Rasagiline

Selective irreversible monoamine oxidase B inhibitor

ATC code: N04BD02

Brand names: Rasagilina Cinfa, Azilect, Rasagilina Normon

Updated 26 May 2026 · Methodology

Indications

Parkinson's disease

First line

First-line in early Parkinson's disease in patients under 65 as monotherapy to delay levodopa per 2021 and SEN 2024. In advanced disease, added to levodopa for motor fluctuations – reduces «off» time by 0.9 hours/day (LARGO, PRESTO). Dose 1 mg once daily, no titration.

Sources

Neurology: Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary: A Report of the AAN Guideline Subcommittee. (2021)
AEMPS: Ficha técnica de Rasagilina (2024)
Cochrane Database Syst Rev: Monoamine oxidase B inhibitors versus other dopaminergic agents in early Parkinson's disease. (2009)
Lancet: Rasagiline as an adjunct to levodopa in patients with Parkinson's disease and motor fluctuations (LARGO, Lasting effect in Adjunct therapy with Rasagiline Given Once daily, study): a randomised, double-blind, parallel-group trial. (2005)
Parkinsons Dis: Rasagiline as Adjunct to Levodopa for Treatment of Parkinson's Disease: A Systematic Review and Meta-Analysis. (2022)

ICD-10: G20 · ICD-11: 8A00.0

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Memory and concentration enhancement

Not recommended

Rasagiline is a selective monoamine oxidase B (MAO-B) inhibitor. It is prescribed only for Parkinson's disease as monotherapy in early stages or as add-on to levodopa ( 2018 and MDS 2018 guidelines). In biohacker circles, rasagiline is promoted as a neuroprotectant for life extension. The ADAGIO 2009 trial did not confirm a disease-modifying effect. There are no clinical studies in healthy adults. The drug has specific risks: orthostatic hypotension, hypertensive crises when combined with tyramine-rich foods at high doses (aged cheeses, fermented foods, soy sauce), and serotonin syndrome when combined with antidepressants. If rasagiline was recommended for longevity, consider seeking a second opinion.

Sources

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

A selective irreversible MAO-B inhibitor – the enzyme degrading dopamine at nigrostriatal synapses. Reduced dopamine breakdown raises and prolongs its action. Compared with selegiline, no amphetamine metabolites – less psychostimulation and insomnia. Half-life 3 hours, but effect lasts until MAO-B recovers (several weeks). ADAGIO suggested neuroprotection, but reanalysis confirmed only symptomatic efficacy.

Safety

Contraindications

Rasagiline hypersensitivity
Severe hepatic impairment
Concomitant other MAO inhibitors, fluoxetine and fluvoxamine, pethidine, tramadol, sympathomimetics, dextromethorphan
Pheochromocytoma
Pregnancy and lactation

Serious adverse effects

Serotonin syndrome with serotonergic drugs
Hypertensive crisis with doses above 1 mg or tyramine diet breach
Impulse-control disorders (gambling, hypersexuality – less than with dopamine agonists)
Melanoma (raised risk described in Parkinson's – linked to the disease itself, not the drug)

Common adverse effects

Headache
Flu-like symptoms
Joint pain
Depression
Dyspepsia

Pregnancy: can you take Rasagiline?

Limited data. Parkinson's is rare in women of reproductive age.

Breastfeeding: can you take Rasagiline?

Not used during lactation – suppresses milk production.

Calculate RID Full profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Take once daily with or without food. Tyramine-containing foods (aged cheeses, cured meats, fermented foods, red wine) at 1 mg dose are safe due to MAO-B selectivity; above 1 mg, hypertensive crisis is possible. Combination with serotonergic antidepressants (SSRIs, SNRIs, tramadol, meperidine) raises serotonin syndrome risk – caution especially with fluoxetine and fluvoxamine (5-week and 2-week washouts).

