rasagiline hemitartrate: clinical use

Prescribing considerations

• Review all serotonergic, sympathomimetic, opioid, cough-and-cold and herbal products before prescribing.
• Assess liver function and impairment status before treatment and if clinical circumstances change.
• When combined with levodopa, review new or worsening dyskinesia and postural hypotension.
• Counsel patients and carers about sudden sleep, hallucinations, impulse-control disorders and suspicious skin lesions.
• Avoid unnecessary interruption during admission; changed swallowing status warrants prompt specialist review.

Contraindications and cautions

• Hypersensitivity to rasagiline or an excipient.
• Concurrent use of another MAO inhibitor, including relevant non-prescription or herbal products.
• Concurrent pethidine use.
• Severe hepatic impairment.

Monitoring

• Clinical response and Parkinson’s symptom control.
• Blood pressure where dizziness, falls or levodopa-associated hypotension occur.
• Daytime somnolence and sudden sleep episodes.
• Hallucinations, confusion and impulse-control behaviour.
• New or changing suspicious skin lesions.
• Emergence or progression of hepatic impairment.
• Adverse effects when smoking status changes or a CYP1A2 inhibitor is introduced.

Clinical pharmacology

A potent, selective and irreversible MAO-B inhibitor, principally metabolised in the liver through CYP1A2. Its major metabolite, 1-aminoindan, does not inhibit MAO-B.

Formulation and product differences

• The selected product is an immediate-release oral tablet containing rasagiline as the hemitartrate salt.
• The tablet is not licensed for crushing, although crushing and mixing with water or soft food is an off-label option for swallowing difficulty under appropriate direction.
• The selected tablet contains microcrystalline cellulose, pregelatinised maize starch, colloidal anhydrous silica, talc and stearic acid.