Rasagiline MAOIs

The other newer selective MAOIs that specifically inhibit MAO-B are ineffective for the treatment of depression and are mainly used for Parkinson s disease, and so are covered elsewhere, see Antiparkinsonian and related drugs , (p.672). In low doses they inhibit MAO-B, leaving MAO-A largely uninhibited. However, selegiline loses some of its seleetivity at doses of more than 10 mg daily and will therefore be subjeet to the same interactions as the non-selective MAOIs. Rasagiline is another irreversible selective inhibitor of MAO-B used for Parkinson s disease. 

SYMPATHOMIMETICS RASAGILINE Risk of adrenergic syndrome - see above Due to inhibition of MAOI, which breaks down sympathomimetics Avoid concurrent use. Onset may be 6-24 hours after ingestion. Do ECG measure electrolytes, FBC, CK and coagulation profile... 

LEVODOPA, SELEGILINE, POSSIBLY RASAGILINE, ENTACAPONE, TOLCAPONE MAOIs Risk of adrenergic syndrome -hypertension, hyperthermia, arrhythmias - and dopaminergic effects with selegiline Levodopa and related drugs are precursors of dopamine. Levodopa is predominantly metabolized to dopamine, and a smaller proportion is converted to epinephrine and norepinephrine. Effects are due to inhibition of MAOI, which breaks down dopamine and sympathomimetics Avoid concurrent use. Onset may be 6-24 hours after ingestion. Carbidopa and benserazide, which inhibit dopa decarboxylase that converts L-dopa to dopamine, is considered to minimize this interaction. However, MAOIs should not be used in patients with Parkinson s disease on treatment with levodopa. Imipramine and amitriptyline are considered safer by some clinicians... 

The manufacturer of rasagiline su ests that its use with dextromethorphan should be avoided. Similarly, some consider that patients taking selegiline should try to avoid dextromethorphan. These warnings are based on the serious adverse reactions (the serotonin syndrome or similar) that have rarely occurred when dextromethorphan has been used with non-selective MAOIs or RIMAs , (p.ll34). The likelihood of any interaction with MAO-B... 

A case of fluctuating stupor and agitation, with muscie rigidity, sweating and a raised temperature has been reported when pethidine was used with seiegiline. This case is simiiar to cases reported with the older non-selective MAOIs or RlMAs and pethidine. The manufacturers say that selegiline and rasagiline should not be used with pethidine. 

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