MAO-B inhibitors (rasagiline, selegiline, safinamide)
This information explains the Parkinson's drugs MAO-B inhibitors including how they work, the benefits and side effects, and the different types.
MAO-B inhibitors is the name used to describe a class (category) of Parkinson’s drugs.
How do MAO–B inhibitors work?
MAO–B inhibitors can help your nerve cells make better use of the dopamine that they have.
Monoamine oxidase type B is an enzyme (a protein which makes a chemical reaction happen). It breaks down dopamine that is not being used by your brain. MAO-B inhibitors stop this enzyme so that more dopamine becomes available to treat your symptoms.
MAO-B inhibitors take two to three weeks to work.
When are MAO–B inhibitors used?
A MAO–B inhibitor can be used on its own in early Parkinson’s when your motor symptoms, which affect movement, are mild. It can also be used with other drugs at any stage. Later on it can help with motor fluctuations (when you go from having good control of your movement symptoms to having less control).
Benefits of MAO–B inhibitors
You don’t need to start gradually
Many drug treatments for Parkinson’s have to be started gradually, with the dose slowly being increased over time. This is not the case for most MAO-B inhibitors.
Helping levodopa work well
When you have been taking levodopa for a while, you may find that its effects wear off too quickly. A MAO–B inhibitor can help.
Taking a MAO–B inhibitor may also mean you can take less levodopa and leave more time between doses.
Risks and side effects of MAO–B inhibitors
Antidepressants
If you’re taking some types of antidepressant, you might not be able to take MAO–B inhibitors. This is because when they are taken together these drugs can raise blood pressure to a dangerous level.
Your specialist can advise you on how to take antidepressants alongside your Parkinson’s medication.
Decongestants or cold remedies
These can affect some types of MAO–B inhibitors. If you need to use them, check with your pharmacist to find out which one is safe for you to use.
Worse levodopa side effects
Involuntary movements (dyskinesia) and sickness may get worse because MAO–B inhibitors strengthen the effects of levodopa. If this happens, your specialist or Parkinson’s nurse can reduce your dose of levodopa.
Impulsive and compulsive behaviours
This medication can cause impulsive and compulsive behaviours. Impulsive and compulsive behaviours can happen with any Parkinson’s drugs.
Increased risk of high blood pressure
Eating foods rich in tyramine while taking high doses of MAO-B inhibitors can cause a sudden increase in blood pressure. Tyramine-rich foods can include cured meats, strong or aged cheeses and pickled foods. Speak to your specialist or Parkinson’s nurse if you have any concerns.
Other side effects
The patient information leaflet that comes with your medication will tell you about all of the side effects that you may experience.
Some of the possible side effects include:
- headaches
- constipation
- dry mouth
- an urgent need to pass urine
- aching joints
- indigestion
- flu-like symptoms
- depression.
Types of MAO-B inhibitors
Below are the types of MAO-B inhibitor drugs. Each drug has a generic (unbranded) name and a branded name.
Rasagiline
Rasagiline is a type of generic MAO-B inhibitor medication. Azilect is the brand name. It comes in tablets.
Taking rasagiline
Rasagiline can be taken on its own. It can also be taken with levodopa to help stop motor fluctuations (when you go from having good control of your movement symptoms to having less control). This happens at the end of your dose or before your next one is due.
You will take rasagiline once per day, which can be helpful if you prefer to take fewer doses. You can take it with or without food.
Selegiline
Selegiline is a type of generic MAO-B inhibitor medication. Eldepryl is the branded version of selegiline. It comes in tablets.
Taking selegiline
You will usually take Eldepryl tablets once per day. However there is also the option of taking one in the morning and then one at lunchtime. Your specialist team can advise you on the best time to take Eldepryl for your Parkinson’s.
Eldepryl tablets can delay the need to take levodopa which is helpful as levodopa can work less well over time.
Eldepryl can also be taken with levodopa to help stop motor fluctuations (when you go from having good control of your movement symptoms to having less control). This can happen at the end of your dose before your next one is due.
Safinamide
Safinamide is a type of generic MAO-B inhibitor medication. Xadago is a brand name for safinamide. It comes in tablets.
Safinamide medication is taken as an addition to your regular dose of levodopa medication. It can also be taken with other medication if your Parkinson’s symptoms have got worse. This helps reduce motor fluctuations (when you go from having good control of your movement symptoms to having less control).
Taking safinamide
You will take safinamide (Xadago) once per day with water and with or without food. This can be helpful if you prefer to take fewer doses. This option may not be suitable for everyone. Your specialist or Parkinson’s nurse can advise you when to take safinamide (Xadago) medication.
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