhibitor treatment. Non-US labeling for some oxycodone products states that such use is contraindicated.
Pindolol	Pindolol's hypotensive impact may be strengthened by monoamine oxidase inhibitors. Management: Pindolol's Canadian labelling warns against using a monoamine oxidase inhibitor at the same time.
Reserpine	Monoamine Oxidase Inhibitors may intensify Reserpine's harmful or hazardous effects. Adding reserpine to current MAOI medication may have paradoxical effects (e.g., excitation, hypertension). Treatment: When a patient is concurrently getting reserpine, monoamine oxidase inhibitors (MAOIs) should be avoided or used very cautiously.
Serotonin Modulators	The serotonergic impact of serotonin modulators may be enhanced by anti-Parkinson drugs (monoamine oxidase inhibitors). Serotonin syndrome might occur from this. If selegiline, rasagiline, or safinamide is taken with a serotonin modulator, keep an eye out for any signs and symptoms of serotonin syndrome or serotonin poisoning. It is not advised to use transdermal selegiline with serotonin modulators. The exception is nigroline.
Vemurafenib	May increase the serum concentration of CYP1A2 Substrates (High risk with Inhibitors). Management: Consider alternatives to such combinations whenever possible, particularly if the CYP1A2 substrate has a relatively narrow therapeutic index. Drugs listed as exceptions to this monograph are discussed in separate drug interaction monographs.
Risk Factor X (Avoid combination)
Alcohol (Ethyl)	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Alpha-/Beta-Agonists (Indirect-Acting)	Alpha-/Beta-Agonists may have a stronger hypertensive effect when combined with monoamine oxidase inhibitors (Indirect-Acting). Although this is the expected mode of action for linezolid, management guidelines are different from those for other monoamine oxidase inhibitors. Details can be found in linezolid-specific monographs.
Alpha1-Agonists	Alpha1Agonists may have a stronger hypertensive effect when combined with monoamine oxidase inhibitors. Although this is the expected mode of action for linezolid, management guidelines are different from those for other monoamine oxidase inhibitors. Details can be found in linezolid-specific monographs.
Amphetamines	Amphetamines' tendency to cause hypertension may be increased by monoamine oxidase inhibitors. However, unlike other monoamine oxidase inhibitors, linezolid and tedizolid have different management recommendations. For more information, consult the monographs for those agents.
Apraclonidine	Monoamine Oxidase Inhibitors might make acrolonidine more harmful or poisonous.
AtoMOXetine	Monoamine Oxidase Inhibitors may intensify AtoMOXetine's neurotoxic (central) impact.
Atropine (Ophthalmic)	Atropine's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors (Ophthalmic).
Bezafibrate	Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Bezafibrate.
Bromperidol	Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents.
Buprenorphine	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
BuPROPion	BuPROPion's ability to raise blood pressure may be enhanced by monoamine oxidase inhibitors.
BusPIRone	The negative or hazardous effects of monoamine oxidase inhibitors can be increased. Increases in blood pressure have specifically been recorded.
CarBAMazepine	The negative or hazardous effects of monoamine oxidase inhibitors can be increased. Management: Avoid from using carbamazepine concurrently with monoamine oxidase inhibitor therapy or within 14 days of stopping it.
Cyclobenzaprine	The serotonergic effects of monoamine oxidase inhibitors may be enhanced. Serotonin syndrome might occur from this.
Cyproheptadine	Monoamine oxidase inhibitors may boost Cyproheptadine's anticholinergic effects. The serotonergic impact of monoamine oxidase inhibitors may be lessened by cyproheptadine.
Dapoxetine	Serotonin modulators' harmful or toxic effects could be exacerbated.
Deutetrabenazine	Monoamine Oxidase Inhibitors may make deutetrabenazine's harmful or hazardous effects worse.
Dexmethylphenidate	Dexmethylphenidate may have a stronger hypertensive effect when used with monoamine oxidase inhibitors.
Dextromethorphan	Monoamine oxidase inhibitors might improve dextromethorphan's serotonergic effects. It might result in serotonin syndrome.
Diethylpropion	Diethylpropion may have a stronger hypertensive effect when used with monoamine oxidase inhibitors.
Diphenoxylate	The hypertensive effects of monoamine oxidase inhibitors might be enhanced.
EPINEPHrine (Oral Inhalation)	Epinephrine's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors (Oral Inhalation).
FentaNYL	The serotonergic effects of monoamine oxidase inhibitors may be enhanced. Serotonin syndrome might occur from this.
Guanethidine	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Heroin	Monoamine Oxidase Inhibitors might make heroin more harmful or poisonous.
HYDROmorphone	Monoamine Oxidase Inhibitors may intensify HYDROmorphone's harmful or hazardous effects.
Indoramin	Indoramin's hypotensive impact may be strengthened by monoamine oxidase inhibitors.
Iobenguane Radiopharmaceutical Products	Iobenguane radiopharmaceutical products' therapeutic effects may be reduced by monoamine oxidase inhibitors. Treatment: Before administering iobenguane, stop taking any medications that could impede or interfere with catecholamine transport or uptake for at least five biological half-lives. After each dose of iobenguane, wait at least 7 days before administering these medications.
Isometheptene	Monoamine Oxidase Inhibitors might make isotheptene more harmful or poisonous.
