Safety of rasagiline for the treatment of Parkinson's disease

Introduction: Levodopa remains the gold standard treatment for Parkinson's disease (PD), but chronic treatment induces motor fluctuations and dyskinesias. Other dopaminergic agents, such as dopamine agonists, catechol-O-methyl transferase inhibitors and monoamine oxidase B enzyme inhibitors (MAO-B I) have also been developed to treat patients with PD. Rasagiline is a second generation MAO-B I inducing moderate symptomatic and possibly disease-modifying benefits with apparently good tolerability and safety profile in PD patients. Areas covered: The safety of rasagiline in early or advanced PD is discussed. Details about clinical trial data, post hoc analysis in the elderly or regarding cognitive or behavioral effects, food--drug interactions and effects on levodopa-induced dyskinesias are given. Expert opinion: Rasagiline is effective and well tolerated in PD as monotherapy or in combination with levodopa. There was no evidence of a difference in tolerability between younger or older PD patients included in published trials. Food interactions studies with tyramine did not provide evidence of clinical concerns. Drug interaction should be monitored. The risk of serotonin toxicity with serotoninergic antidepressants remains insufficiently characterized, while current available data in small groups of subjects suggest a low risk.