Drugs & Aging

, Volume 24, Issue 8, pp 663–680 | Cite as

Community and Long-Term Care Management of Parkinson’s Disease in the Elderly

Focus on Monoamine Oxidase Type B Inhibitors
Review Article


Parkinson’s disease affects up to 1 million people in the US, most of them elderly. Motor and non-motor symptoms can be significantly disabling to the point of necessitating institutionalisation. Age-related changes in drug absorption, distribution, metabolism and excretion complicate the treatment of elderly patients with Parkinson’s disease. General management principles include initiation of medication at low doses with gradual titration based on clinical effects, avoidance of certain classes of drugs (e.g. anticholinergics), and attention to polypharmacy and its risk for potentially toxic drug interactions. Levodopa remains the most efficacious anti-Parkinson’s disease medication and should be the cornerstone of therapy in the elderly Parkinson’s disease patient. Use of dopamine receptor agonists, amantadine and anticholinergic drugs in the elderly is limited by high risk for psychotoxicity. Catechol-O-methyltransferase inhibitors may be used to augment levodopa in the setting of ‘wearing off’ (i.e. motor fluctuations). Monoamine oxidase type B (MAO-B) inhibitors can be used across the spectrum of disease severity, but selegiline (deprenyl), the prototype in this class, is characterised by low and erratic bioavailability of the parent drug and conversion to amphetamine metabolites that may increase the risk of adverse events. A new orally disintegrating tablet formulation overcomes some of these limitations. Rasagiline is a new, selective, second-generation MAO-B inhibitor that is chemically and metabolically distinct from selegiline. The favourable safety profile of rasagiline in the elderly and its once-daily formulation may maximise drug adherence and improve outcomes.


  1. 1.
    Marjama-Lyons JM, Koller WC. Parkinson’s disease: update in diagnosis and symptom management. Geriatrics 2001; 56: 24–35PubMedGoogle Scholar
  2. 2.
    Lang AE, Lozano AM. Medical progress: Parkinson’s disease. First of two parts. N Engl J Med 1998; 339: 1044–53PubMedCrossRefGoogle Scholar
  3. 3.
    Lapane KL, Fernandez HH, Friedman JH, et al. Prevalence, clinical characteristics, and pharmacologie treatment of Parkinson’s disease in residents in long-term care facilities. Pharmacotherapy 1999; 19: 1321–7PubMedCrossRefGoogle Scholar
  4. 4.
    Mackin LA. Understanding Parkinson’s disease: detection and early disease management. Lippincotts Prim Care Pract 2000; 4: 595–607PubMedGoogle Scholar
  5. 5.
    Shulman LM, Taback RL, Bean J, et al. Comorbidity of the nonmotor symptoms of Parkinson’s disease. Mov Disord 2001; 16: 507–10PubMedCrossRefGoogle Scholar
  6. 6.
    Muller T. Drug treatment of non-motor symptoms in Parkinson’s disease. Expert Opin Pharmacother 2002; 3: 381–8PubMedCrossRefGoogle Scholar
  7. 7.
    Elmer L. Cognitive issues in Parkinson’s disease. Neurol Clin 2004; 22 Suppl.: S91–S106PubMedCrossRefGoogle Scholar
  8. 8.
    Rabinstein AA, Shulman LM. Management of behavioral and psychiatric problems in Parkinson’s disease. Parkinsonism Relat Disord 2000; 7: 41–50PubMedCrossRefGoogle Scholar
  9. 9.
    Hely MA, Morris JGL, Reid WGJ, et al. Sydney Multicenter Study of Parkinson’s disease: Non-L-dopa-responsive problems dominate at 15 years. Mov Disord 2005; 20: 190–9PubMedCrossRefGoogle Scholar
  10. 10.
    Buchanan RJ, Wang S, Huang C, et al. Analyses of nursing home residents with Parkinson’s disease using the minimum data set. Parkinsonism Relat Disord 2002; 8: 369–80PubMedCrossRefGoogle Scholar
  11. 11.
