selegiline in parkinsonism

Last reviewed 01/2018

In parkinsonism monoamine oxidase-B inhibitors (e.g. selegiline, rasagiline) can:

• can be used to reduce the effective dosage of L-dopa and so reduce the peripheral adverse effects of L-dopa therapy

• smooth out the fluctuations in dose-related anti-parkinsonism effects of L-dopa

• help reduce the long-term adverse effects of L-dopa therapy, e.g. on/off phenomenon, wearing off

• initial studies of selegiline appeared to suggest that selegiline may have a neuroprotective effect in Parkinson's disease; more recent studies however have not substantiated this, and some evidence suggests that the use of selegiline with L-dopa may in fact lead to a significantly increased mortality. The chronic use of monoamine oxidase-B inhibitors in Parkinson's disease is therefore controversial

NICE state that it is not possible to identify a universal first-choice drug therapy for people with early Parkinson's disease (PD). A possible inititial first-choice therapy is monoamine oxidase-B inhibitor therapy (2)

• monoamine oxidase-B inhibitors may be used as a symptomatic treatment for people with early PD (2)
• monoamine oxidase-B inhibitors may be used to reduce motor fluctuations in people with later PD (2)

Reference:

1. Clarke CE. Managing early Parkinson's disease. The Practitioner 1999; 243: 39-47.
2. NICE (June 2006). Parkinson's disease
3. Lees AJ, on behalf of the Parkinson's Disease Research Group. Comparison of the therapeutic effects and mortality data of levodopa, levodopa in combination with selegiline, and bromocriptine in patients with mild Parkinson's disease. BMJ 1995;311:1602-7.
4. BMJ 1998; 316: 1191-6.