Xadago

Xadago is a prescription medication used with levodopa/carbidopa to treat adults with Parkinson’s disease (PD) who are having off episodes.

Xadago belongs to a group of drugs called MAO-B inhibitors. MAO-B inhibitors work by preventing the breakdown of dopamine in the brain, which helps to increase dopamine levels. In Parkinson's disease, people experience nerve cell damage in the brain, causing dopamine levels to decrease. Dopamine helps transmit signals between areas of the brain responsible for smooth movements. 

This medication comes in tablet form and is taken once daily at the same time every day, with or without food. 

Common side effects of Xadago include uncontrolled, sudden movements, falls, nausea, and insomnia.

Xadago can cause drowsiness and can cause you to suddenly fall asleep. Do not drive or operate heavy machinery until you know how Xadago affects you. 

Xadago is a prescription medication used as an add-on therapy to treat Parkinson's disease in people who currently take levodopa/carbidopa (Sinemet, Parcopa) and experience "off episodes." Off episodes indicate a time when medications are not working well, which can cause an increase in Parkinson's symptoms like tremors and trouble walking.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. 

Serious side effects have been reported with Xadago. See the “Xadago Precautions” section. 

Common side effects of Xadago include the following:

• Uncontrolled, sudden movements (dyskinesia)
• Trouble falling asleep or staying asleep (insomnia)
• Falls
• Nausea

This is not a complete list of Xadago side effects. Ask your doctor or pharmacist for more information. Tell your doctor if you have any side effect that bothers you or that does not go away. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. 

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take: 

• Other drugs that inhibit monoamine oxidase including:
  • Monoamine oxidase inhibitors (MAOIs) such as tranylcypromine (Parnate), phenelzine (Nardil), selegiline (Eldepryl, Zelapar), isocarboxazid (Marplan), and rasagiline (Azilect)
  • Linezolid (Zyvox)
• Opioid drugs such as meperidine (Demerol), hydrocodone, oxycodone, methadone, propoxyphene, and tramadol
• Dextromethorphan (Delsym)
• Medications that could lead to serotonin syndrome, including antidepressants such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), desvenlafaxine (Pristiq), nefazodone (Serzone), paroxetine (Paxil, Pexeva), sertraline (Zoloft), venlafaxine (Effexor), trimipramine (Surmontil), isocarboxazid (Marplan), amitriptyline (Elavil), nortriptyline (Pamelor, Aventyl), protriptyline (Vivactil), and clomipramine (Anafranil)
• Cyclobenzaprine (Flexeril)
• Medications used for ADHD such as methylphenidate or amphetamines
• St. John's Wort

This is not a complete list of Xadago drug interactions. Ask your doctor or pharmacist for more information. 

Xadago can cause serious side effects, including:

High blood pressure (hypertension) – Xadago may raise your blood pressure or make your high blood pressure worse. Your healthcare provider will check your blood pressure while you take Xadago.
Serotonin syndrome – A potentially life-threatening problem called serotonin syndrome can happen when medicines such as Xadago are taken with certain other medicines. Symptoms of serotonin syndrome may include:

• agitation, hallucinations, coma, or other changes in mental status
• high or low blood pressure
• seizures
• problems controlling your movements or muscle twitching 
• sweating or fever
• nausea or vomiting
• fast heartbeat
• muscle stiffness or tightness
• diarrhea

Falling asleep during normal activities – You may fall asleep while doing normal activities such as driving a car, doing physical tasks, or using hazardous machinery while taking Xadago. You may suddenly fall asleep without being drowsy or without warning. This may result in having accidents. Your chances of falling asleep while doing normal activities while taking Xadago are greater if you take other medicines that cause drowsiness. Tell your healthcare provider right away if this happens. Before starting Xadago, be sure to tell your healthcare provider if you take any medicines that make you drowsy.

• Do not drive or operate machinery until you know how Xadago affects you.

Uncontrolled, sudden movements (dyskinesia) – Xadago may cause uncontrolled sudden movements or make such movements you already have worse or more frequent. Tell your healthcare provider if this happens. The doses of your anti-Parkinson’s medicine may need to be changed.

Hallucinations and other psychosis – Xadago can cause or worsen psychotic symptoms including hallucinations (seeing or hearing things that are not real), confusion, agitation, delusional beliefs (believing things that are not real), and disorganized thinking. If you have hallucinations or any of these other psychotic-like changes, talk with your healthcare provider.

Unusual urges – Some patients taking Xadago get urges to behave in a way unusual for them. Examples of this are unusual urge to gamble, increased sexual urges, strong urges to spend money, binge eating and the inability to control these urges. If you notice or your family notices that you are developing any unusual behaviors, talk to your healthcare provider.

Problems with the retina in your eye (retinal changes) – Tell your health care provider if your eyesight changes.

Tyramine - Hypertensive Crisis

Tyramine is a naturally occurring compound found in some cheeses and other foods that may cause dangerously high blood pressure in people taking monoamine oxidase inhibitors (MAOIs) like Xadago. You should avoid eating very large amounts of foods containing high amounts of tyramine such as:

• cheese (particularly strong or aged varieties)
• sour cream
• Chianti wine
• sherry
• beer (including non-alcoholic beer)
• liqueurs
• pickled herring
• anchovies
• caviar
• liver
• canned figs
• raisins
• bananas
• avocados (particularly if overripe)
• chocolate
• soy sauce
• sauerkraut
• the pods of broad beans (fava beans)
• yeast extracts
• yogurt
• meat extracts
• meat prepared with tenderizers
• dry sausage

Some of the signs and symptoms of dangerously high blood pressure (hypertensive crisis) are:

• severe headache
• vision problems
• confusion
• stupor (mental numbness)
• coma
• seizures
• chest pain
• unexplained nausea or vomiting 
• stroke-like symptoms (sudden numbness or weakness - especially on one side of the body)

Get emergency medical help if you experience these symptoms. 

Before taking Xadago, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to Xadago or to any of its ingredients
• have liver problems
• have heart problems, including abnormal blood pressure
• have a sleep disorder
• drink alcoholic beverages
• have a history of abnormal movements
• have or have had mental health problems such as schizophrenia, bipolar disorder, or psychosis
• have or have had unusual urges 
• have had problems with the retina in your eye or have a family history of retina problems
• are pregnant or plan to become pregnant
• are breastfeeding or plan to breastfeed 

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. 

There are no adequate and well-controlled studies of Xadago in pregnant women. In animals, developmental toxicity, including birth defects, was observed when Xadago was given during pregnancy. Developmental toxicity was observed at Xadago doses lower than those used clinically when Xadago was administered during pregnancy in combination with levodopa/carbidopa. Xadago should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the unborn baby. 

It is not known whether this drug is present in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Xadago, a decision should be made by the doctor whether the mother should discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother. 

Take Xadago exactly as prescribed.

Xadago comes in tablet form and is taken once daily at the same time every day, with or without food. 

If you miss a dose, take the next dose at the usual time the next day. 

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• other medical conditions you have 
• other medications you have
• how you respond to this medication
• liver function

The recommended dosage of Xadago for the treatment of Parkinson's disease is to start at 50mg daily. After two weeks, the dose may be increased to 100mg daily, based on how you respond to the medicine. 

If you take too much Xadago, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away. 

• Store Xadago at room temperature: 68°F to 77°F (20°C to 25°C).
• Keep this and all medicines out of the reach of children.