Common Drugs For Parkinson’s Disease
Levodopa and carbidopa . Levodopa is the most commonly prescribed medicine for Parkinsonâs. Itâs also the best at controlling the symptoms of the condition, particularly slow movements and stiff, rigid body parts.
Levodopa works when your brain cells change it into dopamine. Thatâs a chemical the brain uses to send signals that help you move your body. People with Parkinsonâs donât have enough dopamine in their brains to control their movements.
Sinemet is a mix of levodopa and another drug called carbidopa. Carbidopa makes the levodopa work better, so you can take less of it. That prevents many common side effects of levodopa, such as nausea, vomiting, and irregular heart rhythms.
Sinemet has the fewest short-term side effects, compared with other Parkinsonâs medications. But it does raise your odds for some long-term problems, such as involuntary movements. An inhalable powder form of levodopa and the tablet istradefylline have been approved for those experiencing OFF periods, OFF periods can happen when Parkinsonâs symptoms return during periods between scheduled doses of levodopa/carbidopa.
People who take levodopa for 3-5 years may eventually have restlessness, confusion, or unusual movements within a few hours of taking the medicine. Changes in the amount or timing of your dose will usually prevent these side effects.
Important Information About All Medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
Your Parkinsons Drug Treatment
Dopamine is a chemical messenger made in the brain. The symptoms of Parkinsons appear when dopamine levels become too low. This is because many of the cells in your brain that produce dopamine have died or are dying. Taking dopamine as a drug doesnt work because it cannot cross the blood brain barrier. To get around this, doctors use other medication that can act in a similar way.
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Will I Have To Limit My Activity Following Deep Brain Stimulation Surgery
- You should not engage in light activities for 2 weeks after surgery. This includes housework and sexual activity.
- You should not engage in heavy activities for 4 to 6 weeks after surgery. This includes jogging, swimming, or any physical education classes. Anything strenuous should be avoided to allow your surgical wound to heal properly. If you have any questions about activities, call your doctor before performing them.
- You should not lift more than 5 lbs. for at least 2 weeks.
- You should not raise your arms above your shoulders or over bend or stretch your neck.
- Depending on the type of work you do, you may return to work within 4 to 6 weeks.
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Physical Issues Of Your Sex Drive
Parkinsons affects ones autonomic nervous system, which controls sexual response and functioning. Parkinsons acts upon neurons in the brains substantia nigra, causing dopamine-producing nerve cells to die. Since dopamine is a chemical that transmits signals between parts of the brain that usually coordinate smooth muscle movement, this is critical to sexual function on two fronts.
Introducing an easier way to track your symptoms and manage your care.
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First, this dopamine drop may result in a decreased sex drive and sexual interest. Second, the lower levels of dopamine that result are believed to cause ones loss of balance, changes in walking pattern and posture, muscle rigidity, Bradykinesia , and tremors when resting. The symptoms of Parkinsons can also be seen in:
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A Critical Reappraisal Of The Worst Drugs In Parkinsons Disease
What are the worst drugs for Parkinsons disease patients? Couldnt a simple list be assembled and disseminated to the Parkinson community? Recently Ed Steinmetz, an experienced neurologist in Ft. Meyers, FL pointed out to me, a list approach published in the Public Citizen Newsletter . The approach was to list every drug associated with a single confirmed or unconfirmed symptom of Parkinsons disease or parkinsonism. Parkinsons disease is defined as a neurodegenerative syndrome , whereas parkinsonism encompasses a wider net of drug induced and other potential causes. In parkinsonism symptoms are similar to Parkinsons disease, but patients do not have Parkinsons disease. Patients and family members confronted with a simple drug list approach may falsely conclude that most medicines are bad for Parkinsons disease, and that any medicine may cause parkinsonism. This concept is in general, incorrect. Although the approach is well-meaning, it is in need of a major revision, as Parkinsons disease and parkinsonism are too complex to summarize by simple lists. In this months column I will try to summarize the key information that patients and family members need to know about the worst pills, for Parkinsons disease and parkinsonism.
A Florida Parkinsons Treatment Blog by Michael S. Okun, M.D.
UF Center for Movement Disorders & Neurorestoration, Gainesville FL
Prevention Of The Breakdown Of Endogenous Dopamine Medications
MAO-B Inhibitors work by inhibiting the enzymes involved in dopamine metabolism, which preserves the levels of endogenous dopamine. While they are sometimes sufficient for control of symptoms in early disease, most patients ultimately require levodopa-based treatment. MAO-B inhibitors may also be used in combination with levodopa-based preparations, to allow for a reduction in the levodopa dose. Commonly used MAO-B inhibitors include selegiline and rasagiline . More recently, the drug safinamide was also approved for use in PD, which appears to have multiple modes of action, one of which is thought to be inhibition of MAO-B . MAO-B inhibitors are generally well tolerated, with gastrointestinal side effects being the most common problem. Other adverse effects include aching joints, depression, fatigue, dry mouth, insomnia, dizziness, confusion, nightmares, hallucinations, flu-like symptoms, indigestion, and headache.
