PD- MAOIs DI Flashcards
MAOIs used in PD
Selegiline, rasagiline, safinamide (Xagado)
MAOIs MoA
Noncompetitive, selective antagonists of MAO-B → decreases breakdown of dopamine, decreases free radical production → delay need for L-dopa for 9 months
Metabolites of selegiline
3 active metabolites: N-desmethyldeprenyl, 1-amphetamine, 1-methamphetamine
Does selegiline cross the BBB?
Yes
Where do the side effects of selegiline come from?
the metabolites
Selegiline ADEs
CNS, GI, HTN crisis, serotonin syndrome, insomnia, jitteriness, HA, irritation of buccal mucosa with Zelapar dissolving tablet formulation
Selegiline has no absolute CIs with these disease states…
dementia, severe psychosis, concomitant use of meperidine, tramadol, methadone, and propoxyphene
Selegiline DDIs
Nonspecific MAOIs, TCAs, SSRIs, SNRIs, DXM, tyramine-containing foods at doses >10mg, sympathomimetics
Counseling point for selegiline dissolving tablet
No food or drink for 5 minutes before and after dose
Rasagiline is potentially disease modifying: true or false
True
Rasagiline ADEs
Monotherapy: HA, arthralgia, GI upset, falls
With L-dopa: dyskinesia, GI upset, HA, weight loss, arthralgia, orthostasis (most common in first 2 months of treatment)
Rasagiline DDIs
Drugs metabolized by CYP1A2, MAOIs (require a 2-week washout period), TCAs and fluoxetine (require a 5-week washout period), tyramine-containing foods, sympathomimetics
Rasagiline drug CIs
meperidine, tramadol, methadone, St. John’s wort, mirtazapine, cyclobenzaprine, vasoconstrictors
What is safinamide used in?
Adjunct to L-dopa for wearing-off symptoms
Safinamide CI
Child-Pugh Class C hepatic impairment