Levomethadone	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Levonordefrin	Levonordefrin's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors.
Linezolid	Monoamine Oxidase Inhibitors may intensify Linezolid's negative/toxic effects.
Maprotiline	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Meperidine	Monoamine Oxidase Inhibitors may strengthen the impact of serotonin.
Meptazinol	Monoamine Oxidase Inhibitors may intensify Meptazinol's harmful or hazardous effects.
Mequitazine	Mequitazine's anticholinergic effects may be enhanced by monoamine oxidase inhibitors.
Methyldopa	Monoamine Oxidase Inhibitors may intensify Methyldopa's harmful or hazardous effects.
Methylene Blue	Methylene Blue may have a stronger serotonergic impact when taken with monoamine oxidase inhibitors. Serotonin syndrome might occur from this.
Methylene Blue	Could make serotonin modulators' serotonergic effects stronger. Serotonin syndrome might occur from this.
Methylphenidate	Methylphenidate's ability to raise blood pressure may be enhanced by monoamine oxidase inhibitors.
Mianserin	The neurotoxic effect of Mianserin may be increased by monoamine oxidase inhibitors.
Mirtazapine	Monoamine Oxidase Inhibitors may intensify Mirtazapine's neurotoxic (central) impact. While interactions between methylene blue and linezolid are anticipated, their usage is not advised in the same way as other monoamine oxidase inhibitors. For more information, consult the monographs for those agents.
Moclobemide	Monoamine Oxidase Inhibitors may intensify Moclobemide's harmful or hazardous effects.
Monoamine Oxidase Inhibitors	Certain monoamine oxidase inhibitors have the potential to increase their hypertensive effects. Other monoamine oxidase inhibitors' serotonergic effects may be enhanced by monoamine oxidase inhibitors. Serotonin syndrome might occur from this.
Morphine (Systemic)	Monoamine Oxidase Inhibitors might make morphine more harmful or poisonous (Systemic).
Nefopam	Monoamine Oxidase Inhibitors may intensify Nefopam's harmful or hazardous effects.
Opium	Monoamine Oxidase Inhibitors might make opium more harmful or poisonous.
OxyMORphone	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Pheniramine	Monoamine oxidase inhibitors' anticholinergic effects might be strengthened.
Pholcodine	The serotonergic effects of monoamine oxidase inhibitors may be enhanced. Serotonin syndrome might occur from this.
Pizotifen	Monoamine Oxidase Inhibitors may strengthen Pizotifen's anticholinergic effects.
Reboxetine	Monoamine Oxidase Inhibitors may intensify Reboxetine's harmful or hazardous effects.
Selective Serotonin Reuptake Inhibitors	Selective Serotonin Reuptake Inhibitors' serotonergic effects may be enhanced by monoamine oxidase inhibitors. It might result in serotonin syndrome. Although this interaction between methylene blue and linezolid is anticipated, management guidelines for this drug are different from those for other monoamine oxidase inhibitors. For more information, consult the monographs for those agents.
Serotonin 5-HT1D Receptor Agonists	Serotonin 5-HT1D Receptor Agonists' metabolism may be slowed down by monoamine oxidase inhibitors. Management: Naratriptan, eletriptan, or frovatriptan may be suitable 5-HT1D agonists to use if MAO inhibitor medication is necessary. Eletriptan, Frovatriptan, and Naratriptan are exceptions.
Serotonin Reuptake Inhibitor/Antagonists	Serotonin Reuptake Inhibitor/Antagonists' harmful or toxic effects may be increased by monoamine oxidase inhibitors. While interactions between methylene blue and linezolid are anticipated, their usage is not advised in the same way as other monoamine oxidase inhibitors.
Serotonin/Norepinephrine Reuptake Inhibitors	Serotonin/Norepinephrine Reuptake Inhibitors' serotonergic effects may be enhanced by monoamine oxidase inhibitors. It might result in serotonin syndrome. Although this interaction between methylene blue and linezolid is anticipated, management guidelines for this drug are different from those for other monoamine oxidase inhibitors. For more information, consult the monographs for those agents.
Solriamfetol: Monoamine Oxidas	Solriamfetol's hypertensive impact may be strengthened by inhibitors.
SUFentanil	The negative or hazardous effects of monoamine oxidase inhibitors can be increased. Particularly, there may be an elevated risk for serotonin syndrome or opioid toxicities (such as respiratory depression or coma). Management: Due to the risk of serotonin syndrome and/or severe CNS depression, fentanyl should not be administered in conjunction with monoamine oxidase (MAO) inhibitors (or within 14 days of discontinuing an MAO inhibitor).
Tapentadol	The negative or hazardous effects of monoamine oxidase inhibitors can be increased. In particular, norepinephrine's cumulative actions could have harmful cardiovascular repercussions. The serotonergic action of monoamine oxidase inhibitors may be enhanced by tapentadol. Serotonin syndrome might occur from this.
Tetrabenazine	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Tetrahydrozoline (Nasal)	Monoamine Oxidase Inhibitors may increase Tetrahydrozoline's hypertensive impact (Nasal).
Tricyclic Antidepressants	Tricyclic antidepressants' serotonergic action may be strengthened by monoamine oxidase inhibitors. It might result in serotonin syndrome. Although this interaction between methylene blue and linezolid is anticipated, management guidelines for this drug are different from those for other monoamine oxidase inhibitors. For more information, consult the monographs for those agents.
Tryptophan	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Valbenazine	May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.