    Swope DM. Rapid treatment of “wearing off” in Parkinson’s disease. Neurology 2004; 62Suppl. 4: S27–31PubMedCrossRefGoogle Scholar
  12. 12.
    Chen JJ. Anxiety, depression, and psychosis in Parkinson’s disease: unmet needs and treatment challenges. Neurol Clin 2004; 22Suppl. 3: S63–90PubMedCrossRefGoogle Scholar
  13. 13.
    Calne SM, Kumar A. Nursing care of patients with late-stage Parkinson’s disease. J Neurosci Nurs 2003; 35: 242–51PubMedCrossRefGoogle Scholar
  14. 14.
    Waters CH. Treatment of advanced stage patients with Parkinson’s disease. Parkinsonism Relat Disord 2002; 9: 15–21PubMedCrossRefGoogle Scholar
  15. 15.
    Parashos SA, Maraganore DM, O’Brien PC, et al. Medical services utilization and prognosis in Parkinson disease: a population-based study. Mayo Clin Proc 2002; 77: 918–25PubMedGoogle Scholar
  16. 16.
    Aarsland D, Larsen JP, Tandberg E, et al. Predictors of nursing home placement in Parkinson’s disease: a population-based, prospective study. J Am Geriatr Soc 2000; 48: 938–42PubMedGoogle Scholar
  17. 17.
    Hely MA, Morris JGL, Traficante R, et al. The Sydney multicentre study of Parkinson’s disease: progression and mortality at 10 years. J Neurol Neurosurg Psychiatry 1999; 67: 300–7PubMedCrossRefGoogle Scholar
  18. 18.
    Hanagasi HA, Emre M. Treatment of behavioural symptoms and dementia in Parkinson’s disease. Fundam Clin Pharmacol 2005; 19: 133–46PubMedCrossRefGoogle Scholar
  19. 19.
    Bosboom JLW, Stoffers D, Wolters ECh. Cognitive dysfunction and dementia in Parkinson’s disease. J Neural Transm 2004; 111: 1303–15PubMedCrossRefGoogle Scholar
  20. 20.
    Friedman JH, Fernandez HH, Trieschmann MM. Parkinsonism in a nursing home: underrecognition. J Geriatr Psychiatry Neurol 2004; 17: 39–41PubMedCrossRefGoogle Scholar
  21. 21.
    Goetz CG, Stebbins GT. Mortality and hallucinations in nursing home patients with advanced Parkinson’s disease. Neurology 1995; 45: 669–71PubMedCrossRefGoogle Scholar
  22. 22.
    Fernandez HH, Lapane KL. Predictors of mortality among nursing home residents with a diagnosis of Parkinson’s disease. Med Sci Monit 2002; 8: CR241–6PubMedGoogle Scholar
  23. 23.
    Mitchell SL, Sullivan EA, Lipsitz LA. Exclusion of elderly subjects from clinical trials for Parkinson disease. Arch Intern Med 1997; 157: 1393–8CrossRefGoogle Scholar
  24. 24.
    Chan DKY. The art of treating Parkinson disease in the older patient. Aust Fam Physician 2003; 32: 927–31PubMedGoogle Scholar
  25. 25.
    Lees A. Alternatives to levodopa in the initial treatment of early Parkinson’s disease. Drugs Aging 2005; 22: 731–40PubMedCrossRefGoogle Scholar
  26. 26.
    Reichmann H, Brecht MH, Koster J, et al. Pramipexole in routine clinical practice: a prospective observational trial in Parkinson’s disease. CNS Drugs 2003; 17: 965–73PubMedCrossRefGoogle Scholar
  27. 27.
    American Medical Director’s Association. Parkinson’s disease in the long-term care setting: clinical practice guideline. Columbia (MD): American Medical Director’s Association, 2002Google Scholar
  28. 28.
    Kaldy J, Simpson M. Treating Parkinson’s: a long-term care team approach. Schwarz Pharma Parkinson Rep 2005; 1: 13–5Google Scholar
  29. 29.
    Miyasaki JM, Martin W, Suchowersky O, et al. Practice parameter: initiation of treatment for Parkinson’s disease. An evidence-based review. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2002; 58: 11–7PubMedCrossRefGoogle Scholar
  30. 30.
