Xadago for Parkinson's: Benefits, side effects, and Dosage

Drug

By Dr. Smriti Gupta2025-04-17 09:39:20

A degenerative neurological condition is Parkinson’s disease (PD), which mostly affects movement. The management of the disease's symptoms gets more difficult as it progresses. Many individuals have "off" episodes, or times when the effects of the medicine wear off and symptoms reappear, even if levodopa is still a mainstay of treatment. Xadago, also known as safinamide, can help with that.

For those with erratic symptoms, Xadago, which was approved by the FDA in 2017, appears as an adjuvant medication to levodopa/carbidopa.

Let us learn more about it.

What is Xadago (Safinamide)?

Safinamide is a once-daily oral drug used as an adjuvant treatment for Parkinson's disease under the brand name Xadago. It is a member of a class of medications known as monoamine oxidase B (MAO-B) inhibitors, which function by preventing the brain's enzyme from breaking down dopamine. Dopamine levels become more stable as a result, and motor symptoms are better managed.

However, safinamide has a special dual mode of action because it not only inhibits MAO-B but also modifies glutamate, a neurotransmitter implicated in Parkinson's disease symptoms.

How does Xadago work in Parkinson's treatment?

A reversible and specific inhibitor of monoamine oxidase B (MAO-B) is safinamide. In the brain, dopamine is broken down by the enzyme MAO-B. Blocking MAO-B helps to aid a longer duration of dopamine activity, improved motor symptoms, such as stiffness, slowness, and tremor, and reduced "off" times translates into fewer fluctuations throughout the day.

It's another mechanism that includes glutamate, which is an excitatory neurotransmitter that is likewise regulated by safinamide and is involved in Unusual nerve signals, the involuntary motions known as dyskinesia, and the degeneration of neurons.

Glutamate modulation may help Xadago lessen excessive brain cell activation, which can lead to both motor and non-motor symptoms.

Who Can Use Xadago?

Adults suffering from Parkinson's disease can benefit from Xadago.

People who take levodopa or carbidopa (with or without other PD drugs) at the moment
Individuals exhibiting "off" periods or motor fluctuations
It is not utilized as a first-line or independent treatment; rather, it is used as an adjuvant therapy.

Xadago Dosage Guidelines

Once taken orally once a day, Xadago is commonly used in combination with levodopa/carbidopa to assist in reducing motor symptoms and smooth out "off" periods.

The usual Xadago dosage schedule is as follows:

Initially, use 50 mg once daily for the first two weeks.
Maintenance Dose: Beginning in week three, your doctor may raise the dosage to 100 mg once daily if tolerated.
Xadago can be taken with or without food, but for consistency, consider taking it at the same time each day.

Side Effects of Xadago

Common Side Effects of Xadago

While not everyone will have side effects, Xadago (safinamide) can have them, like any other prescription. While the majority of side effects are low to moderate, some can be more severe and necessitate medical care.

Some common Side effects include:

When taking Xadago, the following adverse effects are most commonly reported:

Dyskinesia (jerky or uncontrollable motions)
Feeling Nausea
Insomnia or difficulty falling asleep
Dizziness or falls
A headache
Hypertension, or elevated blood pressure,
An increase in tiredness or sleepiness

Serious Side Effects of Xadago

Some adverse effects, though less frequent, could be more dangerous:

Confusion or hallucinations, particularly in elderly or cognitively impaired people.
Serotonin Syndrome: When taken with certain antidepressants, opioids, or other serotonergic medications, Xadago may cause an uncommon but dangerous illness. Muscle rigidity, fever, excitement, and an elevated heart rate are among the symptoms.
Disorders of impulse control as obsessive eating, shopping, gambling, or sexual activity. If these actions occur, let your doctor know right away.
Impaired vision.

