Exp Neurobiol.  2011 Mar;20(1):1-17. 10.5607/en.2011.20.1.1.

MAO-inhibitors in Parkinson's Disease

• Riederer P
• Laux G

• KMID: 2165341
• DOI: http://doi.org/10.5607/en.2011.20.1.1

Abstract

Monoamine oxidase inhibitors (MAO-I) belong to the earliest drugs tried in Parkinson's disease (PD). They have been used with or without levodopa (L-DOPA). Non-selective MAO-I due to their side-effect/adverse reaction profile, like tranylcypromine have limited use in the treatment of depression in PD, while selective, reversible MAO-A inhibitors are recommended due to their easier clinical handling. For the treatment of akinesia and motor fluctuations selective irreversible MAO-B inhibitors selegiline and rasagiline are recommended. They are safe and well tolerated at the recommended daily doses. Their main differences are related to (1) metabolism, (2) interaction with CYP-enzymes and (3) quantitative properties at the molecular biological/genetic level. Rasagiline is more potent in clinical practise and has a hypothesis driven more favourable side effect/adverse reaction profile due to its metabolism to aminoindan. Both selegiline and rasagiline have a neuroprotective and neurorestaurative potential. A head-to head clinical trial would be of utmost interest from both the clinical outcome and a hypothesis-driven point of view. Selegiline is available as tablet and melting tablet for PD and as transdermal selegiline for depression, while rasagiline is marketed as tablet for PD. In general, the clinical use of MAO-I nowadays is underestimated. There should be more efforts to evaluate their clinical potency as antidepressants and antidementive drugs in addition to the final proof of their disease-modifying potential. In line with this are recent innovative developments of MAO-I plus inhibition of acetylcholine esterase for Alzheimer's disease as well as combined MAO-I and iron chelation for PD.

Keyword

selegiline; rasagiline; moclobemide; phenelzine; tranylcypromine

MeSH Terms

Acetylcholine
Alzheimer Disease
Antidepressive Agents
Depression
Freezing
Handling (Psychology)
Head
Indans
Iron
Levodopa
Moclobemide
Monoamine Oxidase
Monoamine Oxidase Inhibitors
Parkinson Disease
Phenelzine
Selegiline
Tranylcypromine
Acetylcholine
Antidepressive Agents
Indans
Iron
Levodopa
Moclobemide
Monoamine Oxidase
Monoamine Oxidase Inhibitors
Phenelzine
Selegiline
Tranylcypromine