    Koller WC. Treatment of early Parkinson’s disease. Neurology 2002; 58Suppl. 1: S79–86PubMedCrossRefGoogle Scholar
  31. 31.
    Fahn S. Developments in Parkinson’s disease therapy. North Am Pharmacother 2004; 2: 186–7Google Scholar
  32. 32.
    Jankovic J. Levodopa strengths and weaknesses. Neurology 2002; 58Suppl. 1: S19–32PubMedCrossRefGoogle Scholar
  33. 33.
    Fahn S, and the Parkinson Study Group. Does levodopa slow or hasten the rate of progression of Parkinson’s disease? J Neurol 2005; Suppl. 4: IV37–42Google Scholar
  34. 34.
    Hardie RJ, Lees AJ, Stern GM. On-off fluctuations in Parkinson’s disease: a clinical and neuropharmacological study. Brain 1984; 107: 487–506PubMedCrossRefGoogle Scholar
  35. 35.
    Parkinson Study Group. Levodopa and the progression of Parkinson’s disease. N Engl J Med 2004; 351: 2498–508CrossRefGoogle Scholar
  36. 36.
    Obeso JA, Grandas F, Vaamonde J, et al. Motor complications associated with chronic levodopa therapy in Parkinson’s disease. Neurology 1989; 39Suppl. 2: 11–9PubMedGoogle Scholar
  37. 37.
    Ahlskog JE, Muenter MD. Frequency of levodopa-related dyskinesias and motor fluctuations as estimated from the cumulative literature. Mov Disord 2001; 16: 448–58PubMedCrossRefGoogle Scholar
  38. 38.
    Kostic V, Przedborski S, Flaster E, et al. Early development of levodopa-induced dyskinesias and response fluctuations in young-onset Parkinson’s disease. Neurology 1991; 41: 202–5PubMedCrossRefGoogle Scholar
  39. 39.
    Watts RL. The role of dopamine agonists in early Parkinson’s disease. Neurology 1997; 49Suppl. 1: S34–48PubMedCrossRefGoogle Scholar
  40. 40.
    Kumar N, Van Gerpen JA, Bower JH, et al. Levodopa-dyskinesia incidence by age of Parkinson’s disease onset. Mov Disord 2005; 20: 342–4PubMedCrossRefGoogle Scholar
  41. 41.
    Van Gerpen JA, Kumar N, Bower JH, et al. Levodopa-associated dyskinesia risk among Parkinson disease patients in Olmsted County, Minnesota, 1976–1990. Arch Neurol 2006; 63: 205–9PubMedCrossRefGoogle Scholar
  42. 42.
    Fahn S. Adverse effects of levodopa. In: Olanow CW, Lieberman A, editors. Scientific basis for therapy in Parkinson’s disease. New York: Parthenon Press, 1992: 89–112Google Scholar
  43. 43.
    Nutt JG, Wooten GF. Diagnosis and initial management of Parkinson’s disease. N Engl J Med 2005; 353: 1021–7PubMedCrossRefGoogle Scholar
  44. 44.
    Gordin A, Kaakkola S, Teravainen H. Clinical advantages of COMT inhibition with entacapone: a review. J Neural Transm 2004; 111: 1343–63PubMedCrossRefGoogle Scholar
  45. 45.
    Koller WC, Rueda MG. Mechanism of action of dopaminergic agents in Parkinson’s disease. Neurology 1998; 50Suppl. 6: S11–4PubMedCrossRefGoogle Scholar
  46. 46.
    Brooks DJ, Abbott RJ, Lees AJ, et al. A placebo-controlled evaluation of ropinirole, a novel D2 agonist, as sole dopaminergic therapy in Parkinson’s disease. Clin Neuropharmacol 1998; 21: 101–7PubMedGoogle Scholar
  47. 47.
    Rascol O, Goetz C, Koller W, et al. Treatment interventions for Parkinson’s disease: an evidence based assessment. Lancet 2002; 359: 1589–98PubMedCrossRefGoogle Scholar
  48. 48.
