What is the drug Equfina used for?

October 7, 2025 •

3 min read

According to a 2025 market report, the medication safinamide, marketed under the brand name Equfina in Japan and some other Asian countries, is indicated for Parkinson's disease. This targeted therapy helps manage motor fluctuations in patients already receiving treatment with levodopa/carbidopa.

Quick Summary

Equfina, which contains the active ingredient safinamide, is used as an adjunctive treatment for mid- to late-stage Parkinson's disease patients to improve 'off' episodes when taken with levodopa.

Key Points

Equfina's Purpose: Equfina (safinamide) is an add-on medication for Parkinson's disease patients already taking levodopa, used to manage "off" periods and motor fluctuations.
Mechanism of Action: It works as a selective and reversible MAO-B inhibitor, which increases dopamine levels in the brain, alongside a non-dopaminergic effect on sodium and glutamate channels.
Global Brand Names: While known as Equfina in Japan and parts of Asia, the same active ingredient, safinamide, is marketed as Xadago in the US and Europe and Onstryv in Canada.
Clinical Efficacy: Clinical trials have demonstrated that adding Equfina to levodopa therapy significantly increases the duration of "on" time for patients experiencing wearing-off.
Important Side Effects: Patients should be monitored for involuntary movements (dyskinesia), impulse control disorders, hallucinations, and sleep-related side effects like somnolence.
Drug Interactions: Concomitant use with other MAO inhibitors, specific opioids (pethidine), and certain antidepressants is contraindicated or requires caution due to the risk of serious reactions like serotonin syndrome.
Contraindications: Equfina is not suitable for patients with severe liver impairment, certain retinal conditions, or hypersensitivity to its components.

The Primary Indication: Combating the "Wearing-Off" Phenomenon

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by the loss of dopamine-producing neurons. Levodopa is a common and effective treatment for the motor symptoms of PD. However, with disease progression, the effectiveness of levodopa doses can diminish before the next dose is due, leading to periods of worsened symptoms known as the "wearing-off" phenomenon. Equfina (safinamide) is used as an add-on therapy to address this by extending the duration of levodopa's effects and increasing the time when motor symptoms are controlled, referred to as "on" time.

The Dual Mechanism of Action

Equfina's effectiveness is attributed to its dual mechanism, affecting both dopaminergic and non-dopaminergic pathways.

Selective and Reversible MAO-B Inhibition

Safinamide primarily acts as a selective and reversible inhibitor of monoamine oxidase B (MAO-B). By inhibiting this enzyme, which breaks down dopamine, Equfina helps maintain higher dopamine levels, thereby enhancing and prolonging the effects of levodopa. This selective action is distinct from older, non-selective MAOIs and helps avoid some severe side effects.

Non-Dopaminergic Effects

Beyond its effects on dopamine, safinamide also has non-dopaminergic actions that may benefit PD patients. These include blocking sodium channels and inhibiting the release of glutamate. Modulating glutamate release may offer some neuroprotection and potentially reduce dyskinesia, a common side effect of long-term levodopa therapy.

Administration and Considerations

Equfina is typically taken once daily by mouth, with or without food. It is added to a patient's existing stable levodopa treatment regimen.

Potential Side Effects of Equfina

Equfina can cause side effects, and patients require monitoring by their healthcare provider.

Common Adverse Reactions

Dyskinesia: Involuntary movements are frequently reported, often due to the enhanced effects of levodopa.
Falls: An increased risk of falls may occur.
Constipation: Gastrointestinal issues such as constipation can happen.
Nausea: Some individuals may experience nausea.
Insomnia: Difficulty sleeping has been noted.

Serious and Behavioral Side Effects

Impulse Control Disorders: There is a risk of developing impulse control disorders.
Hallucinations and Psychotic Behavior: Hallucinations or other psychotic symptoms can occur.
Somnolence and Sudden Sleep: Daytime sleepiness or sudden sleep onset can be dangerous.
Hypertension: Elevated blood pressure is a potential risk.

Comparison of MAO-B Inhibitors


Feature	Equfina (Safinamide)	Rasagiline	Selegiline
Mechanism	Selective & Reversible MAO-B inhibition; also modulates glutamate release	Selective, Irreversible MAO-B inhibition	Selective, Irreversible MAO-B inhibition at low doses; non-selective at high doses
Indications	Adjunct to levodopa for motor fluctuations in PD	Monotherapy for early PD, adjunct to levodopa for advanced PD	Adjunct to levodopa for motor fluctuations in PD
Active Ingredient	Safinamide	Rasagiline	Selegiline
Side Effects	Dyskinesia, impulse control disorders, somnolence, hallucinations	Nausea, flu-like symptoms, dyskinesia	Dyskinesia, insomnia, hallucinations
Dual Action	Yes (dopaminergic and non-dopaminergic)	No	No

Drug Interactions and Contraindications

Drug Interactions

Equfina can have significant interactions with other medications.

Other MAO Inhibitors: Combining with other MAO inhibitors is not recommended due to the risk of hypertensive crisis.
Certain Antidepressants: Co-administration with some antidepressants (TCAs, SSRIs, SNRIs) can lead to serotonin syndrome.
Opioid Analgesics: Certain opioids like pethidine and tramadol should be avoided.

Contraindications

Equfina is not suitable for everyone.

Severe Hepatic Impairment: Patients with severe liver disease should not take it.
Ocular Conditions: It is contraindicated in patients with specific retinal issues.
Hypersensitivity: Those with a known hypersensitivity to the drug's components should avoid it.

Conclusion

Equfina (safinamide) serves as a valuable adjunctive treatment for Parkinson's disease patients experiencing motor fluctuations while on levodopa therapy. Its mechanism, which includes MAO-B inhibition and non-dopaminergic effects, helps extend motor symptom control. However, healthcare providers must be aware of potential side effects, including impulse control disorders and somnolence, as well as crucial drug interactions, to ensure safe and effective use.

For comprehensive prescribing information on safinamide, consult the official FDA documents for its US brand, Xadago.

Frequently Asked Questions

The active ingredient in Equfina is safinamide mesilate, a selective monoamine oxidase B (MAO-B) inhibitor.

Equfina helps treat Parkinson's disease by increasing dopamine levels in the brain and extending the effects of levodopa, which helps manage the "wearing-off" phenomenon and improve motor function.

Yes, Equfina is the brand name for safinamide mesilate in Japan and some Asian countries, while the same drug is marketed as Xadago in the United States and Europe.

Common side effects include dyskinesia (involuntary movements), falls, constipation, nausea, insomnia, and visual hallucinations.

Yes, serious warnings include the risk of impulse control disorders, sudden sleep episodes, and the possibility of developing serotonin syndrome if combined with certain antidepressants.

No, Equfina is an add-on therapy and is not intended to be used as a monotherapy for Parkinson's disease.

Equfina is contraindicated in patients with severe liver impairment, certain retinal conditions, and those taking other MAO inhibitors or certain antidepressants.