MAO-I Inhibitor
What is it: Medication that slows dopamine breakdown to extend the benefit of existing dopamine.- ⬤ Minimal research: Very little scientific study exists, with no or very few peer-reviewed studies. Insufficient data for conclusions.
- ⬤⬤ Limited research: Few studies exist, mostly small trials or case reports. Findings are preliminary and lack strong validation.
- ⬤⬤⬤ Moderately researched: Multiple studies, including mid-sized trials, exist. Some findings are replicated, but more research is needed.
- ⬤⬤⬤⬤ Well-researched: Supported by substantial evidence, including at least one large trial or meta-analysis.
- ⬤⬤⬤⬤⬤ Extensively studied: Numerous large studies and meta-analyses exist. Findings are widely accepted with strong scientific consensus.
- ⬤ Extremely Difficult to Access: Rare, experimental, or highly specialized. Requires multiple referrals, long wait times, travel, and strict follow-up.
- ⬤⬤ Difficult to Access: Limited to select centers with moderate barriers. Requires referral, potential travel, and wait times of weeks to months.
- ⬤⬤⬤ Moderately Accessible: Available in larger hospitals or clinics. Requires a basic referral, with moderate wait times and some coordination.
- ⬤⬤⬤⬤ Easy to Access: Widely available in most clinics. Minimal referral, short wait times, and simple preparation or follow-up.
- ⬤⬤⬤⬤⬤ Trivial to Access: Easily found in pharmacies or clinics. No referral needed, minimal wait, and straightforward access.
- ⬤ Up to $100
- ⬤⬤ Up to $500
- ⬤⬤⬤ Up to $2000
- ⬤⬤⬤⬤ Up to $10,000
- ⬤⬤⬤⬤⬤ More than $10,000
To calculate the reported effectiveness for a patient view, the model first analyses whether it can be ascertained that the person writing the review has had direct experience of the treatment for themselves or a loved one. If so, it then uses sentiment analysis to rate their view from 1-5 on how effective this treatment was for them, with 1 being the least effective, and 5 the most effective.
14 Resources
Referenced in this guide
45 Research papers
Referenced in this guide
14 Expert views
Contributed in this guide
49 Patient views
Contributed in this guide
Figure out what MAO-I Inhibitor means for you
Page contents
Basics: What you need to know
Selective monoamine oxidase-B (MAO-B) inhibitors, such as selegiline and rasagiline, are specifically designed to reduce the breakdown of dopamine in the brain by targeting the MAO-B enzyme. By preserving dopamine levels, these inhibitors can help address key symptoms associated with the condition. They are often used as a standalone option in early stages or as an add-on therapy alongside other medications. Studies have also explored potential neuroprotective properties, but conclusive evidence of long-term benefits is still under investigation. Despite their common use among individuals who have mild to moderate symptoms, close monitoring for side effects and proper management is required.
History and development
- Early discovery: Selegiline was initially developed in the 1960s by Dr. Joseph Knoll and his team, aiming to modify the breakdown of specific neurotransmitters.
- Selective MAO-B focus: Early research discovered that lower doses of selegiline selectively inhibited MAO-B, reducing dietary restrictions and serious blood pressure risks commonly associated with non-selective MAO inhibitors.
- Introduction of rasagiline: Rasagiline was later developed by researchers at Teva Pharmaceuticals. It shared many properties with selegiline but featured fewer byproducts that could cause side effects.
- Regulatory approvals: Over time, both drugs earned formal recognition from regulatory authorities for their ability to slow the functional decline of motor abilities in individuals with the condition.
What is known
- Symptom management: These treatments help improve control over motor functions by reducing dopamine breakdown, potentially easing tremors, rigidity, and slowed movements.
- Long-term use: MAO-B inhibitors can be used for extended periods, either alone or alongside other therapies, giving some people improved symptom management over time.
- Neuroprotective possibility: Some research suggests these drugs may have a role in protecting nerve cells. While the exact mechanisms remain unclear, ongoing studies continue to explore these effects.
- Fewer dietary restrictions: Compared to older non-selective drugs, selective MAO-B inhibitors have fewer interactions with certain foods like aged cheese or cured meats.
What is not known
- Definitive disease modification: While these inhibitors may slow symptom progression, firm proof that they alter the underlying course of the condition is still debated.
- Optimal usage window: It remains unclear if starting treatment early or later in disease progression yields significantly different outcomes.
- Underlying mechanisms: The exact ways these inhibitors might protect brain cells (if any) have not been conclusively identified.
- Long-term comparative efficacy: Research comparing different dosing regimens or the relative merits of selegiline and rasagiline is ongoing, reflecting uncertainty around which approach works best for different individuals.
- Targeted enzyme inhibition: Blocks monoamine oxidase-B to reduce dopamine breakdown in the brain.
- Dopamine preservation: Helps maintain higher dopamine levels, improving motor control.
- Synergistic use: Often combined with other treatments to extend symptom relief.
- Reduced dietary limits: Unlike non-selective inhibitors, less risk of food interactions.
- Mild nausea or dizziness: Common initial complaints, generally manageable with time.