    Berchou RC. Maximizing the benefit of pharmacotherapy in Parkinson’s disease. Pharmacotherapy 2000; 20: 33S–42SPubMedCrossRefGoogle Scholar
  49. 49.
    Parkinson Study Group. Pramipexole vs levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial. Arch Neurol 2004; 61: 1044–53CrossRefGoogle Scholar
  50. 50.
    Oertel WH, Wolters E, Sampaio C, et al. Pergolide vs levodopa monotherapy in early Parkinson’s disease patients: the PELMOPET study. Mov Disord 2006; 21: 343–53PubMedCrossRefGoogle Scholar
  51. 51.
    Clarke CE, Guttman M. Dopamine agonist monotherapy in Parkinson’s disease. Lancet 2002; 360: 1767–9PubMedCrossRefGoogle Scholar
  52. 52.
    Shulman LM, Minagar A, Rabinstein A, et al. The use of dopamine agonists in very elderly patients with Parkinson’s disease. Mov Disord 2000; 15: 664–8PubMedCrossRefGoogle Scholar
  53. 53.
    Paus S, Brecht HM, Koster J, et al. Sleep attacks, daytime sleepiness, and dopamine agonists in Parkinson’s disease. Mov Disord 2003; 18: 659–67PubMedCrossRefGoogle Scholar
  54. 54.
    Schrag AE, Brooks DJ, Brunt E, et al. The safety of ropinirole, a selective nonergoline dopamine agonist, in patients with Parkinson’s disease. Clin Neuropharmacol 1998; 21: 169–75PubMedGoogle Scholar
  55. 55.
    Weintraub D, Siderowf AD, Potenza MN, et al. Association of dopamine agonist use with impulse control disorders in Parkinson disease. Arch Neurol 2006; 63: 969–73PubMedCrossRefGoogle Scholar
  56. 56.
    Junghanns S, Fuhrmann JT, Simonis G, et al. Valvular heart disease in Parkinson’s disease patients treated with dopamine agonists: a reader-blinded monocenter echocardiography study. Mov Disord 2007; 22: 234–7PubMedCrossRefGoogle Scholar
  57. 57.
    Schade R, Andersohn F, Suissa S, et al. Dopamine agonists and the risk of cardiac-valve regurgitation. N Engl J Med 2007; 356: 29–38PubMedCrossRefGoogle Scholar
  58. 58.
    Zanettini R, Antonini A, Gatto G, et al. Valvular heart disease and the use of dopamine agonists for Parkinson’s disease. N Engl J Med 2007; 356: 39–46PubMedCrossRefGoogle Scholar
  59. 59.
    Requip (ropinirole hydrochloride). United States prescribing information. GlaxoSmithKline, 2005 [online]. Available from URL: http://us.gsk.com/products/assets/us_requip.pdf [Accessed 2007 Jun 27]
  60. 60.
    Mirapex (pramipexole dihydrochloride). United States prescribing information. Boehringer Ingelheim, 2005 [online]. Available from URL: http://mirapex.com [Accessed 2007 Jun 28]
  61. 61.
    Nagatsu T, Sawada M. Molecular mechanism of the relation of monoamine oxidase B and its inhibitors to Parkinson’s disease: possible implications of glial cells. J Neural Transm Suppl 2006; (71): S3–S65Google Scholar
  62. 62.
    Parkinson Study Group. Effect of deprenyl on the progression of disability in early Parkinson’s disease. N Engl J Med 1989; 321: 1364–71CrossRefGoogle Scholar
  63. 63.
    Pålhagen S, Heinonen EH, Hägglund J, et al. Selegiline delays the onset of disability in de novo parkinsonian patients. Neurology 1998; 51: 520–5PubMedCrossRefGoogle Scholar
  64. 64.
    Macleod AD, Counsell CE, Ives N, et al. Monoamine oxidase inhibitors for early Parkinson’s disease. Cochrane Database Syst Rev 2005, CD004898Google Scholar
  65. 65.
