How does this medication work? What will it do for me?

Rasagiline belongs to the family of medications known as monoamine oxidase inhibitors (MAOIs). It is used to treat Parkinson's disease. It acts on the nervous system to increase the levels of a chemical called dopamine. Low dopamine levels in the brain are responsible for many of the symptoms of Parkinson's disease, so this medication works by rebalancing the levels of dopamine.

This medication may be taken alone or in combination with levodopa or a dopamine agonist (i.e., ropinirole, pramipexole) to treat the symptoms of Parkinson's disease.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it. Do not stop taking this medication without consulting your doctor.

What form(s) does this medication come in?

0.5 mg
Each white-to-off-white, round, flat, bevelled-edged tablet, debossed with "GIL" and "0.5" below on one side and plain on the other, contains 0.5 mg of rasagiline. Nonmedicinal ingredients: colloidal silicon dioxide, mannitol, starch, pregelatinized starch, stearic acid, and talc.

1 mg
Each white-to-off-white, round, flat, bevelled-edged tablet, debossed with "GIL" and "1" below on one side and plain on the other, contains 1 mg of rasagiline. Nonmedicinal ingredients: colloidal silicon dioxide, mannitol, starch, pregelatinized starch, stearic acid, and talc.

How should I use this medication?

The recommended dose of rasagiline is 1 mg once daily. The recommended starting dose of rasagiline for someone already taking levodopa is 0.5 mg, which may then be increased to 1 mg once daily if necessary. The recommended starting dose for someone taking a dopamine agonist is 1 mg taken once daily.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

This medication may be taken with or without food.

If you feel you need to stop this medication, contact your doctor for advice on how to discontinue it without causing problems.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take rasagiline if you:

  • are allergic to rasagiline or to any of the ingredients of the medication
  • are taking any of the following medications:
    • antidepressants – at least 14 days must pass after stopping antidepressants (at least 5 weeks for fluoxetine) before starting rasagiline; anyone starting an antidepressant must wait at least 14 days after stopping rasagiline
    • cyclobenzaprine
    • dextromethorphan
    • MAO inhibitors (e.g., phenelzine, tranylcypromine) – at least 14 days must pass after stopping rasagiline
    • meperidine
    • methadone
    • St. John's wort
    • tapentadol
    • tramadol
  • have moderate-to-severe liver disease

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal pain
  • accidental injury
  • constipation
  • difficulty moving or controlling movements
  • dizziness
  • dry mouth
  • falls
  • feeling unwell
  • flu-like symptoms
  • heartburn
  • joint pain
  • lack of coordination
  • loss of appetite
  • muscle aches
  • nausea
  • rash
  • trouble sleeping
  • urgent need to urinate
  • vomiting
  • weight loss

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • abnormal heartbeat
  • behavioural changes (compulsive gambling, compulsive shopping)
  • bruising
  • dizziness or fainting when rising from a sitting or lying position
  • fever
  • hallucinations (hearing, seeing, or feeling things that aren't actually there)
  • increase in unusual movements of body (e.g., twisting movements of body, uncontrolled chewing movements, uncontrolled movements of face, neck, back, arms, or legs)
  • lip smacking or puckering
  • signs of depression (loss of interest in activities, sleeping too much, difficulty sleeping, eating more or less than usual, difficulty concentrating)
  • signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, cough, headache, stiff neck, weight loss, or listlessness)
  • sudden onset of falling asleep without warning

Get medical help immediately if any of the following signs of extremely high blood pressure (caused by the use of this medication with certain foods or other medications) occur:

  • chest pain (severe)
  • fast or slow heartbeat
  • headache (severe)
  • nausea and vomiting (severe)

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • agitation or irritability
  • dizziness (severe) or fainting
  • high or low blood pressure
  • increased sweating (possibly with fever or cold, clammy skin)
  • rapid or irregular pulse
  • severe headache
  • shortness of breath, wheezing, difficult breathing
  • signs of a severe allergic reaction (e.g., hives; difficulty breathing; or swelling of the mouth, lips, tongue, or throat; peeling, blistering skin)
  • signs of heart attack (e.g., sudden chest pain or pain radiating to back, down arm, jaw; sensation of fullness of the chest; nausea; vomiting; sweating; anxiety)
  • signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Antidepressant medication: Severe reactions, including serotonin syndrome, are possible when rasagiline is combined with medications and natural products used to treat depression. Avoid combining rasagiline and antidepressants. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, and changes in mental state including delirium and agitation. Coma and death are also possible.

