From the FDA Drug Label
Serotonin syndrome has been reported with concomitant use of an antidepressant (e.g., selective serotonin reuptake inhibitors-SSRIs, serotonin-norepinephrine reuptake inhibitors-SNRIs, tricyclic antidepressants, tetracyclic antidepressants, triazolopyridine antidepressants) and a nonselective MAOI (e.g., phenelzine, tranylcypromine) or selective MAO-B inhibitors, such as selegiline (Eldepryl) and rasagiline (Rasagiline tablets). Concomitant use of rasagiline with one of many classes of antidepressants (e.g., SSRIs, SNRIs, triazolopyridine, tricyclic or tetracyclic antidepressants) is not recommended [see Drug Interactions (7. 5)]. At least 14 days should elapse between discontinuation of rasagiline and initiation of treatment with a SSRI, SNRI, tricyclic, tetracyclic, or triazolopyridine antidepressant.
It is not safe to take Azilect (rasagiline) with sertraline, an SSRI, due to the risk of serotonin syndrome. Concomitant use is not recommended. If sertraline needs to be started, it is advised to wait at least 14 days after discontinuing rasagiline 1.
From the Research
Taking Azilect (rasagiline) with sertraline can be done safely under careful medical supervision, as the risk of serotonin syndrome is low when recommended doses are not exceeded and the SSRI dose is kept at the lower end of the therapeutic range. According to the most recent and highest quality study available, 2, the combination of SSRIs and MAO-B inhibitors, such as rasagiline, is well tolerated, and serotonin syndrome occurs rarely. The study found that among 1504 patients with Parkinson disease, no cases of serotonin syndrome were reported with the coadministration of rasagiline and an SSRI. Additionally, the study suggests that among SSRIs, citalopram and sertraline may be preferred when coadministered with MAO-B inhibitors. However, it is essential to note that special precautions should be taken, such as using lower doses and monitoring closely for symptoms of serotonin syndrome. Other studies, such as 3, also support the safety of combining rasagiline with antidepressants, including SSRIs, with no reported cases of serotonin syndrome. Therefore, under careful medical supervision, taking Azilect with sertraline can be a viable treatment option, prioritizing the patient's morbidity, mortality, and quality of life. Key considerations include:
- Using recommended doses and not exceeding them
- Keeping the SSRI dose at the lower end of the therapeutic range
- Monitoring closely for symptoms of serotonin syndrome
- Ensuring adequate communication between healthcare providers about all medications being taken.