Drug Interactions and Warnings

While it can be a highly effective treatment for Parkinson’s, Xadago must be used with caution with other medications. Some of the drug interactions include:

Xadago should not be taken with other MAO inhibitors, such as isocarboxazid, phenelzine, rasagiline, or selegiline. The risk of serotonin syndrome or excessively elevated blood pressure is increased.
Meperidine, methadone, and tramadol are some of the opioids that increase the risk of serotonin syndrome.
Some antidepressants, such as SSRIs (such as sertraline and fluoxetine), SNRIs (such as duloxetine and venlafaxine, and tricyclics (like amitriptyline), must be used under strict medical care because of the risk of serotonin syndrome.
Cough suppressants, such as dextromethorphan, increase the risk of serotonin syndrome and hallucinations and must also be avoided.

Precautions and Contradictions:

Some of the precautions and Contraindications for Xadago include:

Severe liver impairment: The medicine may be harmful because the body is unable to effectively remove it.
Other MAO inhibitors (such as selegiline, rasagiline, phenelzine, and linezolid) may result in serotonin syndrome or hypertensive crisis, both of which are potentially fatal.
Avoid Xadago if you have a history of allergies or severe reactions to it.
Past retinal or ocular disorders: Your doctor could advise against it or keep a close eye on your eyes if you already have retinal disease.

Some of the precautions listed while using Xadago are:

People with liver impairment may not be able to safely process Xadago because it is metabolized in the liver. People with severe liver impairment should not take Xadago at all, while those with mild to moderate liver impairment might still be able to take it at a lower dose (maximum 50 mg/day).
Xadago can raise serotonin levels, and serotonin syndrome may occur if it is taken with certain other drugs, such as opioids, SSRIs, SNRIs, or tricyclic antidepressants.
Since Xadago alters the neurotransmitters in the brain, it may exacerbate mental health issues, especially in those who have a history of hallucinations or psychosis. bipolar disorder or manic episodes, and severe depression.
Some Xadago users may have extreme tiredness, daytime drowsiness, or even unexpected sleep episodes, where they abruptly fall asleep while eating or driving.
Xadago should only be taken under close medical care during pregnancy or lactation if the possible advantages exceed the dangers.

FAQs

1. Is Xadago a cure for Parkinson's disease?

No, Parkinson's disease cannot be cured by Xadago. Although it doesn't prevent or reverse Parkinson's disease, it helps control symptoms, particularly "off" episodes, by enhancing the effectiveness of other Parkinson's drugs.

2. How long does it take for Xadago to start working?

Usually, Xadago gets to work in a few days to a few weeks.

Although it may take two to four weeks to fully experience the benefits, some patients may experience improvements in their "off" time and motor symptoms as early as the first week.

3. Can Xadago be taken with levodopa?

Indeed, Xadago is made especially to be taken alongside levodopa.

When the effects of levodopa wear off, it is used as an adjuvant medication to help manage "off" episodes. By intensifying and prolonging the effects of levodopa, Xadago improves symptom control over the course of the day.

4. What should I do if I miss a dose of Xadago?

Unless your next dose is practically due, take Xadago as soon as you remember if you miss one. Avoid taking two doses to compensate for missing one. Continue with your usual dosing plan and omit the missed dose if it's almost time for your next one.

5. Does Xadago cause sleep problems or hallucinations?

Yes, some people may experience hallucinations and sleep issues after using Xadago. Insomnia, severe daytime drowsiness, or even unexpected sleep attacks are possible for certain individuals.

Particularly in elderly persons or those with a history of mental illnesses, Xadago may result in hallucinations or disorientation.

6. Is Xadago available as a generic brand?

Indeed, the FDA has approved a generic form of Xadago (safinamide). It might not be commercially available just yet, though, because of things like market exclusivity and patent protections. Currently, the most common form of Xadago is a brand-name drug.

7. What food should I avoid with Parkinson's disease?

Protein may hinder the absorption of levodopa, reducing its effectiveness. Spread out your protein consumption throughout the day, and think about taking levodopa 30 to 60 minutes before meals. Foods that contain tyramine, which might increase blood pressure when combined with MAO-B inhibitors like Xadago. Processed and sugary foods can exacerbate digestive problems like constipation. Alcohol may make balance problems worse, interfere with prescription drugs, or make you drowsier. Constipation is a common symptom of Parkinson's, so one should avoid diets low in fiber.