Catechol-O-methyl transferase inhibitors: another enzyme that is involved in dopamine degradation is COMT. These drugs are predominantly used as adjunctive therapy to levodopa, prolonging its duration of action by increasing its half-life and its delivery to the brain. COMT inhibitors come in the form of tablets and are not generally prescribed as monotherapy, as on their own they offer only limited effect on PD symptoms. Examples of COMT inhibitors include entacapone , tolcapone , and opicapone .
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Changes In Cognition And Parkinsons Disease
Some people with Parkinsons may experience changes in their cognitive function, including problems with memory, attention, and the ability to plan and accomplish tasks. Stress, depression, and some medications may also contribute to these changes in cognition.
Over time, as the disease progresses, some people may develop dementia and be diagnosed with Parkinsons dementia, a type of Lewy body dementia. People with Parkinsons dementia may have severe memory and thinking problems that affect daily living.
Talk with your doctor if you or a loved one is diagnosed with Parkinsons disease and is experiencing problems with thinking or memory.
Arguments Against Early Use
Few will argue about the superior effectiveness of levodopa, and all Parkinson’s patients will likely eventually need this medication. There are some persuasive arguments for starting it later in the disease’s course, though.
Medications need to be titrated throughout the progression of a disease. In other words, someone with mild Parkinson’s disease who is started on levodopa will need the medication to be steadily increased as their disease worsens. In general, dopamine’s potency will wear off after three years. When maximum doses of levodopa no longer control the symptoms, what else is there to turn to? Without stronger medicinal options, surgery may be the only recourse. Isn’t it better to save the “big gun” for later, when symptoms are more severe?
In addition to the side effects of levodopa already discussed, there are additional potential complications including worsening cognitive function, psychosis, and diminished impulse control. It’s true, though, that other medications such as dopamine agonists also have side effects, such as swelling, somnolence and psychiatric side effects, such as a gambling addiction.
In short, why would you use your “big gun” early, especially when past researchers have suggested it can make the disease worse? Especially when you can use a milder medication that might actually slow the disease process, in addition to helping with symptoms?
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Arguments For Early Use
Levodopa is the most effective medication there is to treat Parkinson’s symptoms. That said, it’s not without side effects.
One of the fears of levodopa use is that it can cause excessive movement called dyskinesia. People with dyskinesia have a writhing movement that is out of their control. While it looks uncomfortable, however, most with dyskinesia prefer it to parkinsonism, and studies suggest that dyskinesia ultimately doesn’t have much an impact on quality of life.
Some researchers have suggested that dopamine may actually accelerate the disease course while patching over the symptoms. More research has not supported this view, however.
Symptoms may fluctuate while on dopamine, meaning there may be times of the day when tremor, rigidity, and slow movements are less well-controlled than others. On the other hand, it’s unclear how those fluctuations actually impact quality of life. Furthermore, people on other medications like dopamine agonists may also eventually have fluctuations.
Other arguments in support of the early use of levodopa say that it will improve the quality of life early in the disease’s course, the importance of which has not been given sufficient attention. Levodopa is also considerably less expensive than dopamine agonists.
What Side Effects Does The Medication Have
The risk of side effects generally depends on the following:
- which medication is being taken
- the persons age and whether they have other diseases
- which other medication the person is on
Dopamine agonists are generally less well tolerated than levodopa. They are more likely to cause side effects such as fluid retention , sleepiness, constipation, dizziness, hallucinations and nausea. People who take dopamine agonists are therefore more likely to stop treatment or not take their medication regularly.
The possible side effects of levodopa include nausea, loss of appetite, dizziness, strong urges, and confusion. At high doses it can also lead to movement problems. Levodopa is usually well tolerated when taken in low doses.
Older people in particular can react to both medications with hallucinations and confusion. Parkinsons medication can also lead to impulsive, obsessive behavior such as a shopping or gambling addiction, an insatiable hunger or sexual desire, or constantly repeating aimless tasks such as putting objects into a certain order.
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What If The Medications Are No Longer Effective Enough
After five years of treatment with medication, about 20 to 40 out of 100 people with Parkinsons notice that the drugs are becoming less effective. Their effectiveness begins to fluctuate considerably: Those affected can sometimes no longer move at all for a while, and then they can move normally again. Another possible side effect of the medication is uncontrolled movements. This is a sign that theres too much dopamine in some areas of the brain.
One aim of treatment is then to keep the effect of the medication as stable as possible. This may involve
- changing the times of the day when you use the medication and changing how often you use it,
- taking sustained-release tablets ,
- changing the doses and taking additional medications such as COMT inhibitors, NMDA antagonists, anticholinergic drugs or MAO-B inhibitors,
- taking a dopamine agonist in addition to levodopa.
Taking additional medication can increase your ability to move. It also decreases the likelihood of suddenly being unable to move. As mentioned above, though: the more medications you take, the more side effects can occur.