    Palhagen S, Heinonen E, Hagglund J, et al. Selegiline slows the progression of the symptoms of Parkinson disease. Swedish Parkinson Study Group. Neurology 2006; 66: 1200–6PubMedCrossRefGoogle Scholar
  66. 66.
    Montastruc JL, Chaumerliac C, Desboeuf K, et al. Adverse drug reactions to selegiline: a review of the French pharmacovigilance database. Clin Neuropharmacol 2000; 23: 271–5PubMedCrossRefGoogle Scholar
  67. 67.
    Churchyard A, Mathias CJ, Lees AJ. Selegiline-induced postural hypotension in Parkinson’s disease: a longitudinal study on the effects of drug withdrawal. Mov Disord 1999; 14: 246–51PubMedCrossRefGoogle Scholar
  68. 68.
    Heinonen EH, Myllyla V. Safety of selegiline (deprenyl) in the treatment of Parkinson’s disease. Drug Saf 1998; 19: 11–22PubMedCrossRefGoogle Scholar
  69. 69.
    Burn DJ, Rowan EN, Allan LM, et al. Motor subtype and cognitive decline in Parkinson’s disease, Parkinson’s disease with dementia, and dementia with Lewy bodies. J Neurol Neurosurg Psychiatry 2006; 77: 585–9PubMedCrossRefGoogle Scholar
  70. 70.
    Levy G, Schupf N, Tang MX, et al. Combined effect of age and severity on the risk of dementia in Parkinson’s disease. Ann Neurol 2002; 51: 722–9PubMedCrossRefGoogle Scholar
  71. 71.
    Leroi I, Brandt J, Reich SG, et al. Randomized placebo-controlled trial of donepezil in cognitive impairment in Parkinson’s disease. Int J Geriatr Psychiatry 2004; 19: 1–8PubMedCrossRefGoogle Scholar
  72. 72.
    Okerele CS, Kirby L, Kumar D, et al. Concurrent administration of donepezil HC1 and levodopa/carbidopa in patients with Parkinson’s disease: assessment of pharmacokinetic changes and safety following multiple oral doses. Br J Clin Pharmacol 2004; 58Suppl. 1: 41–9CrossRefGoogle Scholar
  73. 73.
    Mentis MJ, Delalot D, Naqvi H, et al. Anticholinesterase effect on motor kinematic measures and brain activation in Parkinson’s disease. Mov Disord 2006; 21: 549–55PubMedCrossRefGoogle Scholar
  74. 74.
    Ravina B, Putt M, Siderowf A, et al. Donepezil for dementia in Parkinson’s disease: a randomised, double blind, placebo controlled, crossover study. J Neurol Neurosurg Psychiatry 2005; 76: 934–9PubMedCrossRefGoogle Scholar
  75. 75.
    Emre M, Aarsland D, Albanese A, et al. Rivastigmine for dementia associated with Parkinson’s disease. N Engl J Med 2004; 351: 2509–18PubMedCrossRefGoogle Scholar
  76. 76.
    Novartis. Exelon® (rivastigmine tartrate) capsules and oral solution prescribing information [online]. Available from URL: http://www.pharma.us.novartis.com/product/pi/pdf/exelon.pdf [Accessed 2007 Jun 26]
  77. 77.
    Fernandez HH, Trieschmann ME, Friedman JH. The treatment of psychosis in Parkinson’s disease: safety considerations. Drug Saf 2003; 26: 643–59PubMedCrossRefGoogle Scholar
  78. 78.
    Fernandez HH, Friedman JH. The role of atypical antipsychotics in the treatment of movement disorders. CNS Drugs 1999; 11: 467–83CrossRefGoogle Scholar
  79. 79.
    Fernandez HH, Trieschmann ME, Friedman JH. Aripiprazole for drug induced psychosis in Parkinson’s disease: preliminary experience. Clin Neuropharmacol 2004; 27: 4–5PubMedCrossRefGoogle Scholar
  80. 80.
    Wint DP, Okun MS, Fernandez HH. Psychosis in Parkinson’s disease. J Geriatr Psychiatry Neurol 2004; 17: 127–36PubMedCrossRefGoogle Scholar
  81. 81.
