Rasagiline

About Rasagiline

Rasagiline is a selective, irreversible inhibitor of monoamine oxidase type B (MAO-B), an enzyme that breaks down dopamine. Exactly how it works is not known, but one proposed mechanism is a rise in dopamine levels in the striatum, a brain region involved in movement. The label covers the treatment of Parkinson’s disease. Used alone, or added to other treatment that does not include levodopa, the dose is 1 mg once a day; added to levodopa, it starts at 0.5 mg once a day and is raised to 1 mg if the response is not enough. Doses above 1 mg are not used because of the risk of high blood pressure. Ciprofloxacin and other CYP1A2 inhibitors, or mild liver impairment, cap the dose at 0.5 mg a day, and it is not used with moderate or severe liver impairment.

There is no boxed warning. Blood pressure can rise, so it is monitored; a low-tyramine diet is not needed at recommended doses, but foods with very large amounts of tyramine (more than 150 mg), such as some aged cheeses, are avoided. With certain antidepressants and pain medicines it can cause serotonin syndrome, which can be fatal. People have fallen asleep without warning during daily activities, including driving, and if that happens it is ordinarily stopped. It can also lower blood pressure on standing up, cause or worsen dyskinesia (involuntary movements) when taken with levodopa, cause hallucinations or psychotic-like behavior, and bring on intense urges, such as to gamble, spend or have sex. Cutting the dose quickly or stopping it can bring on high fever and confusion. Flu-like symptoms, joint pain, depression and indigestion were the most common side effects when it was used alone.

Meperidine, tramadol, methadone, other MAO inhibitors (including other MAO-B inhibitors), St. John’s wort, cyclobenzaprine and dextromethorphan, which is found in many cough medicines, must not be taken with it; at least 14 days must pass after stopping rasagiline before meperidine, tramadol, methadone or another MAO inhibitor is started. The label says use with many classes of antidepressants, such as SSRIs, SNRIs and tricyclic, tetracyclic or triazolopyridine antidepressants, is not recommended; at least 14 days pass after stopping rasagiline before one is started, and at least five weeks after stopping fluoxetine before rasagiline is started. Decongestants and cold remedies call for caution, and antipsychotics or metoclopramide may make it less effective.

Taking Rasagiline

How to take it

Once a day, with or without food, exactly as prescribed; more than 1 mg a day is never taken because of the risk of high blood pressure. If you feel drowsy during the day, do not drive or do other dangerous activities, and tell the prescriber.

If you miss a dose

Do not double up to make up for a missed dose; take the next dose at the usual time the following day.

Storage

At room temperature, away from moisture and heat, out of reach of children.

Interactions to know about

Meperidine, tramadol, methadone, dextromethorphan, St. John’s wort, cyclobenzaprine and other MAO inhibitors must not be taken with it, and the label does not recommend it with many antidepressants. Ciprofloxacin and other CYP1A2 inhibitors raise its levels, so the dose stays at 0.5 mg; decongestants and cold remedies need caution; antipsychotics and metoclopramide may make it less effective; and alcohol and other sedating drugs add to sleepiness.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Rasagiline differs from pharmacy to pharmacy

Generic rasagiline has many approved makers, so quotes for the same tablet differ mainly by each pharmacy’s markup and dispensing fee, and whether it is on a pharmacy’s flat-price generic list varies. A prescription that names Azilect and blocks substitution is quoted at a brand price.

A pharmacy that rarely fills the 0.5 mg strength, used when starting with levodopa, alongside ciprofloxacin or with mild liver impairment, may need to order it, and each change of strength while the dose is settled is a separate fill with its own fee.

Ways to pay less for Rasagiline without insurance

• Ask for generic rasagiline, and make sure the prescription allows substitution rather than naming Azilect only.
• Ask whether rasagiline is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Once your dose is settled, ask for a ninety-day supply.
• Check that a 1 mg dose is written as one 1 mg tablet rather than two 0.5 mg tablets.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Rasagiline

1. 1.Are any of my pain, cough, cold or muscle relaxant medicines unsafe with rasagiline?
2. 2.Is it safe with my antidepressant, and how long must I wait when switching?
3. 3.Which foods are high enough in tyramine that I should avoid them?
4. 4.What should I do if I feel sleepy during the day or fall asleep without warning?

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