Rasagiline vs Selegiline: Which One is Better For You?

Monoamine oxidase B (MAO-B) inhibitors are a class of medications that play a crucial role in supporting dopamine levels and managing neurodegenerative diseases. By inhibiting the activity of the MAO-B enzyme, these medications prevent the breakdown of dopamine, a neurotransmitter essential for motor function, mood regulation, and cognitive processes. This mechanism of action makes MAO-B inhibitors an effective treatment option for conditions such as Parkinson’s disease, where dopamine deficiency is a hallmark. By boosting dopamine levels, MAO-B inhibitors help alleviate symptoms, slow disease progression and improve quality of life.

Two major MAO-B inhibitors, rasagiline, and selegiline, have been widely used to manage Parkinson’s disease and other neurodegenerative disorders. Interestingly, selegiline for ADHD has also been explored, given its ability to regulate dopamine levels. Before you get Selegiline, consult with a healthcare professional to discuss the benefits and risks of this medication.

What Is Rasagiline?

Rasagiline is a prescription medication approved by the FDA to treat Parkinson’s disease symptoms. It can be used alone or with other medicines. By selectively inhibiting monoamine oxidase B (MAO-B), rasagiline increases dopamine levels in the brain, alleviating symptoms. Its targeted mechanism of action blocks the MAO-B enzyme, breaking down dopamine, without affecting other neurotransmitters. Rasagiline offers once-daily dosing, consistent inhibition and avoids producing amphetamine metabolites, making it a safer and more tolerable option for many patients with Parkinson’s disease.

What is Selegiline?

Selegiline is a prescription medication approved for treating Parkinson’s disease and major depressive disorder. As a selective monoamine oxidase B (MAO-B) inhibitor, selegiline blocks dopamine’s breakdown, increasing its availability in the brain. This enhances motor function and mood. Selegiline is available in oral tablets and transdermal patches, offering flexible dosing options. However, its metabolism produces amphetamine derivatives, including methamphetamine and amphetamine, which can be active and potentially interact with other medications.

Similarities Between Rasagiline and Selegiline

Rasagiline and selegiline share notable similarities as therapeutic agents in the management of Parkinson’s disease. Both drugs are selective monoamine oxidase B (MAO-B) inhibitors, which enable them to increase dopamine availability in the brain. This mechanism of action helps alleviate motor symptoms associated with Parkinson’s disease, such as tremors and rigidity, thereby improving quality of life. Additionally, both rasagiline and selegiline can be used as monotherapy or in conjunction with levodopa treatment, offering flexible treatment options for patients. By targeting MAO-B, these drugs provide effective symptom management for individuals with Parkinson’s disease.

Key Differences Between Rasagiline and Selegiline

Rasagiline and selegiline are two selective monoamine oxidase B (MAO-B) inhibitors used in the treatment of Parkinson’s disease. Despite sharing a similar mechanism of action, these drugs exhibit distinct differences.  

Rasagiline vs Selegiline 

• Chemical structure: Rasagiline and selegiline have distinct chemical structures, which influence their pharmacokinetic and pharmacodynamic properties, resulting in different clinical impacts.
• Metabolites: A notable difference is that rasagiline does not produce amphetamine derivatives, whereas selegiline is metabolized to amphetamine and methamphetamine.
• Formulations: Rasagiline is available only in oral form, while selegiline is available in both oral and transdermal patch formulations.
• Dosing frequency: Rasagiline is administered once daily, whereas selegiline can be taken multiple times a day orally or once daily via the transdermal patch.
• Onset and duration of action: Rasagiline has a faster onset and longer duration of action compared to selegiline, which may impact treatment outcomes and patient compliance.

Clinical Effects and Efficacy Comparison

Clinical trials comparing rasagiline and selegiline in Parkinson’s disease treatment have demonstrated similarities and differences in their efficacy. Both drugs improved motor symptoms but with distinct profiles.