    Hwang JP, Yang CH, Lee TW, et al. The efficacy and safety of olanzapine for the treatment of geriatric psychosis. J Clin Psychopharmacol 2003; 23: 113–8PubMedCrossRefGoogle Scholar
  82. 82.
    US Food and Drug Administration. Deaths with antipsychotics in elderly patients with behavioral disturbances, 2005 [online]. Available from URL: http://www.fda.gov/cder/drug/advisory/antipsychotics.htm [Accessed 2007 Feb 6]
  83. 83.
    Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol 2003; 38: 843–53PubMedCrossRefGoogle Scholar
  84. 84.
    Aoki FY, Sitar DS. Amantadine kinetics in healthy elderly men: implications for influenza prevention. Clin Pharmacol Ther 1985; 37: 137–44PubMedCrossRefGoogle Scholar
  85. 85.
    Turnheim K. Drug therapy in the elderly. Exp Gerontol 2004; 39: 1731–8PubMedCrossRefGoogle Scholar
  86. 86.
    McDonnell PJ, Jacobs MR. Hospital admissions resulting from preventable adverse drug reactions. Ann Pharmacother 2002; 36: 1331–6PubMedCrossRefGoogle Scholar
  87. 87.
    Bootman JL, Harrison DL, Cox E. The health care cost of drug-related morbidity and mortality in nursing facilities. Arch Intern Med 1997; 157: 2089–96PubMedCrossRefGoogle Scholar
  88. 88.
    Waters CH, Sethi KD, Hauser RA, et al. Zydis selegiline reduces off time in Parkinson’s disease patients with motor fluctuations: a 3-month, randomized, placebo-controlled study. Mov Disord 2004; 19: 426–32PubMedCrossRefGoogle Scholar
  89. 89.
    ZELAPAR™ (selegiline hydrochloride) orally disintegrating tablets. US prescribing information, 2006 [online]. Available from URL: http://www.zelapar.com/HTML-INF/zelapar_PI.pdf [Accessed 2007 Jun 26]
  90. 90.
    AZILECT® (rasagiline) tablets. US prescribing information, 2006 [online]. Available from URL: http://www.azilect.com/contentroot/prescribing_information.pdf [Accessed 2007 Jun 26]
  91. 91.
    Parkinson Study Group. A randomized placebo-controlled trial of rasagiline in levodopa-treated patients with Parkinson disease and motor fluctuations: the PRESTO study. Arch Neurol 2005; 62: 241–8CrossRefGoogle Scholar
  92. 92.
    Rascol O, Brooks DJ, Melamed E, et al. 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. Lancet 2005; 365: 947–54PubMedCrossRefGoogle Scholar
  93. 93.
    Heinonen EH, Rinne UK, Tuominen J. Selegiline in the treatment of daily fluctuations in disability of parkinsonian patients with long-term levodopa treatment. Acta Neurol Scand 1989; 126 Suppl.: 113–8Google Scholar
  94. 94.
    Chouza C, Aljanati R, Scaramelli A, et al. Combination of selegiline and controlled release levodopa in the treatment of fluctuations of clinical disability in parkinsonian patients. Acta Neurol Scand 1989; 126 Suppl.: 127–37CrossRefGoogle Scholar
  95. 95.
    Hubble JP, Koller WC, Waters C. Effects of selegiline dosing on motor fluctuations in Parkinson’s disease. Clin Neuropharmacol 1993; 16: 83–7PubMedCrossRefGoogle Scholar
  96. 96.
    Golbe LI, Duvoisin RC. Double-blind trial of R-(-)-deprenyl for the “on-off” effect complicating Parkinson’s disease. J Neural Transm 1987; 25 Suppl.: 123–9Google Scholar
  97. 97.
    Streifler M, Rabey MJ. Long-term effects of L-deprenyl in chronic levodopa treated parkinsonian patients. J Neural Transm 1983; 19 Suppl.: 265–72Google Scholar
  98. 98.