Monitor:

Blood pressure
Parkinsonism symptoms
New or worsening mental state and behavioral changes
Excessive somnolence or falling asleep while performing daily activities
Skin examination to determine if there is melanoma.

How to administer Rasagiline?

Give without regard to meals.

Mechanism of action of Rasagiline:

It is a powerful, irreversible inhibitor of brain monoamine oxygenase (MAO type B), which plays an important role in the catabolism and metabolism of dopamine.
The primary effect of inhibiting dopamine depletion at the striatal brain region is to reduce the symptoms of Parkinson's disease.
Rasagiline may have neuroprotective (antioxidant, neuroapoptotic) qualities that could prevent or slow the process of neuronal degeneration, according to some research.

Time: Almost 1 week (irreversible inhibition)

AbsorptionRapid

Protein binding: 88%-94%, primarily due to albumin

Metabolism: Hepatic N-dealkylation and/or hydroxylation via CYP1A2 for multiple inactive metabolites

DistributionV : 87 L

Bioavailability: Almost 36%

Eliminating half-life: Almost 3 hours (no correlation to biologic effect due irreversible inhibition).

Plasma peak time- Almost 1 hour

Excretion: By Urine (62%; 1% total dose as unchanged drug); & Feces (7%)

International Brands of Rasagiline:

Azilect
APO-Rasagiline
TEVA-Rasagiline
Dardaren
Dopaminect
Elbrus
Menvix
Parkintreal
Ragitar
Rasalect
Rasax

Rasagiline brands in Pakistan:

Alzilo - Searle Rasagin - Hiranis Pharma