Key findings:

• Motor symptom improvement: Both rasagiline and selegiline improved tremor, rigidity, and bradykinesia symptoms.
• Long-term symptom control: Rasagiline provided sustained symptom control, whereas selegiline’s effects faded over time.
• Disease progression: Rasagiline slowed disease progression, whereas selegiline’s impact was less clear.
• Neuroprotective properties: Rasagiline showed potential neuroprotective effects in preclinical and clinical studies, whereas selegiline’s neuroprotective properties are less established.

Which One Is Right for You?

Choosing between rasagiline and selegiline depends on individual patient factors. Considerations include age, lifestyle, and medical history. For patients with gastrointestinal issues, transdermal selegiline may be preferred to avoid oral administration. On the other hand, some patients may opt for rasagiline due to its cleaner metabolism, avoiding amphetamine derivatives.

Patient-specific considerations

• Gastrointestinal issues: Transdermal selegiline may be preferred for patients with GI problems.
• Cleaner metabolism: Rasagiline may be chosen for patients who want to avoid amphetamine derivatives.
• Age and medical history: Patient-specific factors, such as age and medical history, should be considered when selecting a treatment.
• Lifestyle factors: Lifestyle factors, such as daily routine and ability to administer medication, should also be taken into account.

Ultimately, consulting a healthcare provider is essential to determine the best treatment option for each individual.

FAQ Section 

What is the main difference between rasagiline and Selegiline?

The main difference between rasagiline and selegiline is their metabolism, as rasagiline does not produce amphetamine derivatives, whereas selegiline is metabolized to amphetamine and methamphetamine.

Are both drugs used for the same condition?

Rasagiline and selegiline treat Parkinson’s disease by selectively inhibiting MAO-B, increasing dopamine levels. They alleviate symptoms like tremors, rigidity, and other motor impairments effectively.

Which drug is more effective for long-term use?

Rasagiline is more effective for long-term use in Parkinson’s disease treatment, providing sustained symptom control and potentially slowing disease progression.

Can I switch from Selegiline to Rasagiline?

Switching from selegiline to rasagiline may be possible, but it’s essential to consult your healthcare provider first. They will assess your situation and guide safely transitioning between medications.

References 

1. Nobutaka Hattori, Mika Kajita, Shinji Fujimoto, Miwa Izutsu & Jovelle Fernandez. (2024) Safety and effectiveness of rasagiline in patients with Parkinson’s disease in Japan: a post-marketing surveillance study. Expert Opinion on Drug Safety 23:1, pages 79-88.https://www.tandfonline.com/doi/full/10.1080/07853890.2017.1293285
2. Naoi, M., Maruyama, W., & Shamoto-Nagai, M. (2022). Neuroprotective Function of Rasagiline and Selegiline, Inhibitors of Type B Monoamine Oxidase, and Role of Monoamine Oxidases in Synucleinopathies. International Journal of Molecular Sciences, 23(19), 11059. https://doi.org/10.3390/ijms231911059
3. Cereda E, Cilia R, Canesi M, Tesei S, Mariani CB, Zecchinelli AL, Pezzoli G. Efficacy of rasagiline and selegiline in Parkinson’s disease: a head-to-head 3-year retrospective case-control study. J Neurol. 2017 Jun;264(6):1254-1263. doi: 10.1007/s00415-017-8523-y. Epub 2017 May 26. Erratum in: J Neurol. 2017 Sep;264(9):2051. doi: 10.1007/s00415-017-8585-x. PMID: 28550482; PMCID: PMC5570795.https://pmc.ncbi.nlm.nih.gov/articles/PMC5570795
4. Harsing, L. G., Jr., Timar, J., & Miklya, I. (2023). Striking Neurochemical and Behavioral Differences in the Mode of Action of Selegiline and Rasagiline. International Journal of Molecular Sciences, 24(17), 13334. https://doi.org/10.3390/ijms241713334 

5. Peretz C, Segev H, Rozani V, Gurevich T, El-Ad B, Tsamir J, Giladi N. Comparison of Selegiline and Rasagiline Therapies in Parkinson Disease: A Real-life Study. Clin Neuropharmacol. 2016 Sep-Oct;39(5):227-31. doi: 10.1097/WNF.0000000000000167. PMID: 27438181; PMCID: PMC5028154.https://pmc.ncbi.nlm.nih.gov/articles/PMC5028154