Delayed Administration And Contraindicated Drugs Place Hospitalized Parkinsons Disease Patients At Risk
Mr. Grissinger, an editorial board member of, is Director of Error Reporting Programs at the Institute for Safe Medication Practices in Horsham, Pennsylvania .
Problem: One-third of all patients with Parkinsons disease visit an emergency department or hospital each year, making it a surprisingly common occurrence. The disease affects about 1 million people and is currently the 14th leading cause of death in the U.S. Hospitalization can be risky for patients with Parkinsons disease when viewed from the perspective of pharmacological management.
Undergoing surgical procedures can be particularly risky for patients with Parkinsons disease. Antiparkinsonian agents have been inappropriately withheld because patients were to receive nothing by mouth prior to surgery, and surgical patients have been given a contraindicated anesthetic agent or a centrally acting antidopaminergic drug such as haloperidol, metoclopramide, or prochlorperazine postoperatively. One in three patients with Parkinsons disease has been prescribed contraindicated drugs during hospitalization. Serious complications, mostly neuropsychiatric, have occurred in more than half of these patients.,
Considerations For The Inpatient Management Of Parkinsons Disease
Recognising and managing certain complications of Parkinsons disease can help improve care and reduce the risk of admission for people living with the condition.
Degenerative neurological disorders
Sergio Azenha / Alamy Stock Photo
Parkinsons disease is a neurological disorder in which there is progressive death of dopaminergic neurones in the substantia nigra the part of the mid-brain responsible for managing movement and the dopaminergic system with more than 50% of cell death occurring before symptom manifestation. The subsequent deficiency of dopamine synthesis, owing to this cell death, leads to the progression of motor symptoms including bradykinesia, rigidity, tremor and postural instability,.
Around 137,000 people in the UK have a PD diagnosis. The cause of the disease is yet to be discovered, but a combination of environmental and genetic factors are thought to increase its risk. Despite this, there is a lack of robust, large-scale evidence of a definitive link between any specific environmental risk factors. Around 20% of patients affected by PD have a first-degree relative that is affected by the disease. Prevalence is higher with increasing age and men appear to be at higher risk of developing the disease than women,. Patients with PD have a reduced life expectancy and studies have suggested up to a five-times higher mortality rate than people in the same age group without PD.
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Using Amphetamines May Increase Risk Of Parkinsons Disease Study Suggests
- Date:
- American Academy of Neurology
- Summary:
- New research shows people who have used amphetamines such as benzedrine and dexedrine appear to be at an increased risk of developing Parkinsons disease.
New research shows people who have used amphetamines such as benzedrine and dexedrine appear to be at an increased risk of developing Parkinsons disease, according to a study released February 22 that will be presented at the American Academy of Neurologys 63rd Annual Meeting in Honolulu April 9 to April 16, 2011.
Benzedrine and Dexedrine are amphetamines often prescribed to increase wakefulness and focus for people with attention deficit hyperactivity disorder and narcolepsy, a disorder that can cause excessive daytime sleepiness and sudden attacks of sleep. They are also used to treat traumatic brain injuries.
The study involved 66,348 people in northern California who had participated in the Multiphasic Health Checkup Cohort Exam between 1964 and 1973 and were evaluated again in 1995. The average age of the participants at the start of the study was 36 years old. Of the participants, 1,154 people had been diagnosed with Parkinsons disease by the end of the study.
Exposure to amphetamines was determined by two questions: one on the use of drugs for weight loss and a second question on whether people often used Benzedrine or Dexedrine. Amphetamines were among the drugs commonly used for weight loss when this information was collected.
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Ibuprofen May Help Parkinson’s
In the latest study to suggest that anti-inflammatory drugs may protect against brain disorders, researchers have found that regular use of ibuprofen may lower a person’s risk of Parkinson’s disease.
But the findings are still preliminary and people should not start popping the common painkiller in hopes of warding off the progressive brain disorder, Harvard researchers say.
Parkinson’s disease is caused by the loss of brain cells that control movement. Symptoms include shaking, rigidity, slow movements, and unsteadiness.
