Overnight switch from rasagiline to safinamide in Parkinson's disease patients with motor fluctuations: a tolerability and safety study

Background and purpose When switching between monoamine oxidase type B (MAO‐B) inhibitors, a 15‐day suspension period is a precautionary measure to avoid a serotonin syndrome and hypertensive crisis. However, this indication results in a major inconvenience for parkinsonian patients because of the w...

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Published in:European journal of neurology 2021-01, Vol.28 (1), p.349-354
Main Authors: Stocchi, F., Vacca, L., Grassini, P., Tomino, C., Caminiti, G., Casali, M., D'Antoni, V., Volterrani, M., Torti, M.
Format: Article
Language:English
Subjects:
Amine oxidase (flavin-containing)
Basal ganglia
Blood pressure
Central nervous system diseases
Fluctuations
Hypertension
Levodopa
MAO‐B inhibitors
Medical treatment
Movement disorders
Neurodegenerative diseases
overnight switch
Parkinson's disease
Patients
Population studies
Rasagiline
Safety
Serotonin
serotonin syndrome
Switching
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Summary:Background and purpose When switching between monoamine oxidase type B (MAO‐B) inhibitors, a 15‐day suspension period is a precautionary measure to avoid a serotonin syndrome and hypertensive crisis. However, this indication results in a major inconvenience for parkinsonian patients because of the worsening of their clinical condition. In routine clinical practice, neurologists often perform a substitution of these two drugs without solution of continuity (i.e. overnight), to avoid worsening of fluctuations and prolonged OFF periods. Therefore, a safety open label study was performed to investigate the possible risks of switching overnight from rasagiline to safinamide. Methods The study population included 20 advanced patients with Parkinson's disease on stable treatment with rasagiline and levodopa (alone or in combination with other anti‐parkinsonian medication). The possible occurrence of serotonin syndrome and hypertension was monitored through a strict clinical observation and a 24‐h Holter recording (ABPM) performed twice, whilst subjects were on rasagiline and immediately after switching to safinamide. Results No cases of serotonin syndrome or hypertensive crisis occurred during the study. Changes that were not significant occurred in the primary end‐point: 24‐h mean blood pressure (BP) had a mild +4.4% increase in the ABPM2 versus ABPM1 (P = 0.17), 24‐h systolic and diastolic BP values were slightly higher at ABPM2 compared to ABPM1 (respectively +3.3%, P = 0.13; and 5.4%, P = 0.08) and 24‐h systolic BP variability was unchanged between the two ABPM evaluations (from 8.6 ± 2.9 to 8.9 ± 1.8; P = 0.27). Conclusion The results of the present study confirm that the overnight switch from rasagiline to safinamide is safe and well tolerated by patients. When switching between monoamine oxidase type B (MAO‐B) inhibitors, a washout period is recommended to prevent serotonin syndrome and hypertensive crisis. This open label study was performed to investigate the risks of switching overnight from rasagiline to safinamide. A 24‐hour Holter recording (ABPM) was performed whilst subjects were on rasagiline and immediately after switching to safinamide. The trial met its primary end‐point (24‐h mean blood pressure did not increase by >10 mmHg). No cases of serotonin syndrome or hypertensive crisis occurred during the study. This study demonstrated that the overnight switch from rasagiline to safinamide is safe and well tolerated by patients.
ISSN:1351-5101
1468-1331
DOI:10.1111/ene.14552