Swapping Rasagiline for Safinamide - Hobson’s Choice or out of the frying pan and into the fire?

[Lyricist]

I have been on Rasagiline from the start. 8 years as my staple bedrock of my cocktail of PD drugs principally Ropinirole, Amantadine and of course Co-Careldopa. I have a pacemaker and take Atorvastatin and Ramipril for heart issues. Now the pharmacy says Rasagiline is in short supply in the UK and likely to become unobtainable. My Consultant Neurologist advised me that Safinamade would be a suitable substitute and that I could change over seamlessly stopping Rasagiline on Monday and starting Safinamide on Tuesday - ie no period of assimilation. However the information on Safinamide suggests that it carries with it an almost endless list of possible side effects and that, for example, to change to another drug after stopping Safinamide would require a 7 day wash-out period. Why would this apply to stopping Safinamide but not to stopping Rasagiline?

Does anyone have experience of Safinamide? It seems to carry a lot of warnings of susceptibility to some very serious conditions and the literature suggests that some of the possible side effects include the commencement of features of PD which I have been fortunate enough so far to avoid - eg: uncontrolled movement.

Is there any other option to do Rasagiline’s job?

[park_bear]

Another alternative would be selegiline which is what I use.

[Lyricist in reply to park_bear]

Thanks PB. Can’t understand why my consultant didn’t go for that alternative!

[CuriousMe12]

I tried rasagilene a couple of times but never felt any noticeable change, so stopped. But that may just be me.

[bullet65]

Is there a generic form of rasagilene available to you. If not have you considered an online pharmacy.

[Lyricist in reply to bullet65]

My pharmacist says rasagiline is unavailable via the NHS as their suppliers (somewhere in Eastern Europe) are no longer producing it. I don’t know if that is true but I haven’t found any UK pharmacy that has it. I have not tried on line yet as I would replace it with Safinamide if it is a like for like substitution. I really need to understand whether it is. So far there seem to be some significant differences between Rasagiline and the suggested alternatives Safinamide and Selegiline (the NHS is not offering me the latter). Thank you for your suggestion

[Stillstandingstill]

I'm in the UK and on rasagiline but haven't heard of this issue (yet). It's a bit of a worry.

[Lyricist in reply to Stillstandingstill]

The fact that you are still getting Rasagiline is encouraging. If your pharmacy can get it, I may have been misled by mine. It’s certainly worth enquiring whether your pharmacy endorses the advice from mine

[Stillstandingstill in reply to Lyricist]

I'll check next time I'm there.

[carrow_road]

I have been on Rasagiline for the last 3 years and for the last 6 months generics were not available, so the pharmacy had to get me the original Azilect. Since its 170€ per100 tablets compared to 35€ for the generics , my copay went from 5 to10€. Im in Germany….

[Lyricist in reply to carrow_road]

That is interesting thank you. I think I may have been cost hoodwinked by my pharmacy and will challenge the change as I do not like the sound of the replacement Safinamide