There are a number of known interactions between nonselective MAO inhibitors and other medicinal products.
Rasagiline must not be administered along with other MAO inhibitors (including medicinal and natural products without prescription eg, St. John's wort) as there may be a risk of nonselective MAO inhibition that may lead to hypertensive crises.
Serious adverse reactions have been reported with the concomitant use of pethidine and MAO inhibitors including another selective MAO-B inhibitor. The concomitant administration of rasagiline and pethidine is contraindicated.
With MAO inhibitors there have been reports of medicinal product interactions with the concomitant use of sympathomimetic medicinal products. Therefore, in view of the MAO inhibitory activity of rasagiline concomitant administration of rasagiline and sympathomimetics eg, those present in nasal and oral decongestants or cold medicinal products, containing ephedrine or pseudoephedrine, is not recommended.
There have been reports of medicinal product interactions with the concomitant use of dextromethorphan and nonselective MAO inhibitors. Therefore, in view of the MAO inhibitory activity of rasagiline the concomitant administration of rasagiline and dextromethorphan is not recommended.
The concomitant use of rasagiline and fluoxetine or fluvoxamine should be avoided.
For concomitant use of rasagiline with selective serotonin re-uptake inhibitors (SSRIs)/selective serotonin norepinephrine re-uptake inhibitors (SNRIs) in clinical trials.
Serious adverse reactions have been reported with the concomitant use of SSRIs, SNRIs, tricyclic, tetracyclic antidepressants and MAO inhibitors. Therefore, in view of the MAO inhibitory activity of rasagiline, antidepressants should be administered with caution.
In Parkinson's disease patients receiving chronic levodopa treatment as adjunct therapy there was no clinically significant effect of levodopa treatment on rasagiline clearance.
In vitro metabolism studies have indicated that cytochrome P-450 1A2 (CYP1A2) is the major enzyme responsible for the metabolism of rasagiline. Co-administration of rasagiline and ciprofloxacin (an inhibitor of CYP1A2) increased the AUC of rasagiline by 83%. Co-administration of rasagiline and theophylline (a substrate of CYP1A2) did not affect the pharmacokinetics of either product. Thus, potent CYP1A2 inhibitors may alter rasagiline plasma levels and should be administered with caution.
There is a risk that the plasma levels of rasagiline in smoking patients could be decreased, due to induction of the metabolising enzyme CYP1A2.
In vitro studies showed that rasagiline at a concentration of 1 mcg/mL (equivalent to a level that is 160 times the average Cmax approximately 5.9-8.5 ng/mL in Parkinson's disease patients after 1 mg rasagiline multiple dosing), did not inhibit cytochrome P-450 isoenzymes, CYP1A2, CYP2A6, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4 and CYP4A. These results indicate that rasagiline's therapeutic concentrations are unlikely to cause any clinically significant interference with substrates of these enzymes.
Concomitant administration of rasagiline and entacapone increased rasagiline oral clearance by 28%.
Tyramine/Rasagiline Interaction: Results of 5 tyramine challenge studies (in volunteers and PD patients), together with results of home monitoring of blood pressure after meals (of 464 patients treated with rasagiline 0.5 or 1 mg/day or placebo as adjunct therapy to levodopa for 6 months without tyramine restrictions), and the fact that there were no reports of tyramine/Azilect interaction in clinical studies conducted without tyramine restriction, indicate that rasagiline can be used safely without dietary tyramine restrictions.
Incompatibilities: Not applicable.