Ibuprofen is commonly marketed under the tradenames Advil and Motrin.
The findings, presented at the annual meeting of the American Academy of Neurology, came from data collected in a large study of nearly 150,000 men and women. The participants were tracked over eight-and-a-half years, during which time 413 developed Parkinson’s disease.
Does Ibuprofen Stand Alone?
“Our findings showed that ibuprofen users were 35 percent less likely to develop Parkinson’s disease than nonusers,” says researcher Alberto Ascherio, MD, DrPH, associate professor of nutrition and epidemiology at Harvard School of Public Health in Boston.
But there was no link between the length of time that ibuprofen users had been taking the medication and Parkinson’s disease, Ascherio says.
The researchers did not study whether the dose of ibuprofen had any effect on the risk of Parkinson’s disease.
Surprising Findings
Inflammation Linked To Parkinson’s
Adderall Neurotoxicity: How Dangerous Is It
- Adderall Neurotoxicity: How Dangerous Is It?
Most people are familiar with Adderall due to its frequent use for those dealing with ADHD. The drug is designed to help with hyperactivity and increase impulse control, but it may also have some unpleasant effects if youre not careful. Despite the fact this is a drug commonly prescribed for attention issues, it can be addictive and may cause problems when taken long-term.Adderall is made of two central nervous system stimulants, dextroamphetamine and amphetamine. These may interact with other drugs, so its important that a doctor prescribe your medications. However, the medication on its own may cause something called Adderall neurotoxicity.
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Strattera Popularity And Prescribing Rates
One study26 looked at prescribing trends in Irish children and adolescents with ADHD between 2002 and 2011. Among this population, atomoxetine was the second most prescribed drug after methylphenidate.
During the study period methylphenidate was the most frequently prescribed psychostimulant. The prevalence increased from 3.68/1000 GMS population in 2002 to 7.51/1000 GMS population in 2011. Rates of dexamfetamine remained relatively stable over the 10 years, fluctuating between 0.08/1000 GMS population and 0.15/1000 GMS population . Atomoxetine became available for prescribing in Ireland in January 2007 and immediately became the second most commonly prescribed drug . Since 2007 rates of atomoxetine have steadily increased to 1.57/1000 population in 2011. Figure 1 illustrates the prescribing rates of these drugs per 1000 GMS population over the study period. Modafinil was rarely prescribed between 2002 and 2011 with prevalences of less than 0.02/1000 GMS population.
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Mixing Amphetamines With Other Drugs
The effects of taking amphetamines with other drugs including over-the-counter or prescribed medications can be unpredictable and dangerous, and could cause:
Amphetamines + someantidepressants:increases the risk of irregular heartbeat and seizures.
Amphetamines +alcohol: increased heart rate and blood pressure.
Ampetamines+opioids: increases the risk of irregular heartbeat and seizures.
Use of than one drug or type of drug consumed at the same timeis called polydrug use.
Regular use of amphetamines may eventually cause:
- reduced appetite and extreme weight loss
- tolerance and dependence on amphetamines
- financial, work and social problems.2, 6-8
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How To Talk To Your Doctor
If you want to talk to your doctor about medications or any other concerns you have, we put together a great video with great strategies for making the most out of your time together. You can watch the video here, and be sure to check out all of the videos we have on our YouTube channel and subscribe so youre the first to know when we share something new.
Amphetamine Use And Mental Health
Research demonstrates a relationship between people who use amphetamines and increased mental health issues.9
High doses and frequent heavy use can also create a amphetamine-induced psychosis, characterised by paranoid delusions, hallucinations and out of character aggressive or violent behaviour.9
These symptoms usually disappear after the person stops using amphetamines.41,2
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Introduction: Adhd And Psychostimulants
The center for disease control has estimated that over five million children have been diagnosed with attention deficit hyperactivity disorder in the United States alone. Psychostimulants, including amphetamine salts, are the most widely-prescribed medications for the treatment of ADHD.
