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Xadago
Xadago (generic name: safinamide) is a medication used as an adjunctive treatment for Parkinson’s disease in adults. It is typically prescribed to patients who are experiencing "off" episodes—periods when the effects of their primary Parkinson’s medication, such as levodopa, wear off, resulting in motor symptoms like stiffness, tremors, and difficulty moving. Xadago belongs to a class of medications called monoamine oxidase type B (MAO-B) inhibitors, which work by increasing the levels of dopamine in the brain, helping to manage symptoms of Parkinson’s disease.
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Frequently Asked Questions
How long does it take for Xadago to work?
Xadago may start improving symptoms of Parkinson's disease within a few days to weeks of starting the medication. Full effects may take longer as the dose is adjusted.
Can Xadago be used as monotherapy for Parkinson's disease?
No, Xadago is intended to be used as an adjunctive treatment alongside levodopa/carbidopa and is not effective as monotherapy.
Can I drink alcohol while taking Xadago?
It is best to avoid alcohol while taking Xadago, as it can increase the risk of dizziness, drowsiness, and high blood pressure.
What should I do if I miss a dose of Xadago?
If you miss a dose, take it as soon as you remember, unless it is close to the time for your next dose. Do not take two doses at once to make up for the missed dose.
Is Xadago safe for long-term use?
Yes, Xadago is intended for long-term use under medical supervision to help manage the symptoms of Parkinson’s disease, but regular monitoring for side effects, such as blood pressure and liver function, is recommended.
Comprehensive Drug Guide
How Does Xadago Work?
Xadago works by inhibiting the enzyme monoamine oxidase B (MAO-B), which breaks down dopamine in the brain. By inhibiting this enzyme, Xadago increases dopamine levels, which helps to alleviate the motor symptoms associated with Parkinson’s disease. Additionally, it has effects on glutamate release, further improving motor function and reducing "off" episodes when levodopa's effects diminish.
Common Dosages
- 50 mg tablets
- 100 mg tablets
Typical Dosing
- The typical starting dose is 50 mg once daily, taken with or without food. After two weeks, the dose may be increased to 100 mg once daily if tolerated and if more symptom control is needed.
- Xadago should be taken at the same time each day, and it should not be taken at night due to the potential for insomnia.
Typical Dosing
FDA Approved Indications
- Adjunctive treatment to levodopa/carbidopa in patients with Parkinson's disease experiencing "off" episodes.
Who Shouldn't Take Xadago?
- Severe hepatic impairment (liver issues)
- Known hypersensitivity to safinamide or any of the other ingredients in Xadago
- Concomitant use of other MAO inhibitors, opioids, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs), or selective serotonin reuptake inhibitors (SSRIs) due to the risk of serotonin syndrome.
Advice From The Pharmacist
- Xadago should be taken once daily at the same time each day, with or without food.
- Avoid eating foods high in tyramine, such as aged cheeses or cured meats, while taking Xadago, as they can increase blood pressure.
- Let your healthcare provider know if you are taking any other medications, especially antidepressants, opioids, or other drugs that affect serotonin levels.
- Regular monitoring of liver function may be recommended, particularly in patients with liver issues.
Side Effects of Xadago
Common Side Effects
- Insomnia
- Nausea
- Dizziness
- Orthostatic hypotension (drop in blood pressure when standing)
- Headache
Uncommon/Severe Side Effects
- Hypertension (high blood pressure)
- Serotonin syndrome (especially when combined with certain medications)
- Hallucinations or psychosis
- Increased risk of melanoma
Risks and Warnings of Xadago
- Serotonin Syndrome: The use of Xadago with certain antidepressants or opioid medications can lead to serotonin syndrome, a potentially life-threatening condition. Symptoms include confusion, rapid heart rate, and high blood pressure. If these occur, seek immediate medical attention.
- Hypertension: Xadago can raise blood pressure, particularly when foods high in tyramine are consumed. Patients with a history of hypertension should monitor their blood pressure regularly.
- Hallucinations and Psychosis: Patients with Parkinson’s disease are at an increased risk of developing hallucinations and psychosis. Xadago can exacerbate these conditions, especially in older adults.
Interactions with Xadago
Common Drug Interactions
- Antidepressants (SSRIs, SNRIs, TCAs): Combining Xadago with these medications can increase the risk of serotonin syndrome.
- Opioid pain medications: Avoid taking opioids with Xadago, as they can lead to life-threatening side effects, including respiratory depression.
- Tyramine-rich foods: These foods can increase the risk of hypertensive crisis when taken with Xadago due to interactions with MAO-B inhibitors.
Alternatives to Xadago
- Azilect (rasagiline): Another MAO-B inhibitor used as an adjunctive treatment for Parkinson’s disease.
- Selegiline: A similar MAO-B inhibitor used to manage symptoms of Parkinson’s disease.
- Amantadine: A medication used to treat dyskinesia (involuntary movements) in Parkinson’s disease patients.
- Rytary (levodopa/carbidopa ER): An extended-release formulation of levodopa/carbidopa that may reduce "off" episodes in Parkinson’s disease.
