Your Parkinson’s 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.
Medication Guidelines For Parkinson’s Disease
There is no one best mix of Parkinsonâs medicines. You and your doctor will have to try a few treatment approaches to figure out the best one for you.
But there are some general guidelines for taking your medication. Be sure to ask your doctor or pharmacist for any specific tips for your treatment.
Choosing The Best Treatment Plan For You
As you may know, medications are the backbone of the Parkinsons treatment plan. But because the disease affects everyone differently, and each persons response to therapy will vary, there is no hard-and-fast rule about when you should begin taking medication and what to take first. Some doctors prescribe medication upon diagnosis. Others believe that drugs, especially levodopa, should be delayed as long as possible to avoid earlier onset of medication-related side effects.
Your involvement from the very start is important because you want to be sure your doctor is addressing your individual needs. When your doctor writes a new prescription, or makes a change to an existing one, take the opportunity to ask for an explanation. If her response goes something like, I always start my Parkinsons patients on X dosage of Y, a dopamine agonist, you might want to consider switching to a movement disorders specialist, a neurologist who has had special training in Parkinsons disease and other movement disorders.
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What Side Effects Should I Be Aware Of And What Can I Do To Reduce Them
As with any medication, there can be side effects and these may differ from one medication to another. Each persons reaction to a medication is individual and many experience little or no side effects.
Each prescribed medication has an information leaflet that outlines possible side effects and it is very important that this leaflet is read prior to taking the medication. If you have any concerns, please ensure that you discuss these with your doctor, health professional or pharmacist as soon as possible so that they can advise or change the medication if necessary.
It is important to follow the instructions you are given for taking each individual medication, as some should be taken in a different way or at a different time of day to another. By following this advice you can minimise side effects. Taking the correct dose, on time, is also very important.
See also Managing medication.
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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Risks And Side Effects Of Deep Brain Stimulation
Like any surgery, deep brain stimulation can have side effects, and it carries potential risks. Its also important to consider the complications and side effects of medications you take since their dosages can often be reduced following surgery.
While DBS may cause side effects, it may also reduce side effects from medications.
How Effective Is The Treatment In The Early Stages
It’s difficult to predict how successful treatment will be. The medications don’t have the same effect in everyone and it can sometimes take a while to find the right dose. A noticeable effect can generally be expected within one or two weeks of starting treatment: Movements become easier again and stiffness reduces. Those kinds of symptoms can continue to improve for up to three months after starting treatment. Tremor is often more difficult to treat. Sometimes it only goes away after months or even years of taking medication.
If the symptoms are mild, MAO-B inhibitors are sometimes considered instead. MAO-B inhibitors can relieve symptoms and delay the need to take levodopa by a few months. But they aren’t as effective as levodopa or dopamine agonists, and they aren’t suitable for treating more severe symptoms when used alone.
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What Side Effects Does The Medication Have
The risk of side effects generally depends on the following:
- which medication is being taken
- the dose
- the person’s 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. Parkinson’s 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.
If I Go Into Hospital What Happens About My Medication
It is vital to get the right medication at the right time every time, not just at the set times scheduled for hospital medication rounds, in order for your symptoms to continue to be well managed and to speed up recovery. If admission is as an emergency, this can be more difficult as staff may not have a clear picture of your needs and may be very busy, so it is a good idea to discuss this scenario with those close to you so that they can liaise with staff on your behalf.
For any admission it is essential that staff have clear notes regarding your medication. A medication diary can be very helpful with this, specifying:
- dosage and timing of each medication you have to take, including complementary, trial, non-Parkinsons medications and over the counter medications
- clear instructions on how each medication should be taken, e.g. with food, with water, avoiding protein etc.
Some hospitals will allow you to self-medicate but this is not always the case.
Make sure that you take plenty of each medication with you into hospital as they might not have ready supplies, and ensure that the dosage on the label is what you have indicated on any medications list you provide. If not, staff can sometimes only be authorised to dispense what is written on the label, which could be incorrect.
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The Symptoms That Dbs Treats
Deep brain stimulation is used primarily to treat the motor symptoms of Parkinsons disease, but this can vary somewhat between the different placement sites. Symptoms treated include:
- Stiffness
- Abnormal movements : Dyskinesias are often a side effect of medications for Parkinsons disease and include involuntary movements such as twisting, head bobbing, squirming, and more.
