safinamide

Safinamide is a medication used in the treatment of Parkinson's disease as an add-on to levodopa for patients who experience motor fluctuations. It is a selective, reversible inhibitor of monoamine oxidase B (MAO-B). In addition to MAO-B inhibition, safinamide exerts non-dopaminergic effects that may contribute to symptom control, including modulation of glutamatergic transmission via effects on ion channels that regulate glutamate release.

Pharmacology and administration: Safinamide is taken orally once daily. The usual starting dose is 50 mg per day, with the option to increase to 100 mg per day if tolerated and beneficial after a couple of weeks. The drug can be taken with or without food. It is metabolized in the liver and excreted in urine and feces. The dual action—MAO-B inhibition plus non-dopaminergic mechanisms—contributes to its use as an adjunct to levodopa in managing wearing-off symptoms.

Indications and safety: Safinamide is indicated as an add-on to levodopa in adults with Parkinson's disease who have motor fluctuations. It is generally well tolerated, but potential adverse effects include dyskinesia, nausea, dizziness, and insomnia. Important drug interactions include concomitant use with non-selective monoamine oxidase inhibitors or serotonergic drugs, which can increase the risk of hypertensive events or serotonin syndrome. Cautions apply in hepatic impairment and when combining with certain other medications.