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

# 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](https://durgical.com/en/pharmacology/classes/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](https://www.rcsb.org/structure/2V5Z) · Drag to rotate · pinch to zoom

## 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 →](https://durgical.com/en/conditions/parkinson-disease/)

## Adverse effects

### Common

- Dyskinesia (worse or more frequent involuntary movements)
- Nausea
- Insomnia

### Serious (rare, important)

- Serotonin syndrome with interacting drugs: agitation, fever, sweating, tremor, rigidity
- Hallucinations and delusions
- Falling asleep during daily activities
- Retinal problems (caution in retinal disease or albinism)

## 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.

## Memory aid

«SAFinamide is SAFe to let go»: the reversible MAO-B inhibitor.

## 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.

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

## Related drugs

- [Rasagiline](https://durgical.com/en/pharmacology/rasagiline/)
- [Selegiline](https://durgical.com/en/pharmacology/selegiline/)
- [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: [Safinamide: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a617025.html) (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](https://atcddd.fhi.no/atc_ddd_index/?code=N04BD03) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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