State-based Prevalence Data of ADHD Diagnosis : Children EVER diagnosed with ADHD19
Despite considerable research in animal models and in vitro, the likelihood of irreversible Adderall neurotoxicity to dopaminergic neurons at therapeutic dosages in humans remains controversial and poorly characterized. Physicians have a responsibility to disclose the long-term risks of medications so that patients can make informed decisions with accurate cost-benefit analyses.
Side Effects Of Adhd Medications
There are other ways ADHD drugs such as Adderall, Vyvanse, and Ritalin can impact your central nervous system, though, which can lead to a negative experience overall. Some common side effects include:
- Sexual drive changes
- Slowed growth in children
If you ever feel any serious side effects after taking ADHD medication, contact your health provider immediately. These can include the following:
- Paranoia or hallucinations
- Seizures or uncontrollable shaking
- Depression, anxiety, and other mental health conditions
Some people feel great when they take ADHD medications and only experience side effects when they stop taking them. Typically, people who feel withdrawal symptoms were abusing or overusing ADHD medications before they abruptly stopped taking it however, that is not always the case.
These withdrawal symptoms can be challenging, but they should resolve on their own within a few weeks after you stop taking the medication. Let your doctor know what specific concerns you have with withdrawal symptoms, including:
- Fatigue and lack of energy
- A general feeling of uneasiness
- Sleeping too much or being unable to sleep
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Do They Really Make You Smart
Several small trials have tried to determine if Modafinil really does enhance cognition, with mixed results. Participants reported feeling more alert, attentive and energetic on the drug, in one 2003 trial, and some improvements in certain memory tasks – such as digit span and visual recognition – were reported. In addition, there was a decrease in impulsivity. A 2014 trial also showed improvements in impulsive decision making, but no difference in the accuracy of performance.
Modafinil was found to enhance attention and learning and improve decision making and planning in a review of 24 studies. However, it made no difference to working memory or understanding different points of view and negatively affected creativity in a few studies.
Adderall has been used as a study aid based on the assumption that stimulants used for ADHD help reduce hyperactivity, impulsivity, and inattention. However, there are very few trials investigating whether Adderall does enhance cognition in individuals without ADHD. Results were conflicting, with some studies showing no effect, and others showing minor improvements some even showed a negative effect. While Adderall may promote wakefulness, it does not improve IQ. Any short term gains in alertness are overwhelmingly counteracted by withdrawal symptoms and potentially fatal side effects.
What Does The New Study Show
The study, published Wednesday in Neuropsychopharmacology, found that people with ADHD seemed to have a risk of developing Parkinsons disease or Parkinsons-like diseases.
Parkinsons disease, a movement disorder typically seen in elderly people, is thought to result from a loss of dopamine a neurotransmitter responsible for regulating movement in the brain.
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Are There Side Effects From Dopamine Agonists
Side effects from DA medications can vary depending on the medication , dose, how long the medication is used, and individual traits.
If youre experiencing side effects which are bothersome, dont stop taking the medication on your own. Talk to your doctor about treatment options available to help improve your condition. This includes non-medication options too.
Side effects might be mild and go away after a few days or they may be important enough to need either a dose change or to stop the medication. DA medications can cause withdrawal symptoms or worsening of the condition if theyre suddenly stopped.
This is not a full list of side effects. Ask your pharmacist or doctor about specific concerns related to your medication.
side effects
Side effects for dopamine agonists include:
- heart valve problems, heart failure
- trouble with memory or concentration
- movement-related problems
Amphetamine Use Linked To Increased Parkinson’s Risk
Kate Johnson
February 25, 2011 Exposure to the amphetamines Benzedrine and Dexedrine is associated with a roughly 60% boost in the risk of developing Parkinsons disease , a new study suggests.
The preliminary findings were released February 20 and will be presented in April at the American Academy of Neurology’s 63rd Annual Meeting in Honolulu, Hawaii.
The results could have important clinical implications if they are confirmed by other studies, said principal investigator Stephen K. Van Den Eeden, PhD, a research scientist with Kaiser Permanente Northern California in Oakland.
Amphetamines are prescribed for the treatment of attention-deficit/hyperactivity disorder, narcolepsy, and traumatic brain injuries, and there is also growing interest in their use as cognitive enhancers.
