Rasagiline (patient information)

# Why is this medication prescribed
Rasagiline is used alone or in combination with another medication to treat the symptoms of Parkinson's disease (a slowly progressing disease of the nervous system causing a fixed face without expression, tremor at rest, slowing of movements, walking with shuffling steps, stooped posture and muscle weakness). Rasagiline is in a class of medications called monoamine oxidase (MAO) type B inhibitors. It works by increasing the amounts of certain natural substances in the brain.

# How should this medicine be used
Rasagiline comes as a tablet to take by mouth. It is usually taken once a day with or without food. Take rasagiline at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take rasagiline exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# What special precautions should I follow
Before taking rasagiline:
- tell your doctor and pharmacist if you are allergic to rasagiline or any other medications.
- tell your doctor if you are taking amphetamines (Adderall, Dexedrine, DextroStat); antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), mirtazapine (Remeron), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); ephedrine; cough and cold products containing dextromethorphan (DM; in Robitussin Cough Calmers, Sucrets Cough Control, Suppress, others), phenylephrine (Sudafed PE, others), phenylpropanolamine (not available in the U.S.), or pseudoephedrine (Pediacare, Sudafed, Suphedrine, others); cyclobenzaprine (Flexeril); diet or weight-control products containing ephedrine; meperidine (Demerol); methadone (Dolophine, Methadose); other MAO inhibitors such as phenelzine (Nardil), selegiline (Eldepryl), or tranylcypromine (Parnate); nasal and oral decongestants; propoxyphene (Darvon, in Darvocet-N, others); serotonin-norepinephrine reuptake inhibitors such as duloxetine (Cymbalta) and venlafaxine (Effexor); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft); St. John's wort; or tramadol (Ultram, in Ultracet). Your doctor will probably tell you not to take these medications while taking rasagiline and for at least 14 days after stopping rasagiline.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: atazanavir (Reyataz); cimetidine (Tagamet); fluoroquinolone antibiotics including ciprofloxacin (Cipro), gatifloxacin (Tequin), levofloxacin (Levaquin), norfloxacin (Noroxin), ofloxacin (Floxin), others; and ticlopidine (Ticlid). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have pheochromocytoma (a tumor on a small gland near the kidneys). Your doctor will probably tell you not to take rasagiline.
- tell your doctor if you have or have ever had kidney or liver disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking rasagiline, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking rasagiline. Your doctor will probably tell you to stop taking rasagiline at least 14 days before elective surgery.
- you should know that rasagiline may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common during the first 2 months of taking rasagiline. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
- you should know that rasagiline may cause serious, life-threatening high blood pressure when taken with certain medications or foods. Carefully follow your doctor's instructions about medications and foods to be avoided. Call your doctor right away if you have a severe headache, blurred vision, or any of the other symptoms listed below as serious side effects.
- you should know that patients who took rasagiline had a higher risk of melanoma (a type of skin cancer) than people in the general population. It is not known whether this increased risk is caused by Parkinson's disease or rasagiline. You should have regular visits with a dermatologist to examine your skin for melanoma.

# What special dietary instructions should I follow
Do NOT eat the following foods, which contain tyramine, while taking rasagiline and for 2 weeks after you stop taking it: pickled herring; dried sausage; hard salami; spoiled or improperly stored meat, poultry, fish, and liver; fava bean pods; aged cheeses; tap beer and unpasteurized beers; red wine; concentrated yeast extract; sauerkraut; and most soybean products, including soy sauce and tofu.
You MAY eat the following foods, which contain little or no tyramine, while taking rasagiline: fresh meat, poultry, and fish; fresh processed meats such as lunch meats, hot dogs, breakfast sausage, and cooked sliced ham; processed cheeses; mozzarella cheese; ricotta cheese; cottage cheese; yogurt; bottled and canned beers; white wine; Brewer's yeast; baker's yeast; and soy milk.
Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medicine.

# What should I do if I forget a dose
Do not take a double dose to make up for a missed one. Skip the missed dose and take your next dose at the usual time the next day.

# Side effects

## Mild side effects
Rasagiline may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- mild headache
- joint or neck pain
- heartburn
- stomach pain
- constipation
- diarrhea
- loss of appetite
- weight loss
- flu-like symptoms
- fever
- sweating
- runny nose
- red, swollen, and/or itchy eyes
- dry mouth
- unsteadiness, wobbliness, or lack of coordination
- lack of energy
- sleepiness
- depression
- pain, burning, numbness, or tingling in the hands or feet
- rash
- black and blue marks

## Severe side effects
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:
- severe headache
- blurred vision
- difficulty thinking
- seizures
- chest pain
- nausea`
- vomiting
- shortness of breath or difficulty breathing
- unconsciousness
- slow or difficult speech
- dizziness or faintness
- weakness or numbness of an arm or leg
- hallucinating (seeing things or hearing voices that do not exist)
Rasagiline may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

# What storage conditions are needed for this medicine
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of rasagiline overdose may occur as late as 1 to 2 days after the overdose. Symptoms of overdose may include:
- drowsiness
- dizziness
- faintness
- irritability
- seizures
- hyperactivity
- agitation
- severe headache
- hallucinating
- difficulty opening the mouth
- rigid body spasm that may include an arched back
- unconsciousness
- fast or irregular heart beat
- pain in the area between the stomach and chest
- difficulty breathing
- fever
- sweating
- cool, clammy skin

# What other information should I know
Keep all appointments with your doctor.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Azilect