Parkinsons Disease Medications: The Facts
There have been many developments in Parkinson’s disease treatments in recent years. As such, doctors now have a greater understanding of traditional Parkinson’s disease medications and their side-effects. Scientists have also developed new drugs to help control tremors, slowed movement and other Parkinson’s symptoms.
Before we explore the best medication for Parkinson’s disease, it’s important to address the facts. Firstly, Parkinson’s disease medications cannot cure your condition, nor will they slow down the progression of your symptoms. These medications are prescribed to help patients live independently and improve their quality of life.
It’s important to note that some patients do not respond well to Parkinson’s disease medications. In this case, there are plenty of other treatment options to consider such as homeopathic remedies, physical therapy and surgical intervention. Again, none of these treatments provides a cure, but they can help ease or control your symptoms.
Withdrawal Syndrome With Levodopa
Research has shown that withdrawal symptoms can happen when someone very suddenly stops taking levodopa, perhaps because they are experiencing impulsive and compulsive behaviour. It can lead to symptoms such as depression, anxiety and pain. Any withdrawal from Parkinsons medications needs to be done gradually, under the supervision of a health professional, to avoid the risk of developing this syndrome.
Impulsive And Compulsive Behavior
Some people taking dopamine agonists may experience problems with impulsive or compulsive behaviours. For example an increased desire to gamble or engage in sexual activity. These behaviours often develop slowly so may not seem to be a problem immediately. It is important for both the person living with Parkinsons and their family to be aware of this side effect. If affected by this side effect, a reduction in dose or stopping the medication will stop the behaviour.
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Besides Medication What Other Approaches Should I Use To Deal With This Disease
Medication can certainly reduce the complications of Parkinsons disease, but its not the only way to deal with it. There are other approaches that you may need to consider in order to feel and live much better with this progressive disease. Here are some of them:
- Educate yourself about the disease
What Is Parkinson’s Disease
Parkinsons disease is the deterioration of brain nerves that control movement. The symptoms of Parkinsons disease have a slow onset and get worse over time. You may experience a gradual onset of symptoms, or notice several changes all at once.
Perhaps the most well-known symptom of Parkinsons disease is the development of a tremor. You may notice that your fingers, hands, or chin shake uncontrollably. Other symptoms include:
- Change in handwriting specifically smaller handwriting
- Changes in your tone of voice specifically speaking more quietly
- Lack of facial expressions
- Dizziness and fainting
- Beginning to walk with a hunched back
It is important to keep in mind that medications and other medical conditions can cause symptoms similar to those listed above. But, if you are experiencing a combination of these symptoms, it may be a sign of Parkinsons disease.
While there is not currently a cure for Parkinsons disease, many treatment options are available that can help ease your symptoms. Treatments may include medicine, therapy, and even surgery. Each case of Parkinsons disease is unique, and your treatment plan should be, too.
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Levodopa: The Most Effective Drug For Treating Parkinsons
Levodopa, also known as L-DOPA, has long been, and continues to be, the most effective drug in treating Parkinsons disease symptoms. Most people with Parkinsons disease will take this drug at some point. There are side effects that can occur with Levodopa including nausea, fatigue and orthostatic hypotension. Often these side effects can be successfully treated so that Levodopa can be tolerated better. In addition, as the disease progresses and the brain has less ability to produce and process dopamine, dyskinesias, or involuntary movements can develop from Levodopa.
Medicines For Parkinson’s Disease
Medicines prescribed for Parkinson’s include:
- Drugs that increase the level of dopamine in the brain
- Drugs that affect other brain chemicals in the body
- Drugs that help control nonmotor symptoms
The main therapy for Parkinson’s is levodopa, also called L-dopa. Nerve cells use levodopa to make dopamine to replenish the brain’s dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapysuch as nausea, vomiting, low blood pressure, and restlessnessand reduces the amount of levodopa needed to improve symptoms.
People with Parkinson’s should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, such as being unable to move or having difficulty breathing.
Other medicines used to treat Parkinsons symptoms include:
- Dopamine agonists to mimic the role of dopamine in the brain
- MAO-B inhibitors to slow down an enzyme that breaks down dopamine in the brain
- COMT inhibitors to help break down dopamine
- Amantadine, an old antiviral drug, to reduce involuntary movements
- Anticholinergic drugs to reduce tremors and muscle rigidity
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Treatment Of Late Stage Complications Of Parkinson’s Disease
Postural hypotension
Levodopa and dopamine agonists worsen postural hypotension and it may be necessary to lower the dose of levodopa or withdraw the agonist. Treatment is difficult, but patients should be advised to sleep with the head of the bed raised by one or two bricks and to add salt to their diet. Fludrocortisone can then be added at a dose of 0.1 mg in the morning, increasing if necessary up to 0.5 mg in the morning. If these measures are ineffective, the alpha agonist midodrine 10-20 mg four hourly can be useful but it is experimental and only available via the Special Access Scheme. Patients treated for postural hypotension need to have electrolytes, renal function and supine blood pressures closely monitored.
