MAO-B inhibitors (rasagiline, selegiline, safinamide)

MAO–B inhibitors can help your nerve cells make better use of the dopamine that they have.

Monoamine oxidase type B is an enzyme that wrongly hoovers up dopamine that is not being used by your brain. MAO-B inhibitors stop this enzyme so that more dopamine becomes available to treat your symptoms.

MAO-B inhibitors take two to three weeks to work and when you stop this medication it will be two to three weeks before they stop working.

A MAO–B inhibitor can be used on its own in early Parkinson’s when your motor symptoms are controlled and mild. It can also be used with other drugs at any stage. Later on it can help with motor fluctuations.

You don’t need to start gradually

Many drug treatments for Parkinson’s have to be started gradually, with the dose slowly being increased over time. This is not the case for most MAO-B inhibitors.

Delaying levodopa treatment

By taking a MAO–B inhibitor at an early stage of Parkinson’s, you may be able to delay taking levodopa until your symptoms become more difficult to manage.

Helping levodopa work well

When you have been taking levodopa for a while, you may find that its effects wear off too quickly. A MAO–B inhibitor can help.

Taking a MAO–B inhibitor may also mean you can take less levodopa and leave more time between doses.
 

Antidepressants

If you’re taking some types of antidepressant, you might not be able to take MAO–B inhibitors. This is because these drugs can interact with each other and raise blood pressure to a dangerous level.

Your specialist should be able to advise you on how to take antidepressants alongside your Parkinson’s medication.

Decongestants or cold remedies

These can affect some types of MAO–B inhibitors. If you need to use them, check with your pharmacist to find out which one is safe for you to use.

Worse levodopa side effects

Involuntary movements (dyskinesia) and sickness may get worse because MAO–B inhibitors strengthen the effects of levodopa. If this happens, your specialist or Parkinson’s nurse can reduce your dose of levodopa.

Impulsive and compulsive behaviours

Behaviours may involve gambling, becoming a ‘shopaholic’, binge eating or focusing on sexual feelings and thoughts. This can have a huge impact on people’s lives including family and friends.

Not everyone who takes Parkinson’s medication will experience impulsive and compulsive behaviours, so these side effects should not put you off taking your medication to control your symptoms.

Find out more about impulsive and compulsive behaviours. 

Increased risk of low blood pressure

Eating foods rich in tyramine while taking high doses of MAO-B inhibitors can cause a sudden increase in blood pressure. Tyramine-rich foods can include things cured meats, strong or aged cheeses and pickled foods. Speak to your specialist or Parkinson’s nurse if you have any concerns.

Find out more about low blood pressure in Parkinson's.

Other side effects

The patient information leaflet that comes with your medication will tell you the full range of side effects that you may experience.

Some of the possible side effects include:

• headaches
• constipation
• dry mouth
• an urgent need to pass urine
• aching joints
• indigestion
• flu-like symptoms
• depression

Find out more about the side effects of Parkinson's drugs

Rasagiline is a type of generic (unbranded) MAO-B inhibitor medication. Azilect is the brand name.

Taking rasagiline (Azilect)

Rasagiline can be taken alone. It can also be taken with levodopa to help stop motor fluctuations that happen at the end of your dose or before your next one is due.

You will take rasagiline once per day, which can be helpful if you prefer to take fewer doses. But be aware that this option may not be suitable for everyone. You can take it with or without food.

Selegiline is a type of generic (unbranded) MAO-B inhibitor medication. Eldepryl and Zelapar are the branded versions of selegiline. 

Selegiline is started at 5 mg and increased after two to four weeks to 10 mg.

Eldepryl tablets

You will usually take Eldepryl tablets once per day. However there is also the option of taking one in the morning and then one at lunchtime. Your specialist team can advise you on the best time to take Eldepryl for your Parkinson’s.

Eldepryl tablets can delay the need to take levodopa which is helpful as levodopa can become less effective over time. 

Eldepryl can also be taken with levodopa to help stop motor fluctuations that happen at the end of your dose before your next one is due.

Zelapar dissolvable tablets

Selegiline is available as tablets which dissolve on the tongue (Zelapar dissolvable tablets). This can be helpful if you experience problems with swallowing.

To take Zelapar tablets, put one on your tongue before eating breakfast. You should wait five minutes for it to dissolve before eating, drinking, or rinsing your mouth so this medication can work.

Safinamide is a type of generic (unbranded) MAO-B inhibitor medication. Xadago is the branded version of safinamide.

Safinamide medication is taken as an addition to your regular dose of levodopa medication. It can also be taken with other medication if your condition has progressed to help reduce motor fluctuations.

Taking safinamide (Xadago)

You will take safinamide (Xadago) once per day with water and with or without food. This can be helpful if you prefer to take fewer doses. But be aware this option may not be suitable for everyone. Your healthcare professional will be best placed to advise you when to take safinamide (Xadago) medication.