Rasagiline (Azilect®, Lundbeck) is listed on the PBS as a less expensive monoamine oxidase (MAO)-b inhibitor than selegiline for the treatment of the 100,000 Australians suffering from Parkinson’s disease, despite no direct comparisons of efficacy. It slows the rate of degeneration, and reduces the number of “off” hours per day.
Irreversible inhibition of MAO-b metabolism assists restoring the levels of dopamine diminished by the death of neurons in the substantia nigra in Parkinson’s disease; reducing the demand for dopamine supplementation and without tyramine pressor effects (at recommended doses).
Dosage is not affected by food, age, gender, or moderate renal impairment. It should not be administered with hepatic impairment, other MAO inhibitors (St John’s wort), pethidine, tramadol, tapentadol, methadone, dextropropoxyphene, dextromethorphan, ciprofloxacin and other potent CYP1A2 inhibitors. Serotonin syndrome has been reported in patients also treated with antidepressants, and adverse effects are similar to placebo, with headache the most common.
Increased melanoma rates are likely to be associated with Parkinson’s or more diligent screening than rasagiline.