Parkinsonian psychosis, depression and dementia
Psychotic symptoms such as visual hallucinations and persecutory delusions occur most commonly in the setting of dementia, which may be mild and therefore easily missed. Most drugs for Parkinson’s disease make these symptoms worse. Depression is also common and requires treatment in its own right.
Managing Medication Interactions And Side Effects
All prescribed medications can have potential side effects, including those used to treat Parkinsons. Some things you think are symptoms of Parkinsons may actually be side effects of medication. Some peoples side effects will have a big impact on their lives and have to be kept under control along with the symptoms.
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Can I Be Cured If I Get Parkinsons Disease
Unfortunately, Parkinsons disease is not curable. There has not been developed a method that completely remove or reverse the disease condition. However, the disease symptoms can be managed with treatment. The medication available today has not only increased the quality of life but also enormously prolonged the life expectancy of patients.
What Should I Know About Parkinsons Disease And Medications
There have been rapid and remarkable changes over the past decade in treating Parkinsons disease . The development of new medicines and the understanding of how best to use them and the older drugs have significantly improved the quality of life for people with the disease.
There is currently no treatment that has been proven to affect the disease progression or development of medication that can slow the disease process. There are two general approaches to the treatment of PD improve the symptoms with medications and engage in physical therapy. Most patients with PD can be adequately treated with medicines that alleviate their symptoms. For the approximately 15% of patients for whom medicines are not sufficiently effective, new, highly effective, and safe surgical treatments are available.
Choices about medicines made early in the course of the disease have a strong impact on the long-term course of the illness. Therefore, you should seek the advice of doctors specially trained in treating PD even when the illness is only suspected. Movement disorders specialists are neurologists who have completed their training in neurology and have received special advanced training in treating PD and other related diseases.
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Parkinsons Is A Progressive Disease Whats Meant By That
Parkinsons is not like a flu or fever that you take antibiotics and recover in 2-3 days. It is a progressive disease that means it develops and becomes worse over time.
At first, some abnormal changes appear in the brain that begins to damage parts of the brain responsible for movements. These changes are gradual and the effect is limited to the brain only.
After 15-20 years, the damage reaches the level where it begins to affect body normal movements. This is the early stage where typical symptoms of the disease start to develop. These early symptoms are mild and appear either on one or both sides of the body. At this stage, the disease can easily be diagnosed clinically.
After 10 years of diagnosis, the brains ability of performing movement functions is severely affected. The symptoms become severe and begins to affect the patients daily life activities. This is called the mid-stage of the disease.
When the disease has passed 20 years, it reaches its advanced stage. At this stage, the symptoms become very severe and most often the patient needs assistance for mobility.
Side Effects And Problems Of Anticholinergics
Another reason these drugs are not a first choice for treating Parkinsons are their side effects. Some people may experience confusion, a dry mouth, constipation and blurred vision when taking anticholinergics.
Anticholinergics may interfere with levodopa absorption in the small bowel, which reduces the effectiveness of Madopar or Sinemet, forms of the drug levodopa.
Anticholinergics are not usually prescribed to older people with Parkinsons because there is an increased risk of memory loss and, in men, problems urinating.
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How Should I Know That I Have Parkinsons Disease
In Parkinsons disease, abnormal changes appear in the brain many years before the onset of its typical motor signs. But its is difficult to trace these changes and therefore you wouldnt recognize the disease at this stage.
The disease becomes evidently clear when you experience symptoms like slow movement, stiffness in the muscles, hand trembling, difficulty walking, and problems with balance. In addition, you may also find it difficult to talk, and other people will notice that you have a fixed stare or facial expression has lost.
If you experience most of these signs, its a clear indication that you have Parkinsons disease.
Speech And Occupational Therapy
Parkinsons disease can lead to slurred speech and difficulty swallowing. A speech and language therapist can provide muscle training techniques that may help overcome some of these problems.
An occupational therapist can help identify everyday tasks that can be challenging and work with the person to find practical solutions.
This may include new strategies for dressing, preparing meals, performing household chores, and shopping. Adaptations to the home environment can also make daily living easier.
