Rasagiline interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Alcohol may potentiate some of the pharmacologic effects of central nervous system (CNS)-active agents. Use in combination may result in additive CNS depression and/or impairment of judgment, thinking, and psychomotor skills.

  What to do: Patients receiving CNS-active agents should be advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled against driving, operating machinery, or engaging in potentially hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

  5 sources

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  4. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  5. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):

• Tyrosine-rich foods

  Moderate

  Synergy

  Foods that contain large amounts of tyramine may precipitate a hypertensive crisis in patients treated with monoamine oxidase (MAO) inhibitors. The mechanism involves inhibition of MAO-A, the enzyme responsible for metabolizing exogenous amines such as tyramine in the gut and preventing them from being absorbed intact. Once absorbed, tyramine is metabolized to octopamine, a substance that is believed to displace norepinephrine from storage granules.

  What to do: Dietary restriction is not ordinarily required during rasagiline treatment with respect to most foods and beverages that may contain tyramine such as air-dried and fermented meats or fish, aged cheeses, most soybean products, yeast extracts, red wine, beer, and sauerkraut. However, certain foods like some of the aged cheeses (e.g., Boursault, Liederkrantz, Mycella, Stilton) may contain very high amounts of tyramine and could potentially cause a hypertensive reaction in patients taking rasagiline even at recommended dosages due to increased sensitivity to tyramine. Patients should be advised to avoid ingesting very high levels of tyramine (e.g., greater than 150 mg), and 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. Rasagiline should not be used at dosages exceeding 1 mg/day (0.5 mg/day for patients with mild hepatic impairment or concomitant use of ciprofloxacin or other CYP450 1A2 inhibitors), as it can increase the risk of hypertensive crisis and other adverse reactions associated with nonselective inhibition of MAO. Rasagiline can be administered with or without food.

  11 sources

  1. Goldberg LI "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA 190 (1964): 456-62
  2. Nuessle WF, Norman FC, Miller HE "Pickled herring and tranylcypromine reaction." JAMA 192 (1965): 142-3
  3. 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
  4. McGrath PJ, Stewart JW, Quitkin FM "A possible L-deprenyl induced hypertensive reaction." J Clin Psychopharmacol 9 (1989): 310-1
  5. 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
  6. Zetin M, Plon L, DeAntonio M "MAOI reaction with powdered protein dietary supplement." J Clin Psychiatry 48 (1987): 499
  7. Domino EF, Selden EM "Red wine and reactions." J Clin Psychopharmacol 4 (1984): 173-4
  8. 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

  Show all 11 sourcesShow fewer sources

  9. Pohl R, Balon R, Berchou R "Reaction to chicken nuggets in a patient taking an MAOI." Am J Psychiatry 145 (1988): 651
  10. 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
  11. "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA (2006):

Conditions

Conditions in which Rasagiline needs care, as documented in this source.

• Hepatic Insufficiency

  Major

  Rasagiline should not be used in patients with moderate to severe hepatic impairment. Patients with mild hepatic impairment should not exceed a dose of 0.5 mg daily.

  1 source

  1. "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA (2006):

• Hypotension

  Major

  Dopamine agonists may impair the systemic regulation of blood pressure, with resultant orthostatic hypotension, especially during dose escalation. Therapy with dopamine agonists should be monitored carefully in patients with Parkinson's disease since they may have an impaired ability to respond to an orthostatic challenge, and also in patients receiving antihypertensive drugs.

  11 sources

  1. Hoehn MM "Levodopa-induced postural hypotension. Treatment with fludrocortisone." Arch Neurol 32 (1975): 50-1
  2. Iwasaki S, Hamaguchi K, Iwasaki A, Takakusagi M, Narabayashi Y "Hypotensive effect of long-term levodopa in patients with Parkinson's disease." Eur Neurol 30 (1990): 194-9
  3. "Product Information. Dostinex (cabergoline)." Pharmacia and Upjohn (2001):
  4. "Product Information. Sinemet (carbidopa-levodopa)." DuPont Pharmaceuticals (2001):
  5. "Product Information. Sinemet CR (carbidopa-levodopa)." DuPont Pharmaceuticals (2001):
  6. "Product Information. Mirapex (pramipexole)." Boehringer Ingelheim (2001):
  7. "Product Information. Requip (ropinirole)." SmithKline Beecham (2001):
  8. "Product Information. Comtan (entacapone)." Novartis Pharmaceuticals (2001):

  Show all 11 sourcesShow fewer sources

  9. "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA (2006):
  10. "Product Information. Neupro (rotigotine)." Schwarz Pharma (2007):
  11. "Product Information. Xadago (safinamide)." US WorldMeds LLC (2017):

• Psychotic Disorders

  Major

  Ordinarily, patients with major psychotic disorder should not be treated with dopaminergic antiparkinson agents, because of the risk of exacerbating psychosis. Hallucinations and psychotic-like behavior have been reported with dopaminergic medications. In addition, certain medications used to treat psychosis may exacerbate the symptoms of Parkinson's disease and may decrease the effectiveness of these drugs.

  8 sources

  1. "Product Information. Dostinex (cabergoline)." Pharmacia and Upjohn (2001):
  2. "Product Information. Mirapex (pramipexole)." Boehringer Ingelheim (2001):
  3. "Product Information. Requip (ropinirole)." SmithKline Beecham (2001):
  4. "Product Information. Comtan (entacapone)." Novartis Pharmaceuticals (2001):
  5. "Product Information. Lodosyn (carbidopa)." DuPont Pharma (2001):
  6. "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA (2006):
  7. "Product Information. Neupro (rotigotine)." Schwarz Pharma (2007):
  8. "Product Information. Xadago (safinamide)." US WorldMeds LLC (2017):

• Hypertension

  Moderate

  Exacerbation of hypertension may occur during treatment with rasagiline. Dosage adjustment may be necessary if the elevation is sustained. Patients should be monitored for new onset hypertension or hypertension that is not well controlled after starting treatment.

  1 source

  1. "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA (2006):

• Kidney Diseases

  Moderate

  Dose adjustment of rasagiline is not required for patients with mild or moderate renal impairment. However, rasagiline has not been studied in patients with severe renal impairment. Caution is advised if used.

  1 source

  1. "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA (2006):