- Insomnia or agitation: May appear due to changes in dopamine-related brain chemistry.
- Interaction caution: When used with specific antidepressants, there's a risk of serotonin syndrome.
- Dyskinesias: In rare cases, can worsen abnormal involuntary movements.
- True disease modification: Ongoing debate on whether it genuinely alters disease progression or merely offers symptomatic relief.
- Neuroprotective claims: Some experts suggest protective effects for neurons, but evidence is inconsistent.
- Dose and timing: Disagreements exist on optimal dosing schedules for best long-term results.
Patient views
Experiences
- Patients appreciate that MAO-I inhibitors like rasagiline and selegiline can help manage early symptoms of Parkinson's, such as tremors and stiffness, with minimal side effects for some.
- Many patients report that these medications extend the effectiveness of other treatments like levodopa, improving their quality of life.
- Some patients feel that MAO-I inhibitors may slow disease progression, even if the evidence is not definitive.
- The affordability of generic versions of these drugs is a plus for long-term use.
Challenges
- Some patients feel no noticeable improvement in symptoms, leading to frustration.
- Side effects like nausea, dizziness, or fainting are reported by a few patients.
- Dietary restrictions, though often exaggerated, can be inconvenient and unpleasant.
- The cost of branded versions can be high, and not all generic brands work equally well.
Tips
- Work closely with a neurologist to adjust dosages and combinations for best results.
- Be patient; effects may take weeks or months to become noticeable.
- Consider trying different brands if one doesn't seem effective.
- Maintain a healthy lifestyle, including exercise, to complement the medication's effects.
To calculate the reported effectiveness for a patient view, the model first analyses whether it can be ascertained that the person writing the review has had direct experience of the treatment for themselves or a loved one. If so, it then uses sentiment analysis to rate their view from 1-5 on how effective this treatment was for them, with 1 being the least effective, and 5 the most effective.
Patient view
This has potential side effects and adverse reactions to some medications, including MAO inhibitors such as rasagiline. I'm so happy the individual found this works for them! I take rasagiline so it's out for me.
September 2024 • Turnto Comment
Patient view
On day 3 of 1 pill of 25/100 x3 daily, most of my symptoms were largely gone. My tremor, balance, slowed movement and dystonia all improved by the end of the first week of taking C/L. It's 9 months later and I've added some slight involuntary movement in my left leg but otherwise the same as the first month of taking the drug (I also take Rasagiline and a low dose of Ripinirole ER).
August 2024 • /r/Parkinsons
Expert views
What they liked
- Experts appreciate MAO-I inhibitors for their mild and tolerable side effects.
- They are often recommended for early-stage Parkinson's patients.
- MAO-I inhibitors can increase dopamine levels, improving motor symptoms.
- Resagiline shows potential for disease-modifying effects, though not conclusive.
What they didn't like
- Experts note MAO-I inhibitors have limited effectiveness compared to other treatments.
- Rare risk of serotonin syndrome when combined with antidepressants.
- Mild benefits may not suffice for advanced Parkinson's symptoms.
- Some experts find them less effective for tremors and stiffness.
What are they unsure about
- Experts are uncertain about MAO-I inhibitors' disease-modifying capabilities.
- Long-term effects of combining MAO-I inhibitors with other drugs remain unclear.
- Rare side effects like serotonin syndrome need further study.
- Effectiveness in older patients with advanced Parkinson's is debated.
14 expert views
Expert view
MAO-B inhibitors are medications that help manage Parkinson's symptoms by slowing down the breakdown of dopamine in the brain, which increases its availability. Dr. Aaron Haug explains that these drugs, such as selegiline and rasagiline, are generally mild in their effects and well-tolerated. They are often used early in the disease or added later to smooth out fluctuations in symptom control. While rasagiline showed some potential for disease-modifying effects, this was not conclusively proven. Side effects are similar to other Parkinson's medications but are less likely to occur. These inhibitors are particularly suitable for older patients due to their tolerability.
July 2022 • The Victory Summit: Medication Management for Motor Symptoms
Expert view
MAO-I inhibitors are a treatment option for Parkinson's disease, but their use can be complicated by potential drug interactions, particularly with SSRIs (Selective Serotonin Reuptake Inhibitors). Simon Lewis notes that automated systems often flag these combinations as problematic, but he finds the data reassuring for clinicians. He admits to prescribing MAO-I inhibitors frequently, suggesting that the risks may be manageable with proper oversight.
June 2019 • Motor Complications and Treatment Options
What and who it targets
Patients intolerant to other drugs
Alternative for those with side effects
Patients with motor fluctuations
Helps stabilize motor symptoms
Early-stage patients
Effective for mild motor symptoms
Relevant research
How much evidence on this?
- Over 30 years of research on MAO-I inhibitors.
- Numerous studies, including large-scale trials and meta-analyses.
- Consistent findings across motor and non-motor symptom improvements.
- Widely used in clinical practice for Parkinson's disease.
Research focusing on
- Improves motor symptoms and reduces 'off' time.
- May alleviate depression and some non-motor symptoms.
