Rasagiline, Oral

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KEY POINTS

• This medicine is taken by mouth to treat symptoms of Parkinson's disease. Take it exactly as directed.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may cause you to suddenly fall asleep without warning, have unusual urges, or cause other unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• This medicine may cause life-threatening problems if you take this medicine with certain other medicines. Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: anti-Parkinson's; MAO-B inhibitor

Generic and brand names: rasagiline, oral; Azilect

What is this medicine used for?

This medicine is taken by mouth to treat symptoms of Parkinson's disease. It may be used by itself or along with levodopa/carbidopa.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• High or low blood pressure
• Liver problems
• Mental health problems such as anxiety, bipolar disorder, depression, or schizophrenia
• Pheochromocytoma (a tumor of the adrenal gland)
• Problems with excessive sleepiness
• Skin cancer

Tell your healthcare provider if you are currently taking any other medicine. Taking this medicine with certain other medicines or natural remedies can cause serious side effects or death. This includes antidepressants, some cough and cold medicines, muscle relaxants, some pain medicines, St John’s wort, and others.

Females of childbearing age: Talk with your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without discussing with your healthcare provider.

How do I take it?

Important: Check the label on the medicine for directions about your specific dose. Take this medicine exactly as your healthcare provider prescribes. Do not take more or less or take it longer than prescribed. Taking too much can cause serious side effects. Do not stop taking this medicine without your healthcare provider's approval. You may have to reduce your dosage gradually to keep Parkinson's symptoms from returning.

Check with your healthcare provider before using this medicine in children under age 18.

You may take this medicine with or without food.

Your healthcare provider may reduce the amount of levodopa/carbidopa you are taking when you start taking this medicine. Check with your healthcare provider.

What if I miss a dose?

If you miss a dose, take it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: dizziness, drowsiness, severe headache, hallucinations, feeling irritable, vision problems, fast and uneven heart rate, sweating, cold or clammy skin, shallow breathing, fainting, seizures.

What should I watch out for?

This medicine may cause a life-threatening problem called serotonin syndrome if you take it with certain other medicines, such as antidepressants, migraine medicines, pain medicines, some cough medicines, and St. John’s wort. Make sure that your providers know ALL of the medicines that you take. Contact your healthcare provider right away if you have:

• Confusion, restlessness, hallucinations, agitation, or other unusual thoughts or behavior
• Sudden loss of coordination, muscle twitching, or muscle stiffness
• Fast heart beat
• Rapid changes in blood pressure or fainting
• Increased body temperature
• Unexplained nausea or vomiting
• Diarrhea

Using this medicine for a long time may cause muscle spasms, twitching in the face and body, and uncontrolled tongue or jaw movements. Talk to your healthcare provider about this.

People taking this medicine may have a higher risk for skin cancer (melanoma). Ask your healthcare provider if you are at risk and what skin symptoms to watch for.

This medicine may cause strong urges, such as to gamble, or have sex. Talk with your healthcare if you have unusual urges while taking this medicine.

Your healthcare provider will want to see you regularly to check on your progress and dosage.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

This medicine may cause you to fall asleep suddenly without warning during daily activities, including driving a car, eating, or talking. This may happen even after you have been taking the medicine for several months. Contact your healthcare provider if the drowsiness continues or becomes severe. Do not drive or operate machinery unless you are fully alert and you know how this medicine affects you.

You may feel dizzy or faint when you get up quickly after sitting or lying down. Getting up slowly may help.

Do not drink alcohol while taking this medicine. Do not take other medicines without your healthcare provider's approval. Certain foods, drinks, and medicines can cause dangerously high blood pressure while you are taking this medicine. Talk with your healthcare provider about this.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; chest pain or tightness in your chest; swelling of your lips, tongue, and throat); sudden weakness, numbness, or tingling, especially on one side of your body; sudden or severe headache; sudden trouble with vision, speech, balance, or walking.

Serious (Report these to your healthcare provider right away.): Chest pain; trouble breathing; hallucinations; confusion; unusual thoughts or behavior; depression; loss of coordination; agitation; tremors; muscle twitching; rigid muscles; seizures; unexplained or severe nausea or vomiting; bloody or tarry bowel movements; severe diarrhea; trouble urinating; enlarged pupils; fast or slow heartbeat; irregular heartbeat; increased sensitivity to light; increased sweating or fever; stiff or sore neck; severe dizziness or fainting; unusual urges; unusual changes in a mole, skin lump, or growth; unexplained swelling, burning, or tingling in hands or feet.

