rasagiline, Azilect (cont.)

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DRUG INTERACTIONS: Rasagiline is eliminated by enzymes in the liver. Ciprofloxacin (Cipro, Cipro XR, Proquin XR) inhibits the enzymes in the liver that eliminate rasagiline, thereby increasing blood levels and possibly side effects of rasagiline. Patients taking ciprofloxacin should not exceed 0.5 mg daily of rasagiline.

Rasagiline should not be administered with antidepressants that increase serotonin levels. Combining rasagiline with such antidepressants may lead to excessive levels of serotonin and a fatal condition called the serotonin syndrome. Examples of antidepressants to avoid include selective serotonin uptake inhibitors (for example, fluoxetine [Prozac, Sarafem], sertraline [Zoloft]), tricyclic antidepressants (for example, amitriptyline [Elavil, Endep]), serotonin-norepinephrine uptake inhibitors (for example, venlafaxine [Effexor]) and other MAO inhibitors (for example, selegiline, tranylcypromine). Rasagiline should be discontinued at least 14 days before initiating treatment with antidepressants that increase serotonin levels.

Due to its long half-life, fluoxetine should be discontinuedhadone, mirtazapine [Remeron Soltab], cyclobenzaprine [Flexeril, Amrix] dextromethorphan and St. John's Wort. Serious reactions, including the serotonin syndro at least 5 weeks before initiating rasagiline.

 Rasagiline should not be used with meperidine, propoxyphene [Darvon, Darvon-N, Dolene], tramadol [Ultram, Ultram ER], metme, have occurred when other MAO inhibitors were combined with some of these drugs, and there is concern that rasagiline may cause similar serious reactions.

Rasagiline should not be used with sympathomimetic amine drugs such as amphetamines and products containing vasoconstrictors (blood vessel narrowing drugs, for example, pseudoephedrine, ephedrine, phenylpropanolamine, phenylephrine). Severe hypertensive reactions have occurred when such drugs were combined with other MAO inhibitors. Patients taking rasagiline should not be given cocaine or local anesthetics containing sympathomimetic vasoconstrictor drugs. They also should not undergo elective surgery requiring general anesthesia. Rasagiline should be discontinued at least 14 days before surgery. Rasagiline should not be used with other MAO inhibitors because of the risk of a hypertensive crisis. Rasagiline should be discontinued at least 14 days before starting other MAO inhibitors.

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