Safinamide in the management of patients with Parkinson’s disease not stabilized on levodopa: a review of the current clinical evidence

Safinamide is reviewed as an add-on option for Parkinson’s disease patients whose symptoms are not stabilized on levodopa. The review highlights safinamide’s dopaminergic and non-dopaminergic actions, including reversible selective MAO-B inhibition and modulation of glutamate release. Clinical evidence summarized in the review includes phase III trials in advanced Parkinson’s disease with motor fluctuations showing increased ON time (with no or non-troublesome dyskinesia), reduced daily OFF time, and improvements in motor function and quality of life measures. The review also summarizes pharmacokinetics and pharmacodynamics, including once-daily oral dosing (50-100 mg), a half-life around 20-26 hours, and the point that safinamide has a different selectivity profile than other MAO-B inhibitors. It emphasizes safety and tolerability, notes key drug interaction risks such as hypertensive crisis with other MAO inhibitors and serotonin syndrome with serotonergic agents, and states there is insufficient evidence to recommend safinamide broadly for early Parkinson’s disease, either as monotherapy or add-on therapy.