Ciprofloxacin-rasagiline drug interaction leading to dopaminergic effects
Abstract
Rasagiline, indicated for Parkinson disease (PD), is metabolized in the liver via the cytochrome P450 (CYP) system. Countless other medications including ciprofl oxacin are also metabolized in this pathway. Without proper dose adjustment, this concurrent metabolism leads to increased rasagiline blood concentrations and dopamine levels, causing adverse reactions. Rasagiline, a monoamine oxidase-B inhibitor, is indicated as monotherapy or adjunct therapy for the treatment of PD. It is eliminated from the body through hepatic metabolism via the cytochrome P4501A2 (CYP1A2) pathway and requires a dose adjustment for patients with hepatic impairment or for those taking concomitant medications that inhibit CYP1A2. Numerous medications inhibit the CYP1A2 enzyme, including ciprofl oxacin, fl uvoxamine, amiodarone, and cimetidine. Ciprofl oxacin, as well as fl uoroquinolones as a class, should not be used as fi rst-line antibiotics due to numerous adverse reactions and drug interactions. The FDA released a statement in 2016 that the toxicities of fl uoroquinolones generally outweigh the benefi ts in patients with uncomplicated infections. In addition, the FDA expanded on the statement that fl uoroquinolones should not be used if there are other fi rst-line therapies available for certain infections, such as uncomplicated urinary tract infections (UTIs), acute bacterial sinusitis, and acute bacterial exacerbation of chronic bronchitis. In the event that rasagiline is used concomitantly…
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