4.9.1.3 Monoamine-oxidase-B (MAOB) inhibitors

ChoiceDrugDosage
1st choiceRasagiline tablets 1mgDose:
1mg daily
2nd choiceSelegiline tablets 5mg, 10mg; oral lyophilisate 1.25mg

Dose:
Immediate release tablets:
initially 5mg in the morning, increasing after 2-4 weeks if tolerated to 10mg in the morning (or 5mg at breakfast and midday);
elderly – to avoid initial confusion and agitation, it may be appropriate to start treatment with a dose of 2.5mg daily

Oral lyophilisate tablets:
1.25mg in the morning before breakfast
(1.25mg oral lyophilisate is equivalent to 10mg tablet)

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 levoldopa in later Parkinson’s disease for ‘end-of-dose’ fluctuations.

Cautions

  • When combined with levodopa, MAOB inhibitors should be avoided or used with great caution in postural hypotension.
  • Drug interaction between MAOB inhibitors and antidepressants (risk of serotonin syndrome):
    • SSRIs, venlafaxine or duloxetine should not be used by people taking selegiline or rasagiline
    • tricyclic antidepressants should not be used without specialist advice by people taking selegiline or rasagiline
    • people taking selegiline or rasagiline may cautiously use trazodone or mirtazapine (off-label use for selegiline)