Over the course of the illness, many people develop related problems such as digestive problems and dizziness, sleep problems, or dementia. These often require additional treatment. It then becomes even more important to look out for possible interactions between the various medications.
Increased Falls And Loss Of Balance
Parkinsons disease can alter your sense of balance and make simple tasks like walking seem more dangerous. When youre walking, be sure to move slowly so your body can rebalance itself. Here are some other tips to avoid losing your balance:
- Dont try to turn around by pivoting on your foot. Instead, turn yourself around by walking in a U-turn pattern.
- Avoid carrying things while walking. Your hands help your body balance.
- Prepare your home and remove any fall hazards by arranging furniture with wide spaces between each piece. The wide spaces will give you ample room to walk. Position furniture and lighting so that no extension cords are needed and install handrails in hallways, entryways, stairwells, and along walls.
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Symptomatic And Neuroprotective Therapy
Pharmacologic treatment of Parkinson disease can be divided into symptomatic and neuroprotective therapy. At this time, there is no proven neuroprotective or disease-modifying therapy.
Levodopa, coupled with carbidopa, a peripheral decarboxylase inhibitor , remains the gold standard of symptomatic treatment for Parkinson disease. Carbidopa inhibits the decarboxylation of levodopa to dopamine in the systemic circulation, allowing for greater levodopa distribution into the central nervous system. Levodopa provides the greatest antiparkinsonian benefit for motor signs and symptoms, with the fewest adverse effects in the short term however, its long-term use is associated with the development of motor fluctuations and dyskinesias. Once fluctuations and dyskinesias become problematic, they are difficult to resolve.
Monoamine oxidase -B inhibitors can be considered for initial treatment of early disease. These drugs provide mild symptomatic benefit, have excellent adverse effect profiles, and, according to a Cochrane review, have improved long-term outcomes in quality-of-life indicators by 20-25%.
Neuroprotective therapy aims to slow, block, or reverse disease progression such therapies are defined as those that slow underlying loss of dopamine neurons. Although no therapy has been proven to be neuroprotective, there remains interest in the long-term effects of MAO-B inhibitors. Other agents currently under investigation include creatine and isradipine.
Impulse Control Disorders Up Close And Personal
Michael J. Fox and people from his foundation answer questions about Parkinsons in a Google Hangout
Interestingly, Daniel Weintraub, MD, associate professor of psychiatry and Neurology at the Perelman School of Medicine at the University of Pennsylvania, says that ICDs are most likely to manifest in men as gambling and hyper sexuality, whereas in women it expresses as shopping and overeating.
Needless to say, these compulsive behaviors can have serious repercussions.
Ive seen marriages break up and lives ruined as a result of dopamine agonists, says Howard Weiss, director of the Parkinsons Disease and Movement Disorder Programs at the LifeBridge Health Brain & Spine Institute in Baltimore. Ive had at least three patients who have lost their homes because of bankruptcy after taking the drugs. It sounds like a joke, but its not.
Whats more, ICDs are shockingly common. Weintraub cites a study that demonstrated about 14% of people with PD experience 1of 4 of the typical ICD behaviors. He says his own guess is more like 17% to 20%, perhaps even 25%.
The reason that ICD might be even more prevalent than statistics show lies in the fact that they can easily slip under a doctors radar. Many patients arent forthcoming about the symptoms, and doctors may not take the time to ask the right questions.
Most doctors have no idea how to diagnose ICDs, says Weiss, and most patients are in the dark.
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Whats The Difference Between Multiple System Atrophy And Parkinsons
Parkinsons and MSA both affect the movement control system and the involuntary autonomic control system and early symptoms can make a differential diagnosis a challenge. MSA, however, tends to progress faster than Parkinsons balance problems and a stooped posture happen earlier and get worse more quickly with MSA and autonomic functions such as blood pressure, heart rate, breathing, sweating, bladder function, and sexual problems are more severe in people with MSA.
For more information on multiple symptom atrophy, read this fact sheet.
Common Complications And Side
As Parkinsons disease progresses , symptoms have a knock-on effect. Deterioration and impairments in the body can lead to a variety of other health concerns that cause a person great difficulty.
As much as these potential concerns cause discomfort for a person, all are treatable with appropriate medication or therapies.
Associated complications which can arise include:
How to manage some of the more common side-effects of Parkinsons disease
The nature of Parkinsons disease progression means that the condition manifests in a variety of ways, not just in areas of mobility. Non-motor symptoms can sometimes be of more distress to a sufferer, troubling their day-to-day lives even more so than their physical ailments.
Once certain non-motor symptoms are recognised, it is easier to understand why and how they are adversely affecting quality of life, as well as gain control through appropriate treatment.
Other problems which can also be effectively managed include:
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Looking Out For Side Effects If You’re A Carer
If youre a carer of someone with Parkinsons, medication side effects can be difficult and tiring to cope with.
It may be that the person having side effects such as hallucinations and delusions or impulsive and compulsive behaviour does not realise they are experiencing them.
Its important to seek help from your specialist as soon as you can.