DBS is not usually helpful with walking problems or balance, though improvements in the symptoms above can indirectly affect walking. It also does not provide significant benefits for non-motor symptoms of Parkinsons such as cognitive changes, mood changes , or problems with sleeping.
The benefits of DBS can be estimated by looking at how a person responds to levodopa. Symptoms that respond to levodopa will often respond to DBS . But symptoms that are not changed with levodopa are unlikely to be improved by DBS.
DBS often allows for a reduction in the dosage of levodopa, which in turn can result in fewer involuntary movements and a reduction in off time. The result is often improved quality of life.
An Approach To The Treatment Of Parkinson’s Disease
No treatment can arrest or slow neurodegeneration in Parkinson’s disease. The aim is to relieve symptoms and avoid the complications of therapy.
Early Parkinson’s disease
Many studies have shown that early treatment with dopamine agonists reduces the incidence of dyskinesia.1Fewer motor fluctuations were shown in some but not all of the studies. We recommend a dopamine agonist as the first treatment in younger patients who have mild disease and no cognitive deficit. It is necessary to add levodopa within 1-5 years in most patients. In more severe disease, treatment begins with levodopa but a dopamine agonist may be added to keep the daily dose of levodopa in the lower range if there is no cognitive deficit. Dopamine agonists are used infrequently and with caution in patients more than 70 years old because of the risk of neuropsychiatric adverse effects and postural hypotension. They are contraindicated in the presence of dementia.
Isolated resting tremor is rarely disabling, but if it interferes with function it can usually be managed with levodopa. When this is ineffective at low to moderate doses, the addition of an anticholinergic can sometimes be useful.
Patients with motor fluctuations
Role of physical therapy and surgery
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What Are The Most Common Medicines Used To Treat Pd
Sinemet®
Levodopa is the most commonly prescribed and most effective medicine for controlling the symptoms of PD, particularly bradykinesia and rigidity.
Levodopa is a chemical found naturally in our brains. When given as a medicine, it is transported to the nerve cells in the brain that produce dopamine. It is then converted into dopamine for the nerve cells to use as a neurotransmitter.
Sinemet is made up of levodopa and another drug called carbidopa. Levodopa enters the brain and is converted to dopamine while carbidopa prevents or lessens many of the side effects of levodopa, such as nausea, vomiting, and occasional heart rhythm disturbances. It is generally recommended that patients take Sinemet on an empty stomach, at least ½ hour before or one hour after meals.
There are two forms of Sinemet: controlled-release or immediate-release Sinemet. Controlled-release Sinemet and immediate-release Sinemet are equally effective in treating the symptoms of PD, but some people prefer the controlled release version. Ask your doctor which approach is best for you.
Dopamine agonists
Dopamine agonists are medicines that activate the dopamine receptor. They mimic or copy the function of dopamine in the brain.
Parlodel®, Requip®, and Mirapex® are all dopamine agonists. These medicines might be taken alone or in combination with Sinemet. Generally, dopamine agonists are prescribed first and levodopa is added if the patient’s symptoms cannot be controlled sufficiently.
Symmetrel®
Naturalremedy For Parkinsons #7 Omega
Animal based omega-3 fatty acids are a powerful weapon inthe fight against Parkinsons disease. One of the main fatty acids, DHA, is oneof the essential building blocks for the human brain. Half of your brain andeyes are made up of fat and a large proportion of this is DHA fat.
Omega-3 fatty acids have the unique ability to cross theblood-brain barrier, something most conventional drugs cannot do. They helpincrease dopamine levels and reduce neuroinflammation in the brain, while atthe same time, stimulating neuron growth. So basically, EPA and DHA help preventbrain cell damage and keep the nervous system in tip top working order! 4
Best sources of animal based omega-3s are either fishoil, cod liver oil or krill oil. High strength krill oil is the preferred option as thiscontains a substance called Astaxanthin. Astaxanthin is a potent brain food nutrientthat has been shown to prevent neurodegeneration and inflammation of the brain.For dosages, take AT LEAST the highest recommended amount listed on the bottle the same goes with fish oil or cod liver oil. You cant overdose on thesesupplements so theres nothing to be concerned about. In fact, the more omega-3syou can get into you the better the results!
