Monoamine oxidase inhibitors

♦ MAOB-Is prevent the breakdown of dopamine in the brain and inhibit the re-uptake of dopamine at the presynaptic receptor (see 58).

♦ Enzyme inhibition is irreversible and therefore activity resumes only after new enzyme has been formed.

♦ They can be used as an early monotherapy and can prolong the time before levodopa is needed by approximately 9 months.

In later disease adjunctive MAOB-I therapy can alleviate dose-related fluctuations and end-of-dose deterioration.

♦ A randomized, placebo-controlled, multicentre, double-blind, 12-week clinical trial evaluated the safety and efficacy of Zydis selegiline 15 (1.25 mg, titrated to 2.5 mg daily) as adjunctive therapy in PD patients who were experiencing motor fluctuations, and showed a significant reduction in percentage of off time among patients treated with Zydis selegiline. The total number of off hours was reduced by 2.2 hr/day in Zydis selegiline-treated patients compared with 0.6 hr/day in placebo-treated patients.

♦ It has not been evaluated in head-to-head studies with other adjunct PD therapies or as mono-therapy in PD.

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