Rasator 0.5/Rasator 1 Drug Interactions

Monoamine Oxidase (MAO) Inhibitors: Rasagiline is contraindicated along with other MAO inhibitors (including medicinal and natural products without prescription e.g. St. John's Wort) as there may be a risk of non-selective MAO inhibition that may lead to hypertensive crisis.
Pethidine/Meperidine: Serious adverse reactions have been reported with the concomitant use of pethidine and MAO inhibitors including another selective MAO-B inhibitor. The concomitant administration of rasagiline and pethidine is contraindicated.
Sympathomimetic Medications: Severe hypertensive reactions have followed the administration of sympathomimetics and nonselective MAO inhibitors. Hypertensive crisis has been reported in patients taking the recommended dose of Rasagiline and sympathomimetic medications. Severe hypertension has been reported in patients taking the recommended dose and ophthalmic drops containing sympathomimetic medications. Therefore, in view of the MAO inhibitory activity of rasagiline, concomitant administration of rasagiline and sympathomimetics such as those present in nasal and oral decongestants or cold medicinal products, containing ephedrine or pseudoephedrine, is not recommended.
Dextromethorphan: Co-administration of Rasagiline and dextromethorphan has been reported to cause brief episodes of psychosis or bizarre behavior.
Antidepressants: Serious adverse reactions have been reported with the concomitant use of SSRIs, SNRIs, tricyclic/tetracyclic antidepressants and MAO inhibitors. Therefore, in view of the MAO inhibitory activity of rasagiline, antidepressants should be administered with caution. The concomitant use of rasagiline and fluoxetine or fluvoxamine should be avoided. At least 14 days should elapse between discontinuation of rasagiline and initiation of treatment with fluoxetine or fluvoxamine. At least five weeks should elapse between discontinuation of fluoxetine and initiation of treatment with rasagiline.
Ciprofloxacin or Other CYP1A2 Inhibitors: In Parkinson's disease patients receiving chronic levodopa treatment as adjunct therapy, there was no clinically significant effect of levodopa treatment on rasagiline clearance. Co-administration of rasagiline and ciprofloxacin (an inhibitor of CYP1A2) increased the exposure of Rasagiline. Co-administration of rasagiline and theophylline (a substrate of CYP1A2) did not affect the pharmacokinetics of either product. Thus, potent CYP1A2 inhibitors may alter rasagiline plasma levels and should be administered with caution. In vitro studies showed that rasagiline at a concentration of 1 μg/mL did not inhibit cytochrome P450 isoenzymes, CYP1A2, CYP2A6, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4 and CYP4A. These results indicate that rasagiline's therapeutic concentrations are unlikely to cause any clinically significant interference with substrates of these enzymes.
Entacapone: Concomitant administration of rasagiline and entacapone increased rasagiline oral clearance by 28%.
Dopaminergic Antagonists: Antipsychotics or metoclopramide could diminish the effectiveness of Rasagiline.
Smoking: There is a risk that the plasma levels of rasagiline in smoking patients could be decreased, due to induction of the metabolizing enzyme CYP1A2.
Rasator 0.5: Tyramine/Rasagiline interaction: Results of tyramine challenge studies indicate that Rasagiline at recommended dose can be used safely without dietary tyramine restrictions.
Rasator 1: Tyramine/Rasagiline interaction: Results of tyramine challenge studies indicate that Rasagiline at recommended doses can be used safely without dietary tyramine restrictions. However, certain foods may contain very high amounts of tyramine and could potentially cause a hypertensive reaction in patients taking Rasagiline due to increased sensitivity to tyramine. Consumption of foods containing a very large amount of tyramine while taking recommended dose of rasagiline is not advised.