In addition to this, try and eat some cold water fattyfish such as salmon, tuna, mackerel, sardines or herring 3-4 times a week foran extra supply of DHA and EPA.
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How Do I Get An Ongoing Supply And Can I Obtain Medication If I Go To Other Countries
You will need to discuss with the doctor or specialist who prescribes your medication how you can get an ongoing supply. This will vary according to where you live and the local services available, but usually arrangements are made for repeat prescriptions to be available at a pharmacy which is convenient for you.
Your doctor will also be able to tell you how many weeks’ supply you can have in advance. Again this varies from country to country so you will need to ask about this.
Not all medications are licensed in every country, and some are known by different names so it is a good idea to check the local names of medications you use before you travel if you are going abroad.
For information on availability at other international destinations it is best to check with your pharmacist, or local Parkinsons association. This website contains contact details for Our members, Other Parkinsons organisations.
As some medications are difficult to obtain in certain countries, and also in some cases, the quality may not always be of the highest standards, it is best to ensure that you take with you all the medications that you will need.
Carrying a few spare with you is always a good idea in case of any delays in your return. It is also advisable to carry a spare prescription with you just in case you do run out of medication while you are away.
For more information and useful suggestions on medication and travel, see Travel and relocating.
How Do Anticholinergics Work
The motor symptoms of PD are caused by the reduction in dopamine. This is a neurotransmitter that sends signals in the brain to produce smooth, purposeful movement. As PD damages and destroys the nerve cells that make dopamine, the motor symptoms of PD appear.1,2
The primary treatments for PD directly affect dopamine. However, anticholinergics work in a different way to treat the symptoms of PD. They block the action of acetylcholine. This is another neurotransmitter involved in messages from the brain to the muscles. Anticholinergics work on correcting an imbalance between acetylcholine and dopamine in an area of the brain. Anticholinergics are often used in along with other treatments for PD.1,2
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What Would Happen If I Try To Manage Without Medication For Some Time
Any change to your medication regime must be discussed with your doctor so that you understand how this might affect you.
Parkinsons medication should never be stopped abruptly as this can be dangerous. If both you and your doctor agree to stop any medication, it will be necessary to do so by very gradually reducing the medication dose.
If you agree to do so, it would be useful if you kept a diary to monitor how this was affecting your symptoms. This can help to highlight any changes in symptom pattern, or in your emotions or behaviour that may be related to medication.
Writing down your own individual experiences on a day-to-day basis can also help you to talk about any changes in your symptoms and your feelings with your doctor. This can be very useful, particularly as appointments are often too short for doctors to ask lots of questions, and your visit may be on a day when your symptoms do not follow their general pattern.
See also Keeping a diary.
What Does Levodopa Do For Parkinsons Disease
Levodopa is a central nervous system agent that helps people with Parkinsons because it is converted into dopamine in the brain. It helps to alleviate the symptoms of Parkinsons disease by providing a supply of dopamine.
Simply treating people with Parkinsons disease with dopamine does not work because dopamine can not cross the blood-brain barrier. Levodopa – a metabolic precursor of dopamine – can cross the blood-brain barrier, however.
Levodopa is available in a range of different dosage forms that combine levodopa and carbidopa, such as Sinemet tablets.
Carbidopa is a decarboxylase inhibitor that prevents levodopa from being broken down before it reaches its site of action, the brain. It enables lower doses of levodopa to be used, which reduces the nausea and vomiting patients can experience while taking the drug.
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What’s Missing In Parkinsons Disease Treatments
Dr. Abraham Hoffer andDr. Harold Foster believe that there is a second step missing from currentmedical Parkinsons Disease treatments.
They found that this second setof Parkinson’s symptoms — diminished voluntary movements and increasedinvoluntary movements — can indeed be delayed, reduced and even prevented.How?
Dr.Foster explains:
“I believe that there are twotypes of symptoms seen in Parkinson’s disease patients:
The first set is effectivelytreated with L-Dopa.
This second set of Parkinsons symptoms is different:
- Even with medication, the situationworsens with the appearance of a “second set of symptoms,” thataccording to Drs. Foster and Hoffer, “seems to result from thederivatives, such as the dangerous toxin dopachrome, that is produced by thebreakdown of dopamine.”
As a result, slowly but surely, the L-Dopa increases these “secondarysymptoms” until the patient becomes demented and often dies.