MAOIs provide symptomatic benefit in PD. Selegiline monotherapy delays the need for levodopa by approximately nine months, and permits lower levodopa dosages once levodopa is required. As an adjunct to levodopa, selegiline reduces off time and improves symptom control in more advanced disease. Dopaminergic side effects and dyskinesia may worsen with selegiline and require reduction of levodopa dosage. Zydis selegiline is rapidly absorbed in the buccal mucosa and was approved by the FDA in June 2006 as an adjunct to levodopa. Rasagiline is about 10 times more potent than selegiline and may provide greater symptomatic benefit. In May 2006, it was approved by the FDA for monotherapy in early PD and as an adjunct to lev-odopa in more advanced disease. Rasagiline is well tolerated in early disease and, generally well tolerated in advanced disease and in the elderly (70 years and older). Early initiation of rasagiline may provide greater benefit than delayed initiation, as demonstrated in the TEMPO study.
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