“If this is a true association and someone has a family history of Parkinson’s disease, that would weigh in a clinical decision,” Dr. Van Den Eeden told Medscape Medical News.
“In prescribing amphetamines we need to weigh the benefits and risks, and could be one risk to consider, though small, as the absolute risk does not appear to be large at this point.”
Amphetamine Exposure
The study involved 66,438 people who participated in the Multiphasic Health Checkup Cohort Exam between 1964 and 1973 and were followed for a mean of 38.8 years. The mean age of the participants at baseline was 36 years, and none of them had PD at that time however, family history of the disease was not recorded.
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Search Strategy And Selection Criteria
We identified clinical trials and intervention studies for patients with Lewy body dementia through bibliographic databases, trials registers, and grey literature. Search terms for identification of these studies included and dementia from Jan 1, 1990 to Feb 13, 2019. We prioritised articles published in the past five years. Older articles for citation were chosen for their historical value, importance, ease of access, and timeliness. At least two reviewers J-PT, IGM, JTOB independently assessed search results for inclusion by title and abstract with papers reviewed in full if patients had a diagnosis of dementia with Lewy bodies, Parkinsons disease dementia, or Lewy body dementia and were relevant. We also examined reference lists of relevant studies and previous systematic reviews. In addition, we also sought input from members of the Delphi expert consensus panel for any missing literature and relevant trials in patients with Alzheimers disease and those with Parkinsons disease and papers pertinent to Lewy body dementia symptom cause and epidemiology.
Methamphetamine And Amphetamine Abuse And Parkinsons Disease
The National Institute on Drug Abuse reports that methamphetamine and amphetamine abuse can increase the risk of developing Parkinsons disease.
A main insight from this research is that abuse of these types of drugs damages dopamine neurons in the brain. Parkinsons disease is a dopamine-related disorder, and individuals who misuse drugs and damage their dopamine neurons may develop symptoms of Parkinsons disease. Dopamine damage results in motor impairment, a hallmark of Parkinsons disease.
One research study found a near 300 percent increase in the risk of developing Parkinsons disease in people who have abused methamphetamine or amphetamine. In 2020, an estimated 2.5 millions Americans aged 12 and over were currently using this illicit drug.
A review of the neurological impact of drug abuse and separately, of Parkinsons disease, opens a window into the very nuanced and delicate workings of brain complexes, like the substantia nigra, as well as critical neurotransmitters, like dopamine. Interestingly, this discussion illuminates how there are different pathways to similar outcomes a person who never used drugs and develops Parkinsons disease may experience similar symptoms as a person who has used certain illicit drugs.
If there is one main lesson to be learned from looking at the parallels between substance use disorders and Parkinsons disease, it is that drug misuse exposes individuals to a host of unexpected and severe consequences.
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Amphetamines May Help Slow Parkinsons
Amphetamines, including the party drug Ecstasy, have reversed the effects of Parkinsons disease in mice, researchers said Wednesday.
Their finding does not suggest the use of now-illegal drugs to treat the incurable brain disease, but may offer a way forward in helping patients, they said.
The team at Duke University in North Carolina treated mice that were genetically modified to suffer from Parkinsons-like symptoms with more than 60 types of amphetamines.
Fourteen of the drugs helped reverse the symptoms of the mice, including the tremors and rigidity that mark the disease raising the possibility of exploring related treatments for humans.
We hope to find new drugs that are close chemically, but safe, Marc Caron, who led the research, said in a telephone interview.
Parkinsons disease is caused by the death of brain cells that control physical movement and produce the essential chemical dopamine.
According to the American Parkinsons Disease Association, there are about 1.5 million Americans with the disease.
The new research shows that dopamine replacement, so far the most common, but only partly effective Parkinsons treatment, may not be the only viable option, Caron said.
Amphetamine-like drugs, not unlike those now given to children with attention deficit disorder, could eventually be used for Parkinsons, he said.
The effects of another stimulant, coffee, have been cited in the past as easing Parkinsons symptoms by keeping dopamine levels high.