- Often combined with levodopa for enhanced effects.
- Safinamide shows additional glutamate-modulating benefits.
What needs more research?
- Long-term neuroprotective effects remain unclear.
- Impact on disease progression is still debated.
- Limited data on effects in advanced Parkinson's stages.
- Variability in response among different patient subgroups.
- ⬤ Minimal research: Very little scientific study exists, with no or very few peer-reviewed studies. Insufficient data for conclusions.
- ⬤⬤ Limited research: Few studies exist, mostly small trials or case reports. Findings are preliminary and lack strong validation.
- ⬤⬤⬤ Moderately researched: Multiple studies, including mid-sized trials, exist. Some findings are replicated, but more research is needed.
- ⬤⬤⬤⬤ Well-researched: Supported by substantial evidence, including at least one large trial or meta-analysis.
- ⬤⬤⬤⬤⬤ Extensively studied: Numerous large studies and meta-analyses exist. Findings are widely accepted with strong scientific consensus.
Research
This paper reviewed the effects of three MAO-B inhibitors—selegiline, rasagiline, and safinamide—on non-motor symptoms (NMS) and quality of life (QOL) in Parkinson's disease patients. The authors analyzed 60 studies from databases like PubMed, Scopus, and Cochrane Library to assess the impact of these drugs on various NMS and QOL outcomes.
The review found that rasagiline and safinamide had more evidence supporting their effects on NMS and QOL compared to selegiline, likely due to the latter being studied less in this context. While MAO-B inhibitors showed potential benefits for depression, sleep disturbances, and pain, they were less effective for cognitive and olfactory issues. The evidence for their impact on fatigue, apathy, and other symptoms remains unclear due to a lack of long-term, controlled studies.
For people with Parkinson's, this paper highlights that MAO-B inhibitors might help with certain non-motor symptoms like depression and sleep issues, but their overall impact on quality of life is inconsistent. It also underscores the need for more personalized treatment approaches based on individual symptom profiles.
As a systematic review published in a reputable journal, this paper provides a comprehensive overview of existing research. However, the conclusions are limited by the variability and gaps in the studies reviewed, particularly the lack of long-term and controlled trials.
June 2022 • NPJ Parkinson's disease
Research
This study looked at the long-term effects of using monoamine oxidase type B inhibitors (MAOB-Is) in people with Parkinson's disease. Researchers compared 181 patients who had been on MAOB-I therapy for at least one year to 121 patients who had never used this treatment, focusing on outcomes like dementia, dyskinesia, falls, freezing of gait, and hallucinations.
The study found that long-term use of MAOB-Is was linked to a 44.7% lower risk of developing dyskinesia, a movement disorder often seen in Parkinson's patients. However, there was no significant connection between MAOB-I use and the risk of developing dementia, falls, freezing of gait, or hallucinations.
For people with Parkinson's or their caregivers, this study suggests that MAOB-Is could help reduce the risk of dyskinesia, which can improve quality of life. However, it also indicates that this treatment may not have a significant effect on other common Parkinson's symptoms like dementia or falls.
This study is moderately reliable as it is a cross-sectional cohort study published in a reputable journal, Pharmacotherapy. However, its retrospective nature and reliance on medical records may limit the accuracy of its findings.
July 2015 • Pharmacotherapy
Accessibility
- ⬤ Extremely Difficult to Access: Rare, experimental, or highly specialized. Requires multiple referrals, long wait times, travel, and strict follow-up.
- ⬤⬤ Difficult to Access: Limited to select centers with moderate barriers. Requires referral, potential travel, and wait times of weeks to months.
- ⬤⬤⬤ Moderately Accessible: Available in larger hospitals or clinics. Requires a basic referral, with moderate wait times and some coordination.
- ⬤⬤⬤⬤ Easy to Access: Widely available in most clinics. Minimal referral, short wait times, and simple preparation or follow-up.
- ⬤⬤⬤⬤⬤ Trivial to Access: Easily found in pharmacies or clinics. No referral needed, minimal wait, and straightforward access.
- ⬤ Up to $100
- ⬤⬤ Up to $500
- ⬤⬤⬤ Up to $2000
- ⬤⬤⬤⬤ Up to $10,000
- ⬤⬤⬤⬤⬤ More than $10,000
Method to access
- Obtain a prescription from a healthcare provider.
- Purchase at local pharmacies or online pharmacies.
- No referral is typically required unless specified by insurance for coverage.
Cost
- Rasagiline (Azilect): $2,237 annually in Canada.
- Selegiline (generic): $367 annually in Canada.
- Prices may vary by region and pharmacy.
Insurance cover
- Commonly covered by health insurance in many regions.
- Coverage may depend on the specific MAO-I prescribed and the patient's insurance plan.
- Patients should verify coverage with their insurance provider.
Locations
- Mayo Clinic: Offers comprehensive Parkinson's care.
- Johns Hopkins Medicine: Parkinson's Disease and Movement Disorders Center.
- Cleveland Clinic: Known for advanced treatments for Parkinson's.
- Other major hospitals and neurology centers worldwide.
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