Rasagiline (Azilect) is a medication used to manage Parkinson’s disease. It improves motor symptoms like tremors, rigidity, and slowed movement by affecting certain chemical messengers in the brain.
Standard Dosage Guidelines
The typical dosage for rasagiline varies depending on its use, either as a standalone treatment (monotherapy) or in combination with other Parkinson’s medications like levodopa. For monotherapy, or as an adjunct therapy in patients not yet receiving levodopa, the recommended dose is 1 milligram (mg) taken once daily by mouth.
When rasagiline is prescribed as an adjunct to levodopa, the usual initial dose is 0.5 mg once daily. If a sufficient clinical response is not achieved and the 0.5 mg dose is well-tolerated, the dosage may be increased to 1 mg once daily. A reduction in the levodopa dose might be considered based on the individual patient’s response and tolerability.
Important Dosage Considerations
Several factors can influence the appropriate dosage of rasagiline, requiring careful consideration to ensure patient safety and effectiveness. Liver function, specifically hepatic impairment, plays a role in how the body processes the medication. For individuals with mild hepatic impairment, the dosage should not exceed 0.5 mg once daily. Age, while not a primary factor for general adult dosing, often correlates with comorbidities that may influence overall treatment decisions.
Rasagiline is not recommended for use in patients with moderate to severe hepatic impairment, as the medication’s exposure can significantly increase, potentially leading to heightened side effects. Renal impairment, however, does not necessitate a dosage adjustment for mild to moderate cases, although data for severe renal impairment are not available.
Drug interactions also significantly impact rasagiline dosage. Concomitant use with ciprofloxacin or other strong CYP1A2 inhibitors can increase rasagiline concentrations in the blood, potentially leading to increased adverse reactions. Therefore, when these medications are taken together, the rasagiline dose should not exceed 0.5 mg daily.
Other medications, including certain antidepressants (e.g., SSRIs, SNRIs, tricyclic antidepressants), dextromethorphan, meperidine, tramadol, methadone, propoxyphene, St. John’s Wort, and other MAO inhibitors, are generally contraindicated or not recommended with rasagiline due to the risk of serious reactions like serotonin syndrome or hypertensive crisis. At least 14 days should pass between discontinuing rasagiline and starting another MAO inhibitor, or vice versa.
How to Take and Manage Doses
Rasagiline tablets are taken orally, once daily, with or without food. Adhere strictly to the prescribed dosage and schedule.
If a dose of rasagiline is missed, it should be skipped, and the patient should continue with the next scheduled dose as usual. Doubling up on doses to compensate for a missed one is not advised. In the event of a suspected overdose, immediate medical attention is necessary. Symptoms of an overdose can include a euphoric mood, extremely high blood pressure, or serotonin syndrome, which may present with agitation, confusion, rigidity, fever, and muscle spasms. Taking the medication carton or bottle to the healthcare provider can assist in diagnosis and treatment.
Store rasagiline in a closed container at room temperature, away from excessive heat, moisture, and direct light. It should not be stored above 25°C. Keep rasagiline out of the sight and reach of children. For bottle packs, the medication should be used within two months of first opening. Any outdated medication or medication no longer needed should be disposed of properly, often by consulting a healthcare professional or pharmacist for guidance on safe disposal methods.