The use of rasagiline in conjunction with levodopa in Parkinson's disease

Abstract

The key goals of drug treatment for idiopathic Parkinson's disease are to control symptoms, maintain function and minimize side effects. Modern therapeutic strategies aim to introduce levodopa as late as possible, thereby postponing the development of levodopa-related motor complications, as well as preventing the emergence of drug-related symptoms such as confusion and hallucinations. Levodopa-sparing strategies include the use of dopamine agonists and catechol-o-methyltransferase inhibitors. While these drugs are effective, some patients cannot tolerate them at the doses required to control their symptoms, and they lack a simple dosage regimen or titration schedule. As a result, new treatments are needed. Rasagiline is a second-generation, potent, irreversible and selective inhibitor of monoamine-oxidase type B. A 1 mg tablet is licensed in the UK for use as monotherapy in idiopathic Parkinson's disease and as adjunct therapy to levodopa in those patients with end-of-dose motor fluctuations. It offers once-a-day dosing, with no need for titration, which makes it simple to use in a condition where complicated dosing regimens are common. It has an acceptable side-effect profile and three key trials show it to be effective in, and well tolerated by, patients in early and advanced Parkinson's disease, including the elderly. Trials have also shown a high rate of compliance that should be mirrored in practice. For nurses managing Parkinson's disease patients with end-of-dose fluctuations and for newly diagnosed patients, rasagiline offers a promising new treatment option.