Which Medications Are Used In The Treatment Of Parkinson Disease
The cornerstone of symptomatic treatment for Parkinson disease is dopamine replacement therapy. The criterion standard of symptomatic therapy is levodopa , the metabolic precursor of dopamine, in combination with carbidopa, a peripheral decarboxylase inhibitor . This combination provides the greatest symptomatic benefit with the fewest short-term adverse effects.
Dopamine agonists such as pramipexole and ropinirole can be used as monotherapy to improve symptoms in early disease or as adjuncts to levodopa in patients whose response to levodopa is deteriorating and in those who are experiencing fluctuations in their response to levodopa.
Monoamine oxidase -B inhibitors provide symptomatic benefit as monotherapy in early disease and as adjuncts to levodopa in patients experiencing motor fluctuations.
Catechol-O -methyl transferase inhibitors inhibitors such as entacapone and tolcapone may be used to increase the peripheral half-life of levodopa, thereby delivering more levodopa to the brain over a longer time.
Anticholinergic medications can be used for the treatment of resting tremor. However, they are not particularly effective for bradykinesia, rigidity, gait disturbance, or other features of advanced Parkinson disease and cognitive side effects are common. Therefore, anticholinergics are usually reserved for the treatment of tremor that is not adequately controlled with dopaminergic medications.
References
Full List Of Medications Approved For The Treatment Of Parkinsons Disease In The Usa
Below is a full list of Parkinsons medications that have been approved to treat Parkinsons in the United States. This material is intended to provide you with information. It should not be used for treatment purposes, but rather as a source for discussion with the patients own physician. Work with your physician to determine which medications are best for you, and know the risks and benefits of each.
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If Patients With Parkinson’s Disease Are Deficient In Dopamine Why Then Is Peripheral Dopamine Administration Not Effective At Treating The Bradykinesia Rigidity And Resting Tremor
Summary:
- Patients with Parkinson’s disease are known to have a depletion ofdopaminergic neurons in the substantia nigra in the brain which resultsin problems with both initiation and coordination of muscle movement.
- As such, increasing the amount of dopamine in the brain can improvesymptoms. Unfortunately, peripherally administered dopamine cannotpenetrate the blood brain barrier and thus is ineffective.
- Theprecursor of dopamine is levodopa. It can penetrate the blood brainbarrier where it is then converted to dopamine by amino aciddecarboxylase or dopa decarboxylase enzyme.
Editor-in-Chief:Reviewer: Last Reviewed:
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How Is It Diagnosed
Diagnosing Parkinson’s disease is mostly a clinical process, meaning it relies heavily on a healthcare provider examining your symptoms, asking you questions and reviewing your medical history. Some diagnostic and lab tests are possible, but these are usually needed to rule out other conditions or certain causes. However, most lab tests aren’t necessary unless you don’t respond to treatment for Parkinson’s disease, which can indicate you have another condition.
How Does Treatment Work
Currently most of the drugs that treat PD work to either replace or mimic dopamine in a persons brain.7 A few drugs work by keeping the body from breaking down dopamine, so it can stay in a persons system longer.
Doctors also think that there are other neurotransmitters that affect and are affected by PD.10 They are currently doing research to find out what these neurotransmitters are and how drugs affecting them may help with better PD treatment in the future. Hopefully, these studies will lead to better outcomes for all people with PD.
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Understanding Dopamine And Parkinsons Disease
- Dopamine is a neurotransmitter responsible for sending signals in the brain to coordinate movement.
- In Parkinsons disease, the cells responsible for making dopamine die off, causing movement problems and other symptoms.
- Treatments are available to increase levels of dopamine in the brain and alleviate symptoms.
Parkinsons disease is a neurodegenerative disease caused by low levels of dopamine and improper signaling in the brain, which leads to movement symptoms. Parkinsonism is a set of movement disorders characterized by tremors, muscle stiffness, coordination issues, and slowed movements .
Parkinsons is treated with medications that increase the levels of dopamine in the brain, called dopaminergic treatments. Over time, these medications may cause side effects like dyskinesia that can interfere with daily life.
What Are The Causes
Drug-induced parkinsonism is caused by medications that reduce dopamine levels in the brain. Dopamine is a neurotransmitter that works to control bodily movements.
Dopamine is also part of the brains reward system. It helps you feel pleasure and enjoyment, and it supports your ability to learn and focus.
Medications that bind to and block dopamine receptors are called dopamine antagonists. These medications arent used to treat Parkinsons disease. Rather, theyre used to treat other conditions that might seriously impact your quality of life.
