Parkinson's Disease - Surgery

Other Medications

Monoamine Oxidase B (MAO-B) Inhibitors

Selegiline (Eldepryl, Movergan, Zelepar), also known as deprenyl, is an antioxidant drug that blocks monoamine oxidase B (MAO-B), an enzyme that degrades dopamine. Until recently, selegiline was commonly used in early-onset disease and in combination with levodopa for maintenance. Concerns over significant side effects have been raised, however.

A newer MAO-B inhibitor, rasagiline (Azilect), is used alone during early-stage PD and in combination with L-dopa for moderate-to-advanced PD. Unlike selegiline, which is taken twice a day, rasagiline is taken once a day.

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Side Effects. MAO-B inhibitors may have severe side effects:

• One of the most important side effects is orthostatic hypotension, particularly in people taking Sinemet plus selegiline. This condition is a sudden drop in blood pressure that causes dizziness and lightheadedness when a patient stands up. Orthostatic hypotension can also occur with other Parkinson's drugs.
• Can cause high blood pressure (hypertension) if combined with drugs that increase serotonin levels -- such drugs include many antidepressants. Patients suffering from depression and taking selegiline should discuss all treatment options with their doctor.
• Can also cause a dangerous increase in blood pressure if patients eat foods rich in the amino acid tyramine. While taking selegiline or rasagiline, and for 2 weeks after stopping medication, patients should avoid foods such as aged cheeses, processed lunch meats, pickled herring, yeast extract, aged red wines, draft beers, sauerkraut, and soy sauce.

Debate over Mortality Rates. Some major studies have reported higher mortality rates in patients with advanced PD. Such findings may be due to adverse effects on the heart and blood vessels. Although other studies have not reported lower survival rates, some doctors believe that, given its modest effects, selegiline may be a poorer drug choice than others, particularly in patients with risk factors for heart disease.