    Golbe LI, Lieberman AN, Muenter MD, et al. Deprenyl in the treatment of symptom fluctuations in advanced Parkinson’s disease. Clin Neuropharmacol 1988; 11: 45–55PubMedCrossRefGoogle Scholar
  99. 99.
    Ondo W. Pooled analysis of two identical phase-3 studies of a novel selegiline preparation as adjunctive therapy for Parkinson’s disease [poster]. World Parkinson Congress; 2006 Feb 22–26; Washington, DCGoogle Scholar
  100. 100.
    Parkinson Study Group. A controlled trial of rasagiline in early Parkinson disease: the TEMPO Study. Arch Neurol 2002; 59: 1937–43CrossRefGoogle Scholar
  101. 101.
    Parkinson Study Group. A controlled, randomized, delayed-start study of rasagiline in early Parkinson disease. Arch Neurol 2004; 61: 561–6CrossRefGoogle Scholar
  102. 102.
    Hauser RA, Lew MF, Hurtig HI, et al. Early treatment with rasagiline is more beneficial than delayed treatment start in the long-term management of Parkinson’s disease: a subgroup analysis [abstract]. Mov Disord 2005; 20Suppl. 10: 251Google Scholar
  103. 103.
    ELDEPRYL® (selegiline) capsules. United States prescribing information, 1998 [online]. Available from URL: http://www.somersetpharm.com/products/product_labeling.html [Accessed 2007 Jun 26]
  104. 104.
    Mahmood I. Clinical pharmacokinetics and pharmacodynamics of selegiline: an update. Clin Pharmacokinet 1997; 33: 91–102PubMedCrossRefGoogle Scholar
  105. 105.
    Shin H-S. Metabolism of selegiline in humans: identification, excretion, and stereochemistry of urine metabolites. Drug Metab Dispos 1997; 25: 657–62PubMedGoogle Scholar
  106. 106.
    Am OB, Amit T, Youdim MB. Contrasting neuroprotective and neurotoxic actions of respective metabolites of anti-Parkinson drugs rasagiline and selegiline. Neurosci Lett 2004; 355: 169–72PubMedCrossRefGoogle Scholar
  107. 107.
    Chen J, Swope DM. Clinical pharmacology of rasagiline: a novel, second-generation propargylamine for the treatment of Parkinson disease. J Clin Pharmacol 2005; 45: 878–94PubMedCrossRefGoogle Scholar
  108. 108.
    Henchcliffe C, Schumacher HC, Burgut FT. Recent advances in Parkinson’s disease therapy: use of monoamine oxidase inhibitors. Expert Rev Neurother 2005; 5: 811–21PubMedCrossRefGoogle Scholar
  109. 109.
    Clarke A, Brewer F, Johnson ES, et al. A new formulation of selegiline: improved bioavailability and selectivity for MAOB inhibition. J Neural Transm 2003; 110: 1241–55PubMedCrossRefGoogle Scholar
  110. 110.
    Lamensdorf I, Youdim MB, Finberg JP. Effect of long-term treatment with selective monoamine oxidase A and B inhibitors on dopamine release from rat striatum in vivo. J Neurochem 1996; 67: 1532–9PubMedCrossRefGoogle Scholar
  111. 111.
    Finberg JP, Wang J, Bankiewicz K, et al. Increased striatal dopamine production from L-DOPA following selective inhibition of monoamine oxidase B by R(+)-N-propargyl-l-ami-noindan (rasagiline) in the monkey. J Neural Transm 1998; 52 Suppl.: 279–85CrossRefGoogle Scholar
  112. 112.
    Speiser Z, Levy R, Cohen S. Effects of N-propargyl-l-(R)aminoindan (rasagiline) in models of motor and cognition disorders. J Neural Transm 1998; 52 Suppl.: 287–300CrossRefGoogle Scholar
  113. 113.
    Abu-Raya S, Tabakman R, Blaugrund E, et al. Neuroprotective and neurotoxic effects of monoamine oxidase-B inhibitors and derived metabolites under ischemia in PC12 cells. Eur J Pharmacol 2002; 434: 109–16PubMedCrossRefGoogle Scholar
  114. 114.
