Rasagiline is a selective and irreversible MAO-B inhibitor with minimal effect on MAO-A at conventional doses, but caution should still be exercised regarding tyramine related risks and drug interactions. Standardized dietary management and combined medication screening are the core of preventing hypertensive crisis.

1、 Dietary habits and casein restriction

1.1 Low risk under conventional dosage

At the recommended dose (1mg/day), rasagiline has a weak inhibitory effect on MAO-A and does not require a strict low tyramine diet.

However, individual differences exist, and it is still necessary to avoid excessive intake of high tyramine foods to prevent the occurrence of "cheese reaction" (hypertensive crisis).

1.2 Recommended high tyramine foods for restriction

Fermented food: aged cheese, blue cheese, pickled Chinese cabbage, lobster sauce, fermented sausage.

Marinated/Dried Meat: Italian sausage, salami, dried ham.

Fermented alcoholic beverages: craft beer, red wine (especially aged), sake.

Other: concentrated yeast extract (such as Vegeta), excess fava beans.

1.3 Principles of Safe Eating

Try new foods in small amounts and portions, observe blood pressure and headache symptoms.

If levodopa is used in combination, it is even more important to pay attention to blood pressure fluctuations.

2、 Key Warning on Drug Interactions

2.1 Absolute prohibition of drugs (to avoid serotonin syndrome)

SSRI antidepressants (fluoxetine, sertraline, paroxetine, etc.) - conversion should be done at least 14 days apart.

SNRI class (venlafaxine, duloxetine).

Opioid drugs (pethidine, tramadol, methadone).

Other: St. John's wort, dexmedetomidine (high dose), linezolid.

2.2 Medications to be used in combination with caution

Sympathetic drugs (decongestants such as pseudoephedrine, or cold medicines containing ephedrine): may induce sudden increases in blood pressure.

Levodopa/Carbidopa: can enhance the effect of levodopa, and the dosage of levodopa needs to be adjusted accordingly (usually by 10-30% reduction).

2.3 Medication review for comorbidities

At each visit, a complete list of prescription drugs, over-the-counter drugs, and traditional Chinese medicine/health products currently in use must be provided.

3、 Identification and Management of Hypertension Crisis

3.1 Warning Symptoms

Severe headaches (especially in the occipital region), blurred vision, nausea and vomiting, palpitations, sweating, and neck stiffness.

3.2 Emergency Response Measures

Immediately stop using Reshagilan and call for first aid.

Monitor blood pressure (systolic blood pressure often>180mmHg).

Nifedipine (short acting) 5-10mg sublingual administration or phentolamine 5mg intravenous injection can be given in the emergency department (professional operation is required).

3.3 Prevention points

Strictly follow the list of dietary and medication taboos.

Strengthen blood pressure monitoring after each dose adjustment.

Notify family members or caregivers to identify signs of crisis for emergency response.