DRUG INTERACTIONS: Rasagiline is eliminated by enzymes in the liver. Ciprofloxacin inhibits the enzymes in the liver that eliminate rasagiline, thereby increasing blood levels and possibly side effects of rasagiline.

Rasagiline should not be administered with antidepressants that increase serotonin levels. Combining rasagiline with such antidepressants may lead to excessive levels of serotonin and a fatal condition called the serotonin syndrome. Examples of antidepressants to be avoided include selective serotonin uptake inhibitors (e.g., fluoxetine, sertraline), tricyclic antidepressants (e.g., amitriptyline), serotonin-norepinephrine uptake inhibitors (e.g., venlafaxine) and other MAO inhibitors (e.g., selegiline, tranylcypromine). Rasagiline should be discontinued at least 14 days before initiating treatment with antidepressants that increase serotonin levels. Due to its long half-life, fluoxetine should be discontinued at least 5 weeks before initiating rasagiline.

Rasagiline should not be used with meperidine, propoxyphene, tramadol, methadone, mirtazapine, cyclobenzaprine, dextromethorphan and St. John’s Wort. Serious reactions, including the serotonin syndrome, have occurred when other MAO inhibitors were combined with some of these drugs, and there is concern that rasagiline may cause similar serious reactions.

Rasagiline should not be used with sympathomimetic amine drugs such as amphetamines and products containing vasoconstrictors (blood vessel narrowing drugs, e.g., pseudoephedrine, ephedrine, phenylpropanolamine, phenylephrine). Severe hypertensive reactions have occurred when such drugs were combined with other MAO inhibitors.

Patients taking rasagiline should not be given cocaine or local anesthetics containing sympathomimetic vasoconstrictor drugs. They also should not undergo elective surgery requiring general anesthesia. Rasagiline should be discontinued at least 14 days before surgery.

Rasagiline should not be used with other MAO inhibitors because of the risk of a hypertensive crisis. Rasagiline should be discontinued at least 14 days before starting other MAO inhibitors.

PREGNANCY: There are no adequate studies of rasagiline in pregnant women. Rasagiline should only be used in pregnant women if the benefit is felt to justify the unknown risk.

NURSING MOTHERS: It is not known whether rasagiline is secreted in human milk.

SIDE EFFECTS: Adverse events reported in clinical studies include headache, nausea, joint pain, upset stomach, depression, falls, constipation, postural hypotension (a drop in blood pressure when going from a lying or sitting position to a sitting or standing position, respectively), dry mouth, rash, hallucinations, vomiting and difficulty moving.

A hypertensive crisis may occur if foods high in tyramine are consumed while taking rasagiline. Tyramine in food usually is broken down in the intestine by MAO-A in the intestinal wall as the tyramine is absorbed into the body. There are no adequate studies in humans to determine whether rasagiline also inhibits MAO-A; however, if MAO-A is inhibited, tyramine ingested in food may enter the body in larger amounts and result in a hypertensive crisis. Foods high in tyramine include those that are aged, fermented, pickled, or smoked. Examples include aged cheeses, air-dried meats, sauerkraut, soy sauce, tap/draft beers and red wines. As a precaution, foods high in tyramine should be avoided when taking rasagiline.

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