    Churchyard A, Mathias CJ, Boonkongchuen P, et al. Autonomic effects of selegiline: possible cardiovascular toxicity in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1997; 63: 228–34PubMedCrossRefGoogle Scholar
  115. 115.
    Volz HP, Gleiter CH. Monoamine oxidase inhibitors: a perspective on their use in the elderly. Drugs Aging 1998; 13: 341–55PubMedCrossRefGoogle Scholar
  116. 116.
    Shoulson I, Oakes D, Fahn S, et al. Impact of sustained deprenyl (selegiline) in levodopa-treated Parkinson’s disease: a randomized placebo-controlled extension of the Deprenyl and Tocopherol Antioxidative Therapy of Parkinsonism trial. Ann Neurol 2002; 51: 604–12PubMedCrossRefGoogle Scholar
  117. 117.
    Jones D, Story DA. Serotonin syndrome and the anaesthetist. Anaesth Intensive Care 2005; 33: 181–7PubMedGoogle Scholar
  118. 118.
    Richard IH, Kurlan R, Tanner C, et al. Serotonin syndrome and the combined use of deprenyl and an antidepressant in Parkinson’s disease. Neurology 1997; 48: 1070–7PubMedCrossRefGoogle Scholar
  119. 119.
    Driver JA, Logroscino G, Buring JE, et al. A prospective cohort study of cancer incidence following the diagnosis of Parkinson’s disease. Cancer Epidemiol Biomarkers Prev 2007; 16: 1260–5PubMedCrossRefGoogle Scholar
  120. 120.
    Siddiqui MAA, Plosker GL. Rasagiline. Drugs Aging 2005; 22(1): 83–9PubMedCrossRefGoogle Scholar
  121. 121.
    Youdim MB, Weinstock M. Therapeutic applications of selective and non-selective inhibitors of monoamine oxidase A and B that do not cause significant tyramine potentiation. Neurotoxicology 2004; 25: 243–50PubMedCrossRefGoogle Scholar
  122. 122.
    deMarcaida JA, Schwid SR, White WB, et al. Effects of tyramine administration in Parkinson’s disease patients treated with selective MAO-B inhibitor rasagiline. Mov Disord 2006; 21: 1716–21PubMedCrossRefGoogle Scholar
  123. 123.
    Azzaro AJ, Vandenberg CM, Blob LF, et al. Tyramine pressor sensitivity during treatment with the selegiline transdermal system 6 mg/24h in healthy subjects. J Clin Pharmacol 2006; 46: 933–44PubMedCrossRefGoogle Scholar
  124. 124.
    Goetz CG, Schwid SR, Eberly SW, et al. Safety of rasagiline in elderly patients with Parkinson disease. Neurology 2006; 66: 1427–9PubMedCrossRefGoogle Scholar
  125. 125.
    Pahwa R, Factor SA, Lyons KE, et al.; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006; 66(7): 983–95PubMedCrossRefGoogle Scholar
  126. 126.
    Lees AJ, Shaw KM, Kohout LJ, et al. Deprenyl in Parkinson’s disease. Lancet 1977; 2(8042): 791–5PubMedCrossRefGoogle Scholar
  127. 127.
    National Institutes of Health. A randomized placebo controlled study to show that rasagiline may slow disease progression for Parkinson’s Disease, 2006 [online]. Available from URL: http://www.clinicaltrials.gov/ct/show/NCT00256204 [Accessed 2007 Jun 26]
  128. 128.
    Chen JJ, Berchou RC. Rasagiline, a selective, second-generation, irreversible inhibitor of monoamine oxidase type B, is effective in patients older and younger than 65 years of age with early-to-advanced Parkinson’s disease (PD) [abstract]. Pharmacotherapy 2004; 24: 1448Google Scholar

Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  1. 1.Movement Disorders Center, Schools of Medicine and PharmacyLoma Linda UniversityLoma LindaUSA
  2. 2.Department of NeurologyUniversity of Florida, McKnight Brain InstituteGainesvilleUSA

Personalised recommendations