Label mentions25 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

CriticalDextromethorphan
«CONTRAINDICATIONS: Rasagiline is contraindicated for use with meperidine, tramadol, methadone, propoxyphene and MAO inhibitors (MAOIs), including other selective MAO-B inhibitors, because of risk of…»
FDA, section 4 · Open on DailyMed
CriticalMeperidine
«Tratamiento concomitante con otros inhibidores de la monoamino-oxidasa (MAO) (incluyendo medicamentos y productos naturales sin prescripción, p. ej.: Hierba de San Juan) o petidina (ver sección 4.5)…»
AEMPS, section 4.3 · Open on CIMA
CriticalMeperidine
«CONTRAINDICATIONS: Rasagiline is contraindicated for use with meperidine, tramadol, methadone, propoxyphene and MAO inhibitors (MAOIs), including other selective MAO-B inhibitors, because of risk of…»
FDA, section 4 · Open on DailyMed
CriticalMethadone
«CONTRAINDICATIONS: Rasagiline is contraindicated for use with meperidine, tramadol, methadone, propoxyphene and MAO inhibitors (MAOIs), including other selective MAO-B inhibitors, because of risk of…»
FDA, section 4 · Open on DailyMed
CriticalTramadol
«CONTRAINDICATIONS: Rasagiline is contraindicated for use with meperidine, tramadol, methadone, propoxyphene and MAO inhibitors (MAOIs), including other selective MAO-B inhibitors, because of risk of…»
FDA, section 4 · Open on DailyMed
MajorCiprofloxacin
«Ciprofloxacin or Other CYP1A2 Inhibitors: Rasagiline plasma concentrations may increase up to 2 fold in patients using concomitant ciprofloxacin and other CYP1A2 inhibitors. This could result in…»
FDA, section 7 · Open on DailyMed
MajorCYP1A2 inhibitorsclass named in the label
«Ciprofloxacin or Other CYP1A2 Inhibitors: Rasagiline plasma concentrations may increase up to 2 fold in patients using concomitant ciprofloxacin and other CYP1A2 inhibitors. This could result in…»
FDA, section 7 · Open on DailyMed
MajorDextromethorphan
«Dextrometorfano: Existen informes de interacciones medicamentosas con el empleo concomitante de dextrometorfano e inhibidores de la MAO no selectivos. Por ello, y teniendo en cuenta la actividad…»
AEMPS, section 4.5 · Open on CIMA
MajorFluoxetine
«ISRS/IRSN/antidepresivos tricíclicos y tetracíclicos: Se debe evitar el uso concomitante de rasagilina y fluoxetina o fluvoxamina (ver sección 4.4).»
AEMPS, section 4.5 · Open on CIMA
MajorFluvoxamine
«ISRS/IRSN/antidepresivos tricíclicos y tetracíclicos: Se debe evitar el uso concomitante de rasagilina y fluoxetina o fluvoxamina (ver sección 4.4).»
AEMPS, section 4.5 · Open on CIMA
MajorPseudoephedrine
«Simpaticomiméticos: Con los inhibidores de la MAO, se han notificado interacciones medicamentosas con el empleo concomitante de medicaciones simpáticomiméticas. Por tanto, en vista de la actividad…»
AEMPS, section 4.5 · Open on CIMA
Majorsimpaticomiméticosclass named in the label
«Simpaticomiméticos: Con los inhibidores de la MAO, se han notificado interacciones medicamentosas con el empleo concomitante de medicaciones simpáticomiméticas. Por tanto, en vista de la actividad…»
AEMPS, section 4.5 · Open on CIMA
MajorSSRIs/SNRIsclass named in the label
«Antidepressants: Concomitant use of rasagiline with one of many classes of antidepressants (e.g., SSRIs, SNRIs, triazolopyridine, tricyclic or tetracyclic antidepressants) is not recommended [see…»
FDA, section 7 · Open on DailyMed
Majorsympathomimeticsclass named in the label
«Sympathomimetic Medications: The concomitant use of rasagiline and sympathomimetic medications was not allowed in clinical studies. Severe hypertensive reactions have followed the administration of…»
FDA, section 7 · Open on DailyMed
Majortricyclic antidepressantsclass named in the label
«Antidepressants: Concomitant use of rasagiline with one of many classes of antidepressants (e.g., SSRIs, SNRIs, triazolopyridine, tricyclic or tetracyclic antidepressants) is not recommended [see…»
FDA, section 7 · Open on DailyMed
Moderateantidepresivos tricíclicosclass named in the label
«ISRS/IRSN/antidepresivos tricíclicos y tetracíclicos: Se debe evitar el uso concomitante de rasagilina y fluoxetina o fluvoxamina (ver sección 4.4).»
AEMPS, section 4.5 · Open on CIMA
ModerateCiprofloxacin
«Inhibidores de la CYP1A2: La administración concomitante de rasagilina y ciprofloxacino (un inhibidor de la CYP1A2) elevó la AUC de rasagilina a un 83 %. La administración concomitante de rasagilina…»
AEMPS, section 4.5 · Open on CIMA
Moderateinhibidores del CYP1A2class named in the label
«Inhibidores de la CYP1A2: La administración concomitante de rasagilina y ciprofloxacino (un inhibidor de la CYP1A2) elevó la AUC de rasagilina a un 83 %. La administración concomitante de rasagilina…»
AEMPS, section 4.5 · Open on CIMA
ModerateISRSclass named in the label
«ISRS/IRSN/antidepresivos tricíclicos y tetracíclicos: Se debe evitar el uso concomitante de rasagilina y fluoxetina o fluvoxamina (ver sección 4.4).»
AEMPS, section 4.5 · Open on CIMA
Moderatemedicamentos serotoninérgicosclass named in the label
«Medicamentos que contienen buprenorfina: Rasagilina se debe utilizar con precaución cuando se coadministra con medicamentos que contienen buprenorfina, ya que aumenta el riesgo de síndrome…»
AEMPS, section 4.5 · Open on CIMA
ModerateTheophylline
«Inhibidores de la CYP1A2: La administración concomitante de rasagilina y ciprofloxacino (un inhibidor de la CYP1A2) elevó la AUC de rasagilina a un 83 %. La administración concomitante de rasagilina…»
AEMPS, section 4.5 · Open on CIMA
antipsychoticsclass named in the label
«Dopaminergic Antagonists: It is possible that dopamine antagonists, such as antipsychotics or metoclopramide, could diminish the effectiveness of rasagiline.»
FDA, section 7 · Open on DailyMed
Metoclopramide
«Dopaminergic Antagonists: It is possible that dopamine antagonists, such as antipsychotics or metoclopramide, could diminish the effectiveness of rasagiline.»
FDA, section 7 · Open on DailyMed