If your doctor has prescribed a medication that causes unwanted side effects, you may have options. You may also decide that the side effects are worth it if the medication effectively treats your condition.
Some medications that cause drug-induced parkinsonism include:
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What Should I Do If I Forget A Dose
Take the missed dose of the regular tablet, orally disintegrating tablet, extended-release tablet, or extended-release capsule as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
If you are using levodopa and carbidopa enteral infusion and will be disconnecting the infusion pump for a short time , other than the normal nightly disconnection, ask your doctor if you should use an extra dose before you disconnect the pump. If the infusion pump will be disconnected for longer than 2 hours, call your doctor you probably will be advised to take levodopa and carbidopa by mouth while you are not using the suspension.
Why Is This Medication Prescribed
The combination of levodopa and carbidopa is used to treat the symptoms of Parkinson’s disease and Parkinson’s-like symptoms that may develop after encephalitis or injury to the nervous system caused by carbon monoxide poisoning or manganese poisoning. Parkinson’s symptoms, including tremors , stiffness, and slowness of movement, are caused by a lack of dopamine, a natural substance usually found in the brain. Levodopa is in a class of medications called central nervous system agents. It works by being converted to dopamine in the brain. Carbidopa is in a class of medications called decarboxylase inhibitors. It works by preventing levodopa from being broken down before it reaches the brain. This allows for a lower dose of levodopa, which causes less nausea and vomiting.
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Dyskinesia Current And New Treatment Strategies
The occurrence of dyskinesia is still common in PD notably in those individuals treated with L-dopa . However, disabling troublesome dyskinesia does not appear to be as prevalent as in previous eras and this probably reflects the more cautious treatment of early PD with an emphasis on avoiding dyskinesia induction. The exception is those individuals with a young onset variant of PD who are highly vulnerable to the early occurrence of motor complications . In contrast, non-troublesome dyskinesia remains a frequent side-effect of L-dopa therapy in the PD population but often does not require treatment while other components of motor function are adequately maintained. A lessening of the impact of dyskinesia is also a reflection of the earlier detection and treatment of PD in general as the severity or duration of disease as judged by dopaminergic nigral cell loss, is a primary factor in determining the degree of exposure to L-dopa needed to initiate involuntary movements . However, the impact of dyskinesia is in its inevitable expression by all forms of dopaminergic medication, once involuntary movements are established.
Table 1 Examples of existing and novel approaches to the treatment of dyskinesia
Taking Dopamine Agonist Drugs: Pramipexole And Ropinirole
Below we have included the different forms of pramipexole medication and an overview of how to take them.
The most recent and complete information on your specific drug will be on your patient information leaflet that comes with your medication packet. Always read it carefully before you start your treatment.
For detailed information you should follow the advice of your specialist or Parkinsons nurse about how to take pramipexole so that it works well for your Parkinsons.
Pramipexole drugs are also used to help your symptoms when your levodopa medication causes you to experience wearing off and dyskinesia. This could be motor fluctuations, or wearing off before your next dose of levodopa is due.
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Dealing With Side Effects Of Parkinsons Drugs
Its important to speak to your specialist or pharmacist if you notice anything unusual.
Changing or adding to your medication might help, and your specialist will be able to look into this.
For many people with advanced Parkinsons, medication may start to be reduced if side effects outweigh the benefits of taking medication.
But if some of the medication is reduced, you may find you get the benefits of the remaining ones, rather than the side effects.
If you experience side effects from your Parkinsons medication, you shouldnt stop taking it without guidance from your specialist.
Common Drugs For Parkinsons 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.
What Are Common Dopamine Agonists And What Do They Treat
There are two main categories of DA medications, ergoline and non-ergoline.
The first generation are ergoline type and are used less often today since they have some serious heart- and lung-related risks linked with their use. This is mainly because the older medications attach to any available dopamine receptors in the body and are not selective.
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Types Of Dopamine Agonist Drugs
Below are the types of dopamine agonist drugs. The generic names are written in bold and the brand names are written underneath in bullet points.
Pramipexole
- Mirapexin prolonged release
Rotigotine
- Apo-go pre-filled pen for Intermittent injection
- Dacepton cartridge for Intermittent injection
- Apo-go pre-filled syringe for infusion
Side Effects Talk To Your Doctor Or Pharmacist
If you get side effects from your Parkinsons medicines, tell your doctor or pharmacist. Common side effects include nausea , light-headedness, leg swelling and sleep problems. Also let them know if you think your medicines are causing confusion, hallucinations or involuntary movements. Some people have an unusual desire to gamble or engage in other obsessive behaviors. Your doctor may adjust the amount of medicine you take or you may be given another type. Do not stop taking your Parkinsons medicines until you are advised to do so.
