[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [MAO-B inhibitors](https://durgical.com/en/pharmacology/classes/mao-b-inhibitors/) › Rasagiline

[Pharmacology](https://durgical.com/en/pharmacology/) · [MAO-B inhibitors](https://durgical.com/en/pharmacology/classes/mao-b-inhibitors/)

# Rasagiline

An irreversible, selective MAO-B inhibitor for Parkinson disease, alone or with levodopa. No amphetamine metabolites; serious serotonergic interactions.

Updated 2026-11-01

- Class: [MAO-B inhibitors](https://durgical.com/en/pharmacology/classes/mao-b-inhibitors/)
- Enzyme: Monoamine oxidase B (MAO-B)
- ATC code: N04BD02

✂**Monoamine oxidase B (MAO-B)**Rasagiline

ⓘ The figure shows rasagiline in human MAO-B, attached covalently to the FAD cofactor (the crystal records the adduct form).

**Target in 3D:** Monoamine oxidase B (MAO-B). PDB structure 1S2Q (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/1S2Q) · Drag to rotate · pinch to zoom

## Mechanism of action

Rasagiline is a propargylamine that inactivates MAO-B irreversibly by bonding to its flavin. Striatal dopamine lasts longer. Unlike selegiline it is not metabolized to amphetamines. It is cleared mainly by liver CYP1A2.

- Rasagiline binds the FAD of MAO-B irreversibly
- Striatal dopamine is broken down more slowly
- Early symptoms ease; off time shortens with levodopa

## Pharmacokinetics

**Metabolism**
Liver, mainly CYP1A2; levels rise with ciprofloxacin and in liver disease

**Onset and duration**
Enzyme inhibition persists until new MAO-B is synthesized

## Indications

- Parkinson disease, as monotherapy in early disease or added to levodopa for wearing-off [Parkinson disease →](https://durgical.com/en/conditions/parkinson-disease/)

## Adverse effects

### Common

- Headache, joint pain, indigestion
- Dyskinesia and orthostatic hypotension with levodopa
- Somnolence

### Serious (rare, important)

- Serotonin syndrome with antidepressants, opioids such as meperidine or tramadol, and other MAO inhibitors
- Severe hypertension, including with very tyramine-rich foods
- Hallucinations, impulse-control disorders and sudden sleep

## Contraindications

- Meperidine, tramadol, methadone, propoxyphene and other MAO inhibitors (wait at least 14 days after stopping)
- Dextromethorphan, St John's wort and cyclobenzaprine
- Moderate or severe liver impairment (not used)

## Key interactions

**SSRIs, SNRIs, tricyclic and other antidepressants**
Risk of serotonin syndrome; close monitoring if combined

**Ciprofloxacin and other CYP1A2 inhibitors**
Higher rasagiline levels; dose is limited

**Sympathomimetics (decongestants, some cold remedies)**
Rise in blood pressure

**Dextromethorphan**
Episodes of psychosis or bizarre behaviour; contraindicated

## What is monitored

- Blood pressure
- Every new prescription and over-the-counter product for interactions
- Liver function before starting
- Dyskinesia, hallucinations and impulse-control behaviours

## Administration and safety

- Given once a day by mouth
- At least two weeks must pass after stopping before starting interacting drugs
- Pharmacy should check every new opioid, antidepressant or cough medicine

## Nursing care

- Teach to avoid foods with very high tyramine, such as some aged cheeses
- Teach to avoid dextromethorphan cough syrups and St John's wort
- Recognize serotonin syndrome: agitation, fever, sweating, tremor, rigidity
- Check blood pressure at visits

## Pregnancy and breastfeeding

There are no adequate human data; animal studies showed reduced offspring survival.

## Memory aid

Banned with MAO-B inhibitors – «MTD-SC»: Meperidine, Tramadol, Dextromethorphan, St John's wort, Cyclobenzaprine (plus methadone).

## Test yourself

Think of the answer, then tap the question to see it.

## Which drugs are contraindicated with rasagiline?

Meperidine, tramadol, methadone, dextromethorphan, St John's wort, cyclobenzaprine or other MAO inhibitors.

## How does rasagiline differ from selegiline in its metabolites?

Rasagiline does not produce amphetamine metabolites.

## Why does ciprofloxacin matter with rasagiline?

It inhibits CYP1A2, the main enzyme that clears rasagiline, so levels rise.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/rasagiline/)

## Related drugs

- [Selegiline](https://durgical.com/en/pharmacology/selegiline/)
- [Safinamide](https://durgical.com/en/pharmacology/safinamide/)
- [Levodopa + carbidopa](https://durgical.com/en/pharmacology/levodopa-carbidopa/)

## Related conditions

- [Parkinson disease](https://durgical.com/en/conditions/parkinson-disease/)

[← Back to the class: MAO-B inhibitors](https://durgical.com/en/pharmacology/classes/mao-b-inhibitors/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - RASAGILINE tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e802c83c-e581-4a11-b83d-1df47120078d) (DailyMed (U.S. National Library of Medicine), 2026); [Rasagiline: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a606017.html) (MedlinePlus (U.S. National Library of Medicine), 2016); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 21 (McGraw Hill, 2023).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/rasagiline/
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