Rasagiline (Azilect) and Ketamine Therapy | Tovani Health
Azilect (Rasagiline) — Selective MAO-B inhibitor (Parkinson's disease)
Verdict at Tovani Health
Compatible; the selectivity preserved at standard doses dramatically lowers SS risk relative to non-selective MAOIs, but we still monitor.
Rasagiline and ketamine are compatible with monitoring. At the prescribed Parkinson's dose (0.5-1mg daily), rasagiline's MAO-B selectivity is largely preserved, so the dietary tyramine ('cheese effect') and serotonin syndrome risks that define non-selective MAOIs (phenelzine, tranylcypromine — covered in the dedicated MAOI page) are dramatically lower. The residual theoretical concern with any MAO inhibitor plus ketamine warrants observation rather than avoidance. Worth flagging: the safety dose ceiling matters — at supratherapeutic doses MAO-B selectivity is lost and the picture changes.
If you take Azilect regularly and are considering at-home ketamine therapy, the combination is safe with monitoring or modest dose adjustment. This page covers the brief pharmacologic context and what we do at intake.
How Azilect interacts with ketamine
Rasagiline irreversibly inhibits monoamine oxidase B, raising dopamine in basal ganglia. MAO-B selective at therapeutic doses; loses selectivity at higher exposures. Mostly hepatic CYP1A2 metabolism (smoking and ciprofloxacin matter for rasagiline levels, independent of KAP).
What we do at intake
Disclose your rasagiline dose and any recent dose changes. Don't exceed your prescribed dose — selectivity matters. Tell us about all serotonergic medications including over-the-counter (dextromethorphan in cough syrups, St John's wort, tramadol).
Bottom line
Rasagiline and ketamine are compatible with monitoring. At the prescribed Parkinson's dose (0.5-1mg daily), rasagiline's MAO-B selectivity is largely preserved, so the dietary tyramine ('cheese effect') and serotonin syndrome risks that define non-selective MAOIs (phenelzine, tranylcypromine — covered in the dedicated MAOI page) are dramatically lower. The residual theoretical concern with any MAO inhibitor plus ketamine warrants observation rather than avoidance. Worth flagging: the safety dose ceiling matters — at supratherapeutic doses MAO-B selectivity is lost and the picture changes.
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Azilect (Rasagiline) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Sources
The verdict and clinical guidance on this page are based on the following peer-reviewed literature and FDA prescribing information.
- Safety of Ketamine Augmentation to Monoamine Oxidase Inhibitors in Treatment-Resistant Depression: A Systematic Literature Review. Veraart JKE, Smith-Apeldoorn SY, Kutscher M. Journal of Clinical Psychiatry. 2022. PMID: 36300995
- Combination of paroxetine and rasagiline induces serotonin syndrome in a parkinsonian patient. Hébant B, Guillaume M, Desbordes M. Revue Neurologique. 2016. PMID: 27838092
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 22, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.