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Medications To Avoid Or Use With Caution
Sign up for our email list and receive our publication on medications with potential complications you should be aware of.
Before making any decisions about treatment of Parkinsons disease, you will want to learn about the different types of medications available for Parkinsons disease and discuss the pros and cons of each with your physician. It may help to know that there is no right answer, and if you try something that doesnt work for you, you can always adjust your plan.
To learn more about adjusting medication plans, view our webinar on What to Do When Your Medications Stop Working.
What Are Dopaminergic Antiparkinsonism Agents
Dopaminergic antiparkinsonism agents aim to replace dopamine or prevent the degradation of dopamine.Antiparkinson drugs that aim to replace dopamine in the central nervous system, either release dopamine or mimic the action of dopamine. Drugs that replace dopamine are generally given with peripherally acting dopa carboxylase inhibitors, to prevent the metabolism of levodopa to dopamine peripherally. Dopamine receptor agonists bind to dopamine receptors and mimic the action of dopamine.Selective monoamine oxidase inhibitors bind to the enzyme MAO-B and prevent dopamine from being broken down. Antiparkinson agents are used to treat Parkinsons disease, which is a degenerative disorder of movement that occurs due to dopamine deficiency in the brain, particularly in the basal ganglia.
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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.
How Do I Take Care Of Myself
If you have Parkinsons disease, the best thing you can do is follow the guidance of your healthcare provider on how to take care of yourself.
- Take your medication as prescribed. Taking your medications can make a huge difference in the symptoms of Parkinson’s disease. You should take your medications as prescribed and talk to your provider if you notice side effects or start to feel like your medications aren’t as effective.
- See your provider as recommended. Your healthcare provider will set up a schedule for you to see them. These visits are especially important to help with managing your conditions and finding the right medications and dosages.
- Dont ignore or avoid symptoms. Parkinsons disease can cause a wide range of symptoms, many of which are treatable by treating the condition or the symptoms themselves. Treatment can make a major difference in keeping symptoms from having worse effects.
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What Are The Symptoms
The best-known symptoms of Parkinson’s disease involve loss of muscle control. However, experts now know that muscle control-related issues aren’t the only possible symptoms of Parkinson’s disease.
Motor-related symptoms
Motor symptoms which means movement-related symptoms of Parkinsons disease include the following:
Additional motor symptoms can include:
- Blinking less often than usual. This is also a symptom of reduced control of facial muscles.
- Cramped or small handwriting. Known as micrographia, this happens because of muscle control problems.
- Drooling. Another symptom that happens because of loss of facial muscle control.
- Mask-like facial expression. Known as hypomimia, this means facial expressions change very little or not at all.
- Trouble swallowing . This happens with reduced throat muscle control. It increases the risk of problems like pneumonia or choking.
- Unusually soft speaking voice . This happens because of reduced muscle control in the throat and chest.
Non-motor symptoms
Several symptoms are possible that aren’t connected to movement and muscle control. In years past, experts believed non-motor symptoms were risk factors for this disease when seen before motor symptoms. However, theres a growing amount of evidence that these symptoms can appear in the earliest stages of the disease. That means these symptoms might be warning signs that start years or even decades before motor symptoms.
Non-motor symptoms include:
Stages of Parkinsons disease
Side Effects And Problems With Dopamine Agonists
Common side effects of dopamine agonists include:
- Nausea and vomiting
- Hallucinations or delusions and confusion
- Existing dyskinesias becoming more troublesome initially
If you are taking Cabergoline , Pergolide or Bromocriptine your neurologist or GP will have to arrange a chest CT scan or ultrasound of your heart yearly as over time these medications may effect heart or lung tissue.
This precaution does not apply to the other dopamine agonists available in Australia.
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Levodopa In The Treatment Of Parkinson’s Disease: Current Status And New Developments
Article type: Review Article
Authors: Salat, David | Tolosa, Eduardo
Affiliations: Universitat Autònoma de Barcelona, Barcelona, Spain | Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital ClÃnic, University of Barcelona Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas Barcelona, Spain
Note: Correspondence to: Eduardo Tolosa MD, FRCP, Neurology Service, Hospital Clinic, University of Barcelona, Villarroel 170, Barcelona 080036, Spain. Tel.: +34 93 227 57 85 Fax: +34 93 227 57 83 E-mail:
Keywords: Levodopa/carbidopa, Parkinson’s disease, wearing-off, dyskinesia, entacapone
DOI: 10.3233/JPD-130186
Journal: Journal of Parkinson’s Disease, vol. 3, no. 3, pp. 255-269, 2013
Abstract