4.9.1.3 Monoamine-oxidase-B (MAOB) inhibitors

ChoiceDrugDosage
1st choiceRasagiline tablets 1mgDose:
See BNF - seek specialist advice
2nd choiceSelegiline tablets 5mg, 10mg; oral lyophilisate 1.25mgDose:
See BNF - seek specialist advice

Prescribing Notes

  • MAOB inhibitors can be used as monotherapy in early Parkinson’s disease to improve motor symptoms and delay the need for levodopa
  • MAOB inhibitors may be used as an adjunct to levodopa in later Parkinson’s disease for ‘end-of-dose’ fluctuations

Cautions

  • The combination of MAOB inhibitors and antidepressants can increase the risk of serotonin syndrome. However, depression is commonly associated with PD and SSRIs are often used for its management. According to the literature, serotonin syndrome occurs rarely and this combination is sometimes used under specialist advice. Recommended doses should not be exceeded and SSRI dose should be kept at the lower end of the therapeutic range. Among the SSRIs, citalopram and sertraline may be preferred. Healthcare professionals should remain vigilant to this potential complication