From other drugs’ labels

CriticalTranylcypromine
«Combination with Certain Drugs: dopamine rasagiline»
FDA, section 4 · Open on DailyMed
ModerateVortioxetine
«Inhibidores de la MAO-B irreversibles y selectivos (selegilina, rasagilina): Si bien con los inhibidores de la MAO-B selectivos se prevé un riesgo menor de síndrome serotoninérgico que con los…»
AEMPS, section 4.5 · Open on CIMA

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Frequently asked

What is Rasagiline used for?

Rasagiline is evaluated for the following indications with varying evidence strength: Parkinson's disease (evidence tier A), Memory and concentration enhancement (evidence tier F). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Rasagiline?

Common side effects of Rasagiline (≥ 1 in 100): Headache, Flu-like symptoms, Joint pain, Depression, Dyspepsia. See the Safety section for uncommon and serious reactions.

Is Rasagiline safe during pregnancy?

Limited data. Parkinson's is rare in women of reproductive age.

Is Rasagiline compatible with breastfeeding?

Not used during lactation – suppresses milk production.

Who should not take Rasagiline?

Rasagiline is contraindicated in: Rasagiline hypersensitivity; Severe hepatic impairment; Concomitant other MAO inhibitors, fluoxetine and fluvoxamine, pethidine, tramadol, sympathomimetics, dextromethorphan; Pheochromocytoma; Pregnancy and lactation. Full list in the Safety section.

Official sources

Direct links to regulator labels. Open in a new tab.

AEMPS / CIMALabel dated 01/22/2025
EMALabel dated 04/04/2016
FDA / DailyMedLabel dated 08/26/2026

Other drugs in this group

Bromocriptine, Cabergoline, Levodopa + Carbidopa + Entacapone, Pramipexole, Ropinirole, Selegiline