II. Indications

  1. Parkinsonism
    1. May be used as monotherapy in early Parkinsonism to delay Levodopa start
    2. Typically used as adjunctive therapy with Levodopa
      1. May slow Parkinsonism progression when used in combination with Levodopa
      2. Reduces "off" time

III. Mechanism

  1. Irreversible MAO Inhibitor (Type B only, in CNS, Liver, Platelets)
    1. Inhibits intracerebral Dopamine metabolism

IV. Metabolism

  1. Rapid oral absorption
  2. Readily crosses blood brain barrier
  3. Hepatic metabolism

V. Adverse Effects

VI. Drug Interactions

  1. See MAO Inhibitors
  2. Tyramine Containing Food
    1. Significant tyramine restriction is not typically needed at typical doses of Type B MAO Inhibitors
    2. Avoid foods with high tyramine concentrations
  3. Hypertensive Crisis risk when combined with other agents
    1. See MAO Inhibitor

VII. Dosing: Parkinsonism

  1. Start 0.5 mg orally daily in AM
  2. Maximum: 1 mg per day
    1. Maximum 0.5 mg if on CYP1A2 Inhibitor or hepatic Impairment

IX. References

  1. (2021) Med Lett Drugs Ther 63(1618): 25-32
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 46-7
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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