Rasagiline

INTRODUCTION

Indications

Parkinson's disease (monotherapy and adjunctive to levodopa).

Action

Irreversibly inactivates monoamine oxidase (MAO) by binding to it at type B (brain sites); inactivation of MAO leads to increased amounts of dopamine available in the CNS. Differs from selegiline by its nonamphetamine characteristics. Therapeutic Effects: Improvement in symptoms of Parkinson's disease, allowing increase in function.

Adverse Reactions/Side Effects

CNS: depression, dizziness, hallucinations, malaise, vertigo. EENT: conjunctivitis, rhinitis. Resp: asthma. CV: chest pain, orthostatic hypotension (may ↑ levodopa-induced hypotension), syncope. GI: anorexia, dizziness, dyspepsia, gastroenteritis, vomiting. GU: albuminuria, ↓ libido. Derm: alopecia, ecchymosis, ↑ melanoma risk, rash. Endo: weight loss. Hemat: leukopenia. MS: arthralgia, arthritis, neck pain. Neuro: dyskinesia (may ↑ levodopa-induced dyskinesia), paresthesia. Misc: allergic reactions, flu-like syndrome, ↑ fall risk, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess patient's gait and motor function to help determine antiparkinson effects, especially when starting drug therapy, or during dosing changes or addition of other antiparkinson drugs. Motor function should be assessed at different times of the day, such as when drugs are reaching peak therapeutic levels (i.e., 30–60 min after oral dose), as well as when drug effects are minimal (just before the next dose).

• Document increased side effects such as involuntary movements (dyskinesias), especially if used with levodopa. Notify physician because increased side effects might require dose adjustment or a change in medication regimen.

• Assess blood pressure (BP) when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg or diastolic BP falls >10 mm Hg.

• Monitor hallucinations, malaise, depression, and other psychologic problems. Repeated or excessive symptoms may require change in dose or medication.

• Assess dizziness, vertigo, or syncope that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess signs of paresthesia (numbness, tingling). Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Assess symptoms of asthma, such as wheezing, dyspnea, coughing, chest pain, and tightness in the throat and chest. Perform pulmonary function tests to quantify suspected changes in ventilation and respiration (See Appendixes I, J, K).

• Monitor signs of blood dyscrasias such as leukopenia (fever, sore throat, signs of infection). Report these signs to the physician.

• Monitor signs of allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Assess any joint or neck pain to rule out musculoskeletal ...