Nalisar (Rasagiline Hemitartrate)

Rasagiline is a monoamine oxidase B (MAO‑B) inhibitor used in the treatment of Parkinson's disease.

• Early‑stage Parkinson's disease: helps maintain motor function, reduce tremor severity, and delay progression of motor symptoms.
• Advanced‑stage Parkinson's disease: reduces OFF periods and improves overall mobility.
• Adjunct therapy with levodopa: enhances dopaminergic response, allowing lower levodopa doses.
• Motor fluctuations in Parkinson's disease: stabilizes dopamine levels to smooth symptom control.

• Rasagiline irreversibly binds to the active site of monoamine oxidase B enzymes in the brain, selectively inhibiting their activity. By blocking MAO‑B, the drug prevents dopamine breakdown, leading to increased extracellular dopamine concentrations in the striatum. The elevated dopamine enhances dopaminergic neurotransmission, improving motor control in patients with Parkinson's disease. The inhibition is selective for MAO‑B, sparing MAO‑A, and the effect persists for the lifespan of the enzyme, providing sustained therapeutic benefit.

Rasagiline may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Headache: mild to moderate headache.
• Nausea: occasional nausea.
• Dizziness: transient dizziness or light‑headedness.
• Joint pain: arthralgia.

Serious or Rare Side Effects

• Hypertensive crisis: severe high blood pressure when combined with tyramine‑rich foods or certain drugs.
• Serotonin syndrome: risk when used with serotonergic agents, presenting with agitation, fever, and neuromuscular abnormalities.
• Liver function abnormalities: elevated liver enzymes indicating possible hepatic injury.

Before initiating rasagiline therapy, consider the following precautions and warnings.

• Assess cardiovascular status: monitor blood pressure, especially if the patient consumes tyramine‑rich foods.
• Review psychiatric history: avoid use in patients with uncontrolled depression or psychosis.
• Evaluate concomitant serotonergic drugs: consider risk of serotonin syndrome.
• Adjust levodopa dosing: monitor for dyskinesia when rasagiline is added.
• Store at ambient temperature: keep below 25 °C, retain in original packaging, protect from moisture and light.

Rasagiline can interact with several medicines; interactions are classified by their clinical significance.

Major Interactions (Avoid)

• Meperidine or other opioid analgesics: may precipitate severe hypotension or serotonin syndrome.
• Selective serotonin reuptake inhibitors (SSRIs) and other serotonergic agents: increase risk of serotonin syndrome.
• Tyramine‑rich foods combined with non‑selective MAO inhibitors: can cause hypertensive crisis.

Moderate Interactions (Monitor Closely)

• Levodopa/carbidopa: may enhance dopaminergic effects, requiring dose adjustment.
• Sympathomimetic drugs (e.g., epinephrine): may augment pressor response.
• Antihypertensive agents: monitor for additive blood pressure lowering.