Xadago was approved in 2017 by the U.S. Food and Drug Administration (FDA) to decrease "off" time (periods when medication is not working well and symptoms return). Xadago is taken once a day, usually in the morning, in addition to a person's daily levodopa medication regimen. Because it treats "off" time, which typically appears in middle or later phases of Parkinson's, Xadago is an option to be taken several years into the course of disease.
Xadago is a monoamine oxidase B (MAO-B) inhibitor. It blocks an enzyme in the brain that breaks down dopamine, which means it allows dopamine to work for a longer period of time. Xadago also works on the glutamate brain chemical system.
Xadago decreases the total time per day that symptoms are present ("off" time) and increases the amount of time that symptoms are controlled ("on" time). It is an add-on to levodopa and may allow some people to decrease the amount of levodopa they need each day to control symptoms.
Cons and Complications
Potential side effects include dyskinesia (uncontrolled, involuntary movement), falls, nausea and insomnia. As with all MAO-B inhibitors, there is a risk of a rare, but potentially severe, reaction called serotonin syndrome when Xadago is taken with certain drugs. These include, but are not limited to, specific antidepressants, muscle relaxants and pain medications, as well as herbal supplements (St. John's Wort, for example) and over-the-counter cough or cold therapies, such as dextromethorphan. Serotonin syndrome causes muscle stiffness, increased tremor, high blood pressure and heart rate, sweating, diarrhea, fever, shivering, confusion and agitation. Talk with your doctor and pharmacist before adding medications or supplements to your regimen.
Combining high doses of MAO-B inhibitors (typically higher than those prescribed for Parkinson's) and large amounts of tyramine-containing foods, such as aged cheeses and cured meats, can significantly raise blood pressure. This side effect, also rare, is called hypertensive crisis. You don't need to eliminate foods high in tyramine from the diet, but you should probably eat them in moderation.