Basic Information
ID DDInter1572 and DDInter614
Interaction Coadministration with inhibitors of CYP450 1A2 may increase the plasma concentrations of rasagiline, which is primarily metabolized by the isoenzyme. Because the MAO-B selectivity of rasagiline may diminish with increasing dosage above the recommended range of 0.5 to 1 mg/day, there may be an increased risk of hypertensive crisis and other adverse reactions associated with nonselective inhibition of MAO if the maximum dosage is used in the presence of ciprofloxacin or other CYP450 1A2 inhibitors.
Management Rasagiline should be prescribed at a maximum dosage of 0.5 mg/day during coadministration with moderate or potent CYP450 1A2 inhibitors. Patients should be advised to promptly seek medical attention if they experience potential signs and symptoms of a hypertensive crisis such as severe headache, visual disturbances, confusion, stupor or coma, seizures, chest pain, unexplained nausea or vomiting, and stroke-like symptoms.
References [1] Cerner Multum, Inc. "Australian Product Information." O 0 [2] Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0 [3] "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA, North Wales, PA. [4] McGrath PJ, Stewart JW, Quitkin FM "A possible L-deprenyl induced hypertensive reaction." J Clin Psychopharmacol 9 (1989): 310-1 [5] "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA, North Wales, PA. [6] Sweet RA, Liebowitz MR, Holt CS, Heimberg RG "Potential interactions between monoamine oxidase inhibitors and prescribed dietary supplements." J Clin Psychopharmacol 11 (1991): 331-2 [7] Tailor SA, Shulman KI, Walker SE, Moss J, Gardner D "Hypertensive episode associated with phenelzine and tap beer--a reanalysis of the role of pressor amines in beer." J Clin Psychopharmacol 14 (1994): 5-14 [8] Goldberg LI "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA 190 (1964): 456-62 [9] Domino EF, Selden EM "Red wine and reactions." J Clin Psychopharmacol 4 (1984): 173-4 [10] Nuessle WF, Norman FC, Miller HE "Pickled herring and tranylcypromine reaction." JAMA 192 (1965): 142-3 [11] Pohl R, Balon R, Berchou R "Reaction to chicken nuggets in a patient taking an MAOI." Am J Psychiatry 145 (1988): 651 [12] Ito D, Amano T, Sato H, Fukuuchi Y "Paroxysmal hypertensive crises induced by selegiline in a patient with Parkinson's disease." J Neurol 248 (2001): 533-4 [13] Zetin M, Plon L, DeAntonio M "MAOI reaction with powdered protein dietary supplement." J Clin Psychiatry 48 (1987): 499 [14] Lefebvre H, Noblet C, Morre N, Wolf LM "Pseudo-phaeochromocytoma after multiple drug interactions involving the selective monoamine oxidase inhibitor selegiline." Clin Endocrinol (Oxf) 42 (1995): 95-8
Alternative for Rasagiline N04B
Pergolide Tolcapone Levodopa Pramipexole Selegiline Cabergoline
Rotigotine Safinamide Entacapone Apomorphine Amantadine Opicapone
Alternative for Echinacea -
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.