For people with Parkinsons disease, deep brain stimulation may help manage:
- tremor
- an electrode inside the part of the brain that controls movement
- a pacemaker-like device, or neurostimulator, under the skin in the upper chest
- a wire under the skin connecting the neurostimulator to the electrode
The neurostimulator sends electrical impulses along the wire and into the brain via the electrode. These impulses can prevent symptoms by interfering with the electrical signals that cause them.
There is a small risk of brain hemorrhage, infection, and headaches. Some people may see no improvement, or their symptoms may worsen. There may also be discomfort during stimulation.
Nevertheless, the AAN considers this treatment safe and effective for specific people and say any adverse effects are usually mild and reversible. Anyone considering this treatment should discuss the pros and cons with a healthcare professional.
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How Does Alcohol Affect Parkinsons Medication
The interaction between Parkinsons medications and alcohol is a common topic on MyParkinsonsTeam. I miss my red wine and whiskey on occasion, one member wrote. I found that it just makes my meds stop working. Another member said, My husband has been told he shouldn’t drink with his meds.
Alcohol can exacerbate the side effects of one of the most common Parkinsons medications, levodopa/carbidopa. Many neurologists recommend avoiding alcohol while taking this drug.
I have to limit myself to one Scotch on the rocks now, a MyParkinsonsTeam member said. I used to have three or four, but the side effects are too bad. Another wrote, Never really a good idea to mix alcohol with meds.
Whether you decide to continue your current drinking habits, cut down, or eliminate alcohol altogether, its important to listen to your body and have open conversations about these topics with your neurologist.
If you find yourself drinking alcohol to cope with other issues, such as depression and anxiety, you may find that healthy practices such as physical activity can help. In addition, participating in activities such as tai chi, yoga, and meditation may help ease the symptoms and complications of PD.
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.
Dopamine agonists. These drugs act like dopamine in the brain. They include pramipexole , rotigotine , and ropinirole , .
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Some Disadvantages Of Comt Inhibitors
These drugs can increase the side effects caused by levodopa, notably dyskinesias , nausea and vomiting.
If these side effects increase after starting the drug, people should raise the issue with their healthcare professional, as reducing the levodopa dose can often help.
COMT inhibtors will discolour urine making it a reddish-brown colour. Some people also experience diarrhoea which may occur some months after commencing the medication.
Be aware that other drugs for Parkinsons or other conditions can affect the action of COMT inhibitors. The combination of apomorphine and entacapone needs careful supervision.
Symptoms Of Parkinsons Disease
The most common symptoms of Parkinsons disease are:
- Tremors that are felt in the arms, legs, fingers, head, jaw or neck while at rest
- Slowed movement and walking or dragging feet while walking
- Muscle stiffness in the trunk or limbs that can intensify during movement
- Stooped posture or balance problems
- Inability to perform automatic movements such as blinking or smiling
- Slurred or other speech issues
Diagnosis of Parkinsons disease
Parkinsons disease can be diagnosed in an exam with a neurologist. During the exam, he or she will take a full medical history, perform a full physical and neurological exam and evaluate your symptoms. Your doctor may order additional testing to confirm the diagnosis and rule out other conditions that cause similar symptoms. Other testing could include:
- Medication a medication called carbidopa-levodopa can be tried to see if the brain can turn the medication into dopamine if your symptoms notably improve while on the medication, you will likely be diagnosed with Parkinsons disease.
- Blood tests Parkinsons disease cant be diagnosed with a blood test, but blood tests can rule out other conditions that may cause similar symptoms.
- Imaging tests tests such as PET , MRI , ultrasound or SPECT scans can rule out other conditions that present with similar symptoms.
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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.
How Does Alcohol Affect Parkinsons Symptoms
In general, alcohol can be harmful to people with chronic conditions. According to the Centers for Disease Control and Prevention , overconsuming alcohol can be a long-term risk factor for a weakened immune system, learning and memory problems, high blood pressure, digestive issues, and various types of cancer. When looking specifically at Parkinsons symptoms, however, reports differ on how alcohol and PD may be linked.
The type of alcoholic beverage consumed may affect whether drinking has an impact on PD. A 2013 study found that the risk for developing Parkinson’s disease appeared to increase depending on the amount of liquor consumed, although no link was conclusively found between drinking wine and the development of PD.
In terms of how long-term alcohol use affects the risk of PD, one study published in 2013 followed people who had been admitted to the hospital with alcohol use disorders for up to 37 years. The study authors found that a history of alcohol abuse increased the risk of admission into the hospital for Parkinsons for both men and women. The study authors suggested that chronically drinking too much alcohol can have neurotoxic effects on dopamine, the neurotransmitter in the brain that is relevant to Parkinson’s disease.
There may also be factors other than observable symptoms such as how alcohol interacts with your medication that are important to consider when making decisions about your lifestyle and drinking habits.
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