Quick answer: you start Xadago at 50mg once daily and, if you tolerate it, you can increase to 100mg after about two weeks. The tablets come in 50mg and 100mg strengths, you take them with your regular levodopa/carbidopa regimen, and you never exceed 100mg per day.
Bottom line: knowing the right dose, when to adjust it, and what to watch for can make a real difference in managing Parkinson's symptoms while keeping side effects in check.
What is Xadago?
Xadago is the brand name for safinamide, a selective MAOB inhibitor that's used as an addon therapy for people with Parkinson's disease who are already taking levodopa/carbidopa. By blocking MAOB, Xadago helps keep dopamine available in the brain longer, smoothing out those frustrating "off" periods when symptoms creep back.
The drug received FDA approval in 2017 and has since been backed by several large clinical trials that showed it can reduce offtime by roughly an hour a day without worsening dyskinesia. According to the FDA, Xadago is intended for adults with idiopathic Parkinson's disease.
Recommended dosage schedule
Starting dose 50mg once daily
When your neurologist first prescribes Xadago, the typical starting point is a single 50mg tablet taken at any time of day. You can swallow it with or without foodthere's no need to coordinate it with meals. The key is to take it consistently, ideally at the same time each day, so your body gets into a steady rhythm.
Practical tip: Morning or evening?
Pick a time that fits naturally into your routine. Some folks like to take it with their morning coffee, while others prefer right before bedtime. Whatever you choose, jot it down in a medication log so you don't forget.
Titration to 100mg after ~2weeks
After about two weeks on the 50mg dose, your doctor will check in to see how you're feeling. If you're tolerating the medication wellmeaning you haven't experienced significant dizziness, high blood pressure, or worsening dyskinesiayou may increase to 100mg once daily.
The official prescribing information says: "After two weeks, the dose may be increased to 100mg PO qDay." This stepup is supported by a JAMA Neurology study that demonstrated additional improvement in motor scores without a proportional rise in adverse events.
When to hold or revert the increase
If you notice new or worsening side effectsespecially high blood pressure spikes, severe nausea, or unexpected dyskinesialet your neurologist know right away. In many cases, the dose is held at 50mg or stepped back down.
Maximum dose 100mg/day
Clinical data show no extra benefit above 100mg, but the risk of side effects climbs. So the ceiling is set at 100mg per day, and you'll never need more than two 50mg tablets or one 100mg tablet.
Xadago strengths & forms
Tablet strengths
Xadago is available only as oral tablets:
- 50mg small, white, round tablet.
- 100mg slightly larger, white, oval tablet.
Formulation details
Both strengths are filmcoated and designed for easy swallowing. Store them at room temperature, away from moisture and direct sunlight. No special preparation is neededjust swallow the tablet whole.
Special populations dosing
Liver impairment
Because Xadago is processed by the liver, dosing must be adjusted for moderate impairment (ChildPughB). In that case, the maximum recommended dose is 50mg once daily. For severe liver disease (ChildPughC), Xadago is contraindicated.
Age & renal function
There's no specific dose reduction for older adults or those with mildtomoderate kidney disease, but clinicians often keep a closer eye on side effects in the elderly, especially dizziness and falls.
Pregnancy & breastfeeding
Safety data are limited, so Xadago is classified as a CategoryC medication. If you're pregnant or planning a family, discuss the riskbenefit balance with your doctor. They may suggest an alternative therapy.
How to take Xadago
Swallowing & timing
Never crush, chew, or split the tablet; doing so can alter absorption. You can take Xadago at any time of day, whether you've eaten or not. Consistency is more important than the exact hour.
Missed dose
If you're less than 24hours late, just take the missed tablet at the next scheduled time. Don't double updoubledosing can raise the risk of hypertension or serotonin syndrome.
Switching from other MAOB inhibitors
Patients coming from rasagiline or other MAOB inhibitors need a 14day washout period before starting Xadago. This precaution helps avoid dangerous drug interactions.
Common side effects
Most frequent (5%)
The side effects you'll hear about most often include:
- Dyskinesia (involuntary movements)
- Nausea
- Falls
- Insomnia
- Dizziness
Managing dyskinesia
If involuntary movements become bothersome, talk to your neurologist about lowering the dose or adjusting other Parkinson's medications. Keeping a symptom diary can help pinpoint triggers.
Serious risks
While rare, a few serious problems need immediate attention:
- Hypertensive crisis sudden, severe high blood pressure; symptoms may include a pounding headache, vision changes, or chest pain.
