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Rasagiline oral

Presentation

Oral formulations of rasagiline.

Drugs List

  • AZILECT 1mg tablets
  • rasagiline 1mg tablets
  • Therapeutic Indications

    Uses

    Parkinson's disease

    Dosage

    Adults

    1mg once daily.

    Contraindications

    Children under 18 years
    Within 2 weeks of discontinuing MAOIs
    Within 5 weeks of discontinuing fluoxetine or 2 weeks of other SSRIs
    Severe hepatic impairment

    Precautions and Warnings

    Breastfeeding
    Mild hepatic impairment
    Pregnancy

    Advise ability to drive/operate machinery may be affected by side effects
    Advise patient not to drive until they know how the medicine affects them
    Advise patient that sudden onset sleep episodes may affect ability to drive
    Monitor patients for impulse control disorders
    Refer suspicious skin lesions to a specialist
    Review treatment if impulse control disorders symptoms occur
    Avoid abrupt withdrawal
    Discontinue if hepatic function deteriorates in pts with hepatic impairment
    Reduce dose or discontinue if sudden onset of sleep during daily activities
    Dose adjustment required if patient starts/stops smoking during therapy
    Advise patient not to take St John's wort concurrently
    Advise patient/carer about symptoms of impulse control disorders

    Pregnancy and Lactation

    Pregnancy

    Use rasagiline with caution in pregnancy.

    At the time of writing there is limited published information regarding the use of rasagiline during pregnancy.

    Animal studies do not indicate any harmful effects.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

    Lactation

    Use rasagiline with caution in breastfeeding.

    At the time of writing there is limited published information regarding the use of rasagiline during breastfeeding. Rasagiline inhibits prolactin secretion, and may inhibit lactation. Briggs (2015) suggests that rasagiline will be excreted into breast milk due to the molecular weight (about 267 for the mesylate salt), the protein binding (88% to 94%) and elimination half-life of 3 hours.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

    Side Effects

    Abdominal pain
    Allergic reaction
    Angina pectoris
    Arthralgia
    Arthritis
    Carpal tunnel syndrome
    Cerebrovascular accident
    Confusion
    Conjunctivitis
    Constipation
    Decreased appetite
    Depression
    Dermatitis
    Dream abnormalities
    Dry mouth
    Dyskinesia
    Dystonia
    Falls
    Fever
    Flatulence
    Hallucinations
    Headache
    Influenza-like syndrome
    Leucopenia
    Loss of balance
    Malaise
    Musculoskeletal pain
    Myocardial infarction
    Nausea
    Neck pain
    Postural hypotension
    Rash
    Rhinitis
    Skin carcinoma
    Urinary urgency
    Vertigo
    Vesiculo-bullous reactions
    Vomiting
    Weight loss

    Overdosage

    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

    Further Information

    Last Full Review Date: April 2017

    Reference Sources

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: Azilect 1mg Tablets. Teva Pharmaceuticals Ltd. Revised September 2017.

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