If you have taken antidepressants recently, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Behaviour changes: People taking rasagiline have experienced abnormal behaviour such as compulsive gambling, compulsive shopping, hypersexuality, and binge eating. If you experience these symptoms or any other behaviour change while taking this medication, contact your doctor immediately.

Kidney function: Rasagiline should not be used by people with moderate or severe kidney function impairment. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function impairment: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have reduced liver function or liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. People with mild liver function impairment may be given 0.5 mg of rasagiline daily. Do not take rasagiline if you have moderate or severe liver function impairment.

Skin cancer: People taking this medication have a higher risk of developing skin cancer. It is unclear whether this increased risk is due to Parkinson's disease or to rasagiline. You and your doctor should check your skin regularly for signs of skin cancer (e.g., moles that have an irregular shape or border, moles that change colour, or moles that are larger than 6 mm).

Sudden onset of sleep: People taking rasagiline have reported suddenly falling sleep without warning signs of sleepiness or drowsiness. Be careful if driving or operating machinery while taking this medication. If you experience excessive drowsiness or falling asleep suddenly, avoid operating machines or driving and contact your doctor immediately.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: Rasagiline can reduce the amount of milk produced by a breast-feeding mother. It is not known if rasagiline passes into breast milk. If you are a breast-feeding mother and are taking rasagiline, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between rasagiline and any of the following:

  • alcohol
  • aldesleukin
  • aliskiren
  • alpha agonists (e.g., clonidine, guanfacine, methyldopa)
  • alpha-adrenergic receptor blockers (e.g., alfuzosin, doxazosin, terazosin)
  • amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
  • amphotericin B
  • angiotensin converting enzyme inhibitors (ACEIs; e.g., captopril, lisinopril, ramipril)
  • angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
  • antiarrhythmics (e.g., amiodarone, disopyramide, mexiletine)
  • anti-psychotics (e.g., cariprazine, chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
  • apomorphine
  • apraclonidine
  • atomoxetine
  • atropine
  • barbiturates (e.g., butalbital, phenobarbital)
  • beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
  • beta agonists (e.g., formoterol, indacaterol, salmeterol, salbutamol)
  • betahistine
  • bezafibrate
  • bortezomib
  • brimonidine
  • bromocriptine
  • buprenorphine
  • bupropion
  • buspirone
  • butorphanol
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
  • carbamazepine
  • ciprofloxacin
  • clonidine
  • conivaptan
  • cyclobenzaprine
  • cyproheptadine
  • decongestant cold medications (e.g., phenylephrine, pseudoephedrine)
  • decongestant eye drops and nose sprays (e.g., naphazoline, oxymetazoline, xylometazoline)
  • deferasirox
  • dextromethorphan
  • diabetes medications (e.g., acarbose, glyburide, insulins, liraglutide, metformin, rosiglitazone, saxagliptin)
  • diphenoxylate
  • diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
  • domperidone
  • epinephrine
  • eplerenone
  • esketamine
  • fentanyl
  • hydralazine
  • hydroxychloroquine
  • levodopa
  • linezolid
  • lithium
  • MAO inhibitors (e.g., moclobemide, phenelzine, tranylcypromine, selegiline)
  • meperidine
  • methadone
  • methylphenidate
  • metoclopramide
  • midodrine
  • mifepristone
  • mirtazapine
  • morphine
  • nabilone
  • narcotic pain relievers (e.g., codeine, hydromorphone, morphine, oxycodone, tapentadol, tramadol)
  • nitrates (e.g., isosorbide dinitrate, nitroglycerine)
  • ozanimod
  • pentoxifylline
  • pheniramine
  • phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
  • pizotifen
  • pramipexole
  • primidone
  • quinine
  • repaglinide
  • rifampin
  • riociguat
  • ropinirole
  • rotigotine
  • sacubitril
  • selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, vortioxetine)
  • serotonin-norepinephrine reuptake inhibitors (SNRI antidepressants; e.g., desvenlafaxine, duloxetine, venlafaxine)
  • St. John's wort
  • somatostatin-like medications (e.g., lanreotide, octreotide, pasireotide)
  • spironolactone
  • sunitinib
  • sympathomimetic medications (e.g., pseudoephedrine, phenylephrine, ephedrine)
  • tapentadol
  • terbutaline
  • tetrabenazine
  • tizanidine
  • trazodone
  • tretinoin
  • tricyclic and tetracyclic antidepressants (e.g., amitriptyline, doxepin, nortriptyline)
  • tryptophan
  • vemurafenib

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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