Concern About Rasagiline Interactions

AR is a 71-year-old man who currently lives at home with his wife. AR’s medical history is positive for type 2 diabetes mellitus, arthritis, depression, and Parkinson’s disease. AR is picking up a refill for rasagiline (Azilect) 1 mg po daily. AR explains that he was experiencing some “wearing off” of his carbidopa/levodopa, and his primary care provider wrote him a prescription for rasagiline approximately 1 month ago to help with this wearing off and for its potential neuroprotective effects.

AR stated that he spoke to his neighbor about his new medication and its function as a monoamine oxidase (MAO) B inhibitor. His neighbor, who takes an MAO inhibitor for depression, commented that her doctor had given her specific dietary instructions to follow and discontinued her selective serotonin reuptake inhibitor (SSRI) therapy because of possible drug interactions. AR realized that he was also on an SSRI for his depression and is concerned about the possibility of experiencing adverse effects due to interactions between rasagiline, his SSRI, and his diet.

AR is taking the following medications per his current medication list that he carries in his wallet: rasagiline (Azilect) 1 mg po daily; carbidopa/levodopa (Sinemet) 25/100 mg q4-6h; entacapone (Comtan) 200 mg po q4-6h; escitalopram (Lexapro) 10 mg po daily; metformin (Glucophage) 1,000 mg po bid; and acetaminophen (Tylenol Arthritis) 650 mg po tid.

What are your thoughts about AR’s concerns, and how would you counsel AR on his new rasagiline prescription?

Jacqueline Groat, PharmD Student, Class of 2013

Joshua J Neumiller, PharmD, CDE, CGP, FASCP
Assistant Professor
Department of Pharmacotherapy
College of Pharmacy
Washington State University
Spokane, Washington