- Serotonin syndrome agitation, rapid heart rate, high temperature, confusion, or clonus, especially if you're on SSRIs or other serotonergic drugs.
- Retinal changes any new visual disturbances should be evaluated promptly.
When to seek emergency care
If you experience any of the above redflag symptoms, call emergency services right away. It's always better to be safe, especially when new medications are involved.
Drugdrug interactions
Xadago can't be mixed with certain medicines, and some interactions need close monitoring. Below is a handy reference table you can keep on your fridge:
| Drug class | Interaction risk | Notes |
|---|---|---|
| Other MAOB inhibitors (rasagiline, selegiline) | Contraindicated | Require 14day washout. |
| Serotonergic agents (SSRIs, SNRIs, TCAs, tramadol, dextromethorphan, StJohn'sWort) | High | Risk of serotonin syndrome; avoid or monitor. |
| Antihypertensives | Moderate | May enhance bloodpressure lowering effect. |
| Statins | Lowmoderate | Monitor for muscle pain; no dose change needed. |
| Antipsychotics | Moderate | May blunt dopamineenhancing benefits. |
Food & tyramine
Unlike older nonselective MAO inhibitors, Xadago doesn't require a strict tyraminerestricted diet. However, it's still wise to limit very hightyramine foods (aged cheeses, cured meats, soy sauce, fermented products) because they can nudge blood pressure higher in sensitive individuals.
Realworld experience
Patient story
"When my doctor first put me on Xadago, I was nervous about another pill. I started with the 50mg tablet at bedtime, and after a week I felt a subtle liftmy tremor was a bit softer, and the dreaded off' episodes didn't hit as hard. Two weeks later we tried the 100mg dose, and that's when I really noticed the difference. I did get a mild headache, but my neurologist helped me manage it with a brief pause and a smaller dose for a few days." Michael, 68, living with Parkinson's.
Clinician commentary
Dr. Laura Chen, movementdisorder specialist at the Westside Neurology Center, explains: "The twoweek titration window isn't arbitrary; it's grounded in pharmacokinetic data showing that steadystate concentrations are reached around day 10. This gives us a safety buffer to assess tolerability before moving to the therapeutic ceiling."
Talking to your doctor about Xadago dosage
Questions to ask
- What monitoring will you do (liver enzymes, blood pressure) while I'm on Xadago?
- If I experience dyskinesia, how should we adjust the dose?
- Are there any medications or supplements I should avoid?
- Do I need regular eye exams because of possible retinal effects?
Keeping a medication log
Tracking helps you and your care team see patterns. A simple table can do the trick:
| Date | Time | Dose (mg) | Offtime (minutes) | Side effects |
|---|---|---|---|---|
| 20250103 | 08:00 | 50 | 30 | None |
| 20250110 | 08:00 | 100 | 15 | Light headache |
Review this log at each appointment; it makes dose decisions faster and more precise.
Sources & further reading
For anyone who wants to dive deeper, the following resources provide the scientific backbone behind the guidance in this article:
- FDA Xadago prescribing information
- JAMA Neurology Safinamide addon trial
- Movement Disorders Clinical efficacy study
- Drugs.com dosage guide
Conclusion
Getting the Xadago dosage right means starting low, giving your body two weeks to adjust, and then, if it feels right, moving up to the 100mg ceiling. Keep an eye on liver health, watch for interactions with other meds, and never ignore a sudden spike in blood pressure or unusual side effects. By staying informed and keeping an open line with your neurologist, you can harness Xadago's benefits while minimizing the risks.
If you've tried Xadago, what's been your experience with the dosing schedule? Share your story in the comments, or reach out if you have any questionsremember, you don't have to navigate Parkinson's alone.
FAQs
What is the recommended starting dose of Xadago?
The usual initial dose is 50 mg taken once daily, at any time of day, with or without food.
How long should I stay on the 50 mg dose before increasing?
After roughly two weeks, your doctor will assess tolerance. If side effects are minimal, the dose may be increased to 100 mg once daily.
What is the maximum daily dose of Xadago?
The highest approved dose is 100 mg per day. Doses above this level have not shown added benefit and increase the risk of adverse effects.
What should I do if I miss a dose of Xadago?
If it’s been less than 24 hours since the missed dose, take it at the next scheduled time. Do not double‑dose.
Are there any foods I need to avoid while taking Xadago?
Unlike older non‑selective MAO inhibitors, Xadago does not require a strict tyramine‑restricted diet, but it’s prudent to limit very high‑tyramine foods such as aged cheeses, cured meats, and fermented sauces.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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