A MAO-B inhibitor add-on for Parkinson's
Safinamide
A once-daily MAO-B inhibitor added to levodopa to reduce 'off' time in people with Parkinson's disease who have motor fluctuations.
What is Safinamide?
Safinamide is a MAO-B inhibitor used as an add-on to levodopa in Parkinson's disease. It is given to people who get 'off' periods, when symptoms return before the next dose, to help reduce that time. It works by slowing dopamine breakdown and has some additional effects on nerve signalling.
Education and reference only. This is a plain-language guide to Safinamide — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Safinamide is a newer MAO-B inhibitor used specifically as an add-on to levodopa in mid-to-late Parkinson's disease, rather than on its own. It is taken once a day for people who experience 'off' periods, when Parkinson's symptoms come back before the next levodopa dose is due. It is used long-term alongside a person's other Parkinson's medicines.
How it works
Safinamide blocks monoamine oxidase type B (MAO-B), the enzyme that breaks down dopamine in the brain, leaving more dopamine available to support movement. It also has additional effects on the release of another brain messenger (glutamate), which may contribute to its benefit. Added to levodopa, it helps extend 'on' time and reduce the 'off' periods between doses.
Company & origin
Originated / developed by: Developed by Newron Pharmaceuticals; marketed in Europe by Zambon..
Developed by the Italian company Newron Pharmaceuticals and approved in Europe in 2015 as an add-on therapy for Parkinson's disease.
What it treats
Conditions Safinamide is used for
Practical use
How to take Safinamide
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it once a day at about the same time, always alongside your levodopa.
- It is an add-on treatment, not a replacement for levodopa.
- Your levodopa dose may be adjusted to manage any increase in involuntary movements.
- Keep taking it consistently; do not stop suddenly without specialist advice.
- Tell your prescriber about all other medicines, especially antidepressants and strong painkillers.
Weighing it up
Advantages & disadvantages of Safinamide
Advantages
- Simple once-daily dosing as an add-on to levodopa.
- Reduces 'off' time and increases useful 'on' time.
- Has additional effects on nerve signalling that may add to its benefit.
Disadvantages
- Only licensed as an add-on to levodopa, not for use on its own.
- Can worsen levodopa-related involuntary movements (dyskinesia).
- Shares the MAO-B inhibitor interaction risks with antidepressants and opioids.
Practical use
Good to know
Safinamide is taken once a day and is always used together with levodopa, not as a stand-alone treatment. Like other MAO-B inhibitors it can worsen levodopa-related involuntary movements (dyskinesia), which can be managed by adjusting the levodopa dose. It carries the same caution as other MAO-B inhibitors around certain antidepressants and opioids, and should not be stopped abruptly.
Who should not take it / use with caution
- People taking certain antidepressants (such as SSRIs, SNRIs and other MAOIs) or the painkiller pethidine, because of the risk of a serious reaction.
- People with severe liver impairment, or certain eye conditions affecting the retina, need caution and specialist advice.
- Anyone whose specialist advises against it after reviewing their full medicine list.
Monitoring
- Review of 'off' time and overall symptom control.
- Watch for new or worsening involuntary movements.
- Eye review may be advised in people with pre-existing retinal disease.
Side effects
- Worsening of involuntary movements when used with levodopa.
- Nausea or difficulty sleeping.
- Dizziness or light-headedness on standing.
- Confusion or hallucinations, more likely in older or frail people.
Key interactions
- Pethidine and some other opioids (such as tramadol) — risk of serotonin syndrome; avoid.
- SSRI, SNRI and other antidepressants — risk of serotonin syndrome; combinations need specialist caution or avoidance.
- Other MAO inhibitors — should not be combined.
- Sympathomimetic decongestants — can raise blood pressure.
Available as: Tablets.
Answers
Safinamide: frequently asked questions
Can safinamide be used on its own?
No. Unlike some other MAO-B inhibitors, safinamide is only licensed as an add-on to levodopa, for people who experience 'off' periods between doses.
What does safinamide do for 'off' time?
It helps reduce the periods when Parkinson's symptoms return before the next levodopa dose, and increases the amount of useful 'on' time.
Will it make my involuntary movements worse?
It can increase levodopa-related involuntary movements (dyskinesia). If this happens, your specialist can adjust your levodopa dose.
Are the antidepressant cautions the same as other MAO-B inhibitors?
Yes. Combining it with certain antidepressants such as SSRIs and SNRIs can cause serotonin syndrome, so tell your specialist about every antidepressant you take.
Can I stop safinamide suddenly?
No. Like other Parkinson's medicines it should not be stopped abruptly. Speak to your specialist before making any change.
The wider class
About MAO-B inhibitors
Safinamide belongs to the mao-b inhibitors class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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