From the FDA Drug Label
The effectiveness of rasagiline tablets for the treatment of Parkinson’s disease was established in four 18-to 26-week, randomized, placebo-controlled trials, as initial monotherapy or adjunct therapy. One of the two early Parkinson's disease studies (N=335) was a double-blind, placebo-controlled, parallel trial consisting of a 7 week dose escalation period and a 6 month maintenance period.
The initial treatment options for Parkinson's disease include:
- Rasagiline tablets as monotherapy, with a recommended dose of 1 mg/day 1
- Pramipexole dihydrochloride tablets as monotherapy, with a starting daily dose of 0.375 mg and titrated to a maximally tolerated dose, but no higher than 4.5 mg/day in three divided doses 2 Key points to consider:
- Rasagiline tablets were superior to placebo on the primary measure of effectiveness in patients receiving six months of treatment and not on dopaminergic therapy.
- Pramipexole dihydrochloride tablets had a statistically significant difference from placebo on the UPDRS part II and part III total scores.
From the Research
The initial treatment for Parkinson's disease typically involves medications that increase dopamine levels or mimic dopamine's effects in the brain, with levodopa combined with carbidopa being the most effective option for patients with symptoms affecting daily functioning. For patients with mild symptoms, monoamine oxidase B (MAO-B) inhibitors like selegiline (5-10 mg daily) or rasagiline (1 mg daily) may be prescribed first 3. When symptoms affect daily functioning, levodopa combined with carbidopa (typically starting at 25/100 mg three times daily) is the most effective option. Dopamine agonists such as pramipexole (0.125-1.5 mg three times daily), ropinirole (0.25-4 mg three times daily), or rotigotine patches (2-8 mg/24 hours) may be used, particularly in younger patients, to delay levodopa initiation and reduce dyskinesia risk 4.
Key Considerations
- Treatment should be individualized based on symptom severity, age, cognitive status, and comorbidities.
- Non-pharmacological approaches like regular exercise, physical therapy, and occupational therapy are also important components of initial management.
- As the disease progresses, medication adjustments will be necessary to manage symptoms effectively.
- The most recent study 5 highlights the importance of a multidisciplinary approach in managing Parkinson's disease, particularly in the perioperative period.
Medication Options
- Levodopa combined with carbidopa: most effective option for patients with symptoms affecting daily functioning.
- Monoamine oxidase B (MAO-B) inhibitors: selegiline (5-10 mg daily) or rasagiline (1 mg daily) for patients with mild symptoms.
- Dopamine agonists: pramipexole (0.125-1.5 mg three times daily), ropinirole (0.25-4 mg three times daily), or rotigotine patches (2-8 mg/24 hours) for younger patients to delay levodopa initiation and reduce dyskinesia risk.