Safinamide !

A reversible MAO-B inhibitor added to levodopa for «off» episodes. It also reduces glutamate release; same interaction cautions as other MAO-B inhibitors.

Updated 2026-11-01

Class: MAO-B inhibitors
Enzyme: Monoamine oxidase B (MAO-B)
ATC code: N04BD03

Monoamine oxidase B (MAO-B)Safinamide

The figure shows safinamide bound reversibly (not covalently) in the substrate cavity of human MAO-B.

Target in 3D: Monoamine oxidase B (MAO-B). PDB structure 2V5Z (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Safinamide inhibits MAO-B reversibly, unlike selegiline and rasagiline, so striatal dopamine lasts longer. It also reduces glutamate release, an action that may add to its effect.

Safinamide occupies the MAO-B active site reversibly
Dopamine is broken down more slowly
Glutamate release is also reduced
Off episodes become shorter

Pharmacokinetics

Metabolism: Liver; dose limited in moderate liver impairment and avoided in severe liver disease

Indications

Add-on to levodopa + carbidopa for off episodes in Parkinson disease Parkinson disease →

Adverse effects

Common

Dyskinesia (worse or more frequent involuntary movements)
Nausea
Insomnia

Contraindications

Severe liver impairment
Other MAO inhibitors, including linezolid and methylene blue
Opioids such as meperidine, dextromethorphan, St John's wort (class contraindications)

Key interactions

MAO inhibitors, linezolid, methylene blue: Hypertensive or serotonergic reactions
Antidepressants (SSRIs, SNRIs, tricyclics): Serotonin syndrome risk
Dextromethorphan and St John's wort: Serotonergic toxicity
Sympathomimetics and very tyramine-rich foods: Rise in blood pressure

What is monitored

Dyskinesia and hallucinations
Blood pressure
Liver function
Vision changes

Administration and safety

Always used together with levodopa
Tapered rather than stopped abruptly
A drug-free gap is needed before starting other MAO inhibitors

Nursing care

Check every new medicine, cough syrup or herbal product for interactions
Ask about sudden sleep and warn about driving
Record changes in involuntary movements

Pregnancy and breastfeeding

Human data are limited; pregnancy during treatment is discussed with the specialist.

Test yourself

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

How does safinamide differ from rasagiline at the enzyme?

Safinamide inhibits MAO-B reversibly; rasagiline and selegiline inhibit it irreversibly.

For which problem is safinamide added to levodopa?

Off episodes in Parkinson disease.

Which second action besides MAO-B inhibition does safinamide have?

It reduces glutamate release.

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Parkinson disease

← Back to the class: 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: Safinamide: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2017); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 21 (McGraw Hill, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.