Carbidopa, levodopa, and entacapone and Rasagiline interaction

Carbidopa, levodopa and entacapone tablets is contraindicated in patients: Taking nonselective monoamine oxidase (MAO) inhibitors (e.g., phenelzine and tranylcypromine).

These nonselective MAO inhibitors must be discontinued at least two weeks prior to initiating therapy with Carbidopa, levodopa and entacapone tablets.

• Concomitant use of nonselective monoamine oxidase (MAO) inhibitors ( 4 )

Therefore, the use of Carbidopa, levodopa and entacapone tablets is contraindicated in patients receiving nonselective MAO inhibitors [see Contraindications ( 4 )].

MAO Inhibitors Patients receiving nonselective MAO inhibitors and carbidopa, levodopa and entacapone may be at risk of increased adrenergic tone.

Decreasing the levodopa dose may lessen or eliminate this side effect ( 5.7 )

In Study 3, rasagiline (1 mg/day) given in conjunction with levodopa, produced an increased incidence of significant blood pressure elevation (systolic > 180 or diastolic > 100 mm Hg) of 4% compared to 3% for placebo [see Adverse Reactions ( 6.1 )] .

When used as an adjunct to levodopa (Studies 3 and 4), the risk for developing post-treatment high blood pressure (e.g., systolic > 180 or diastolic >100 mm Hg) combined with a significant increase from baseline (e.g., systolic > 30 or diastolic > 20 mm Hg) was higher for rasagiline (2%) compared to placebo (1%).

In Study 2 where rasagiline was given as an adjunct therapy in patients not taking concomitant levodopa, there were 5 reports of orthostatic hypotension in patients taking rasagiline 1 mg (3.1%) and 1 report in patients taking placebo (0.6%) [see Adverse Reactions ( 6.1 )] .

When used as an adjunct to levodopa, postural hypotension was also reported as an adverse reaction in approximately 6% of patients treated with rasagiline 0.5 mg, 9% of patients treated with rasagiline 1 mg and 3% of patients treated with placebo.