Other: Mild headache, dizziness, lightheadedness, dry mouth, stomach cramps, mild nausea, decreased appetite, constipation, joint pain, unusual dreams.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Abiraterone (Zytiga)
• ACE inhibitors such as benazepril (Lotensin), captopril, enalapril (Vasotec), fosinopril, lisinopril (Prinivil, Zestril), moexipril (Univasc), quinapril (Accupril), and ramipril (Altace)
• Allergy, cold, or cough medicines such as dextromethorphan, naphazoline, oxymetazoline (Afrin, Dristan), phenylephrine (Neo-Synephrine, Sudafed PE), pseudoephedrine (Sudafed), and tetrahydrozoline (Tyzine, Visine)
• Alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress) and terazosin
• Angiotensin receptor blockers (ARBs) such as azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan)
• Antianxiety medicines such as alprazolam (Xanax), clonazepam (Klonopin), clorazepate (Gen-Xene, Tranxene), diazepam (Valium), lorazepam (Ativan), and oxazepam
• Antibiotics such as ciprofloxacin (Cipro), ofloxacin, and rifampin (Rifadin)
• Antidepressants such as amitriptyline, citalopram (Celexa), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), imipramine (Tofranil), maprotiline, mirtazapine (Remeron), nefazodone, nortriptyline (Pamelor), sertraline (Zoloft), trazodone, venlafaxine (Effexor), and vilazodone (Viibryd) (Do not take this medicine and these antidepressants within at least 14 days of each other; or within 5 weeks of fluoxetine.)
• Antihistamines such as chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), hydroxyzine (Vistaril), and meclizine (Dramamine)
• Antipsychotic medicines such as aripiprazole (Abilify), asenapine (Saphris), chlorpromazine, clozapine (Clozaril, FazaClo), fluphenazine, haloperidol (Haldol), lurasidone (Latuda), olanzapine (Zyprexa), paliperidone (Invega), perphenazine, pimozide (Orap), quetiapine (Seroquel), risperidone (Risperdal), thioridazine, trifluoperazine, and ziprasidone (Geodon)
• Antiseizure medicines such as carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), and primidone (Mysoline)
• Atomoxetine (Strattera)
• Barbiturates such as butabarbital (Butisol), pentobarbital (Nembutal), phenobarbital, and secobarbital (Seconal)
• Beta blockers such as acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), carvedilol (Coreg), labetalol (Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), nebivolol (Bystolic), pindolol, and sotalol (Betapace, Sorine)
• Bupropion (Aplenzin, Forfivo, Wellbutrin, Buproban, Zyban)
• Buspirone
• Cabergoline
• Calcium channel blockers such as diltiazem (Cardizem, Cartia, Tiazac), felodipine, isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat CC, Procardia), and verapamil (Calan, Covera, Verelan)
• Clonidine (Catapres, Kapvay)
• Diet pills such as benzphetamine (Regimex), diethylpropion (Tenuate), phendimetrazine, and phentermine (Adipex-P, Suprenza)
• Diuretics (water pills) such as amiloride, bumetanide, chlorothiazide (Diuril), furosemide (Lasix), hydrochlorothiazide (Microzide), spironolactone (Aldactone), torsemide (Demadex), and triamterene (Dyrenium)
• Doxepin (Silenor)
• Ephedrine
• Epinephrine (Adrenalin, Asthmanefrin, Auvi-Q, EpiPen)
• Eye medicines such as apraclonidine (Iopidine) and brimonidine (Alphagan P)
• Linezolid (Zyvox)
• Lithium (Lithobid)
• MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• Medicines to treat breathing or lung problems such as albuterol (ProAir, Proventil, Ventolin), arformoterol (Brovana), levalbuterol (Xopenex), pirbuterol (Maxair), salmeterol (Serevent), and theophylline
• Methoxsalen (8-MOP, Oxsoralen Ultra, Uvadex)
• Methyldopa
• Metoclopramide (Metozolv, Reglan)
• Mexiletine
• Midodrine
• Migraine medicines such as almotriptan (Axert), dihydroergotamine (D.H.E. 45, Migranal), eletriptan (Relpax), ergotamine (Ergomar), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Alsuma, Imitrex, Sumavel), and zolmitriptan (Zomig)
• Milnacipran (Savella)
• Muscle relaxants such as baclofen (Gablofen, Lioresal), carisoprodol (Soma), cyclobenzaprine (Amrix), methocarbamol (Robaxin), and tizanidine (Zanaflex)
• Natural remedies such as ephedra, kava, phenylalanine, SAMe, St. John's wort, tryptophan, tyrosine, and valerian
• Other Parkinson’s disease medicines such as bromocriptine (Cycloset, Parlodel), entacapone (Comtan), levodopa/carbidopa (Duopa, Rytary, Sinemet), ropinirole (Requip) and tolcapone (Tasmar)
• Pain medicines such as buprenorphine (Buprenex, Butrans), codeine, fentanyl (Abstral, Actiq, Duragesic, Fentora, Sublimaze), hydrocodone (Hysingla, Zohydro), hydrocodone/acetaminophen (Norco, Vicodin), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin), oxycodone (OxyContin, Roxicodone), oxycodone/acetaminophen (Percocet, Roxicet), tapentadol (Nucynta), and tramadol (ConZip, Ultram)
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Primaquine
• Procarbazine (Matulane)
• Products that contain methylene blue (Hyophen, Prosed DS, Urophen, Uta)
• Promethazine
• Propranolol (Hemangeol, Inderal, InnoPran)
• Sleeping pills such as eszopiclone (Lunesta), flurazepam, temazepam (Restoril), triazolam (Halcion), zaleplon (Sonata), and zolpidem (Ambien, Edluar, Intermezzo)
• Stimulants such as amphetamine/dextroamphetamine (Adderall), armodafinil (Nuvigil), caffeine, dexmethylphenidate (Focalin), dextroamphetamine (Dexedrine), ephedrine, lisdexamfetamine (Vyvanse), methamphetamine (Desoxyn), and methylphenidate (Concerta, Daytrana, Metadate, Ritalin)

When taken with certain foods or drinks, this medicine can cause an increase in blood pressure. To avoid this, do not eat large amounts of foods or drink beverages that have a high tyramine content. This includes foods that are aged, fermented, pickled, or smoked, such as aged cheeses; yogurt, dried fruits, smoked fish, meat, or poultry; sauerkraut; soy sauce; red wine; or tap beer. Talk with your healthcare provider about this.

Do not drink alcohol while using this medicine unless your healthcare provider approves.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.