Brief Answer:
No significant interactions to report

Detailed Answer:
Good afternoon. My name is Dr. Saghafi and I am a neurologist from the XXXXXXX Ohio area.you have Parkinson's disease and are on the following medications: Azilect, Mirapex, and citalopram. Your question is whether or not there are any significant drug to drug interactions to worry about.

Of course, as you probably know citalopram is an antidepressant medication while the other two medications are specifically designed to treat Parkinson's disease.

There is a reaction between Azilect and Citalopram (Celexa) and you had mentioned this in your note. The reaction is listed as a potential for what we refer to as Serontonin syndrome. I can tell you that in all honesty and for at least 20 years that I've been practicing neurology I have many patients who are on clinically therapeutic levels of many drugs that are felt to be risky for serotonin syndrome and never had 1 complication as a result of drug to drug interactions of that type. Having said that since the warning on the label is to suggest the use of a substitute drug then, you are best advised to check with either your PMD or psychiatrist as to a substitute for the Celexa if you feel it is absolutely necessary to your condition.

Azilect (Rasagiline) is a medication which has very marginal effects on the progression of Parkinson's disease. It has not proven to be a very robust drug in terms of slowing the process down and therefore, in many of my patients who are on other agents that interact or interfere with the drug I have always opted to reduce or eliminate the Azilect as opposed to any SSRI such as Celexa if the patient feels it is of benefit to them.

Your other option would be to reduce the Azilect to its minimum dose of 0.5mg/day in patch form which would still give you a nearly equivalent dosing to either the 1 mg. or higher presentation since if taken together with Celexa there is an additive effect between the 2 (which is why the warning is given for serontonin syndrome) which behaves as if you were using a higher dose of the patch.

In conclusion, I believe the following options are available to you in this situation:

1. There is no significant reaction between Azilect and Mirapex

2. There is no significant reaction between Mirapex and Celexa

3. There is a warning of a drug to drug interaction between Azilect and Celexa which is referred to as a Serotonin Syndrome. I have not seen such a complication occur between similar drugs to Azilect and similar drugs to or even Celexa and have many patients on the regimen. I believe that with close monitoring these drugs have a margin of safety which is acceptable and they can be therapeutically effective without any fear of Serotonin Syndrome.

4. However, if the preference would be to substitute an agent my recommendation (given that you feel Celexa is very beneficial to you) would be to either eliminate or reduce the dose of prescribed Azilect as this drug in my experience and in the literature since its release has had marginal effects on preventing the progression of symptoms in Parkinson's disease.

5. If your interest would be to change the antidepressant then, your best resource for a new choice would be the prescriber (if your psychiatrist) of that medication. You should let them know that you are on the Azilect as well so that they may choose something other than an SSRI.

Cheers!

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