Medications To Avoid In Parkinson’s Disease

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

Activities Of Daily Living

There are many things a person does every day without even thinking about it such as bathing, brushing teeth, walking, turning in bed, signing checks, cutting food. When a person is diagnosed with Parkinson’s, it can eventually make all of these things more difficult. The following tips are meant to be helpful and raise awareness of adjusting to some of the difficulties with PD.

Falling

• Remove throw rugs and low-lying obstacles from pathways inside and outside your home.
• Use a cane when necessary.
• Avoid using stepladders or stools to reach high objects.
• Stop walking or sit down if you feel dizzy.
• Install handrails, especially along stairways.
• Slow down when you feel yourself in a hurry.
• Before rising from your bed or bath, pause for a moment in a sitting position.

Sensory complaints

• Stretch every day, especially before exercising.
• Exercise daily to build stamina.
• Warm baths and regular massage will help relax tired muscles.
• When your hands or feet get cold, wear gloves or warm socks.
• Don’t overdo physical activities know your limits and stay within them.

Turning in bed

Sleep problems

Dressing

Hygiene

Walking

Swallowing

Freezing

Tremor

• Perform difficult tasks when you feel well and when your medication is working effectively.
• Relax. Sit down from time to time, relax your arms and shoulders, and take deep breaths.
• Get a regular massage.
• Ask your physical therapist or doctor to recommend a stretching and exercise program.
• Avoid caffeine and alcohol.
• Get plenty of rest.

Speech

Serotonin Reuptake Blocking Antidepressants Fluoxetine Sertraline And Paroxetine

Several other medications have been reported to cause drug-induced parkinsonism and to worsen parkinsonism in people with Parkinson disease, including the serotonin reuptake blocking antidepressants fluoxetine, sertraline, and paroxetine. Two calcium channel blockers available in Europe and South America , which are piperazine derivatives, are thought to cause drug-induced parkinsonism by blocking dopamine receptors. Reports of parkinsonism induced by other drugs, such as lithium and amiodarone, are so rare that only after parkinsonism has developed should the possible drug effect be taken into account. Because lithium is not known to block dopamine receptors, another mechanism is likely. Some animal data implicate an effect of lithium on intercellular signalling via G-protein coupled receptors . One antidepressant, amoxapine, has dopamine receptor-blocking properties and, therefore, may induce parkinsonism. Parkinsonism as a transient side effect of alcohol withdrawal has been reported without later development of Parkinson disease, but it is unknown how common this is .

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Do Not Abruptly Discontinue Medications

Never abruptly discontinue antiparkinsonian medications. Serious reactions, such as neuroleptic malignant-like syndrome, can occur when antiparkinsonian medications are discontinued or the dose of levodopa has been reduced abruptly. This can result in a high fever, sweating, unstable blood pressure, stupor, muscular rigidity, and autonomic dysfunctions that can be life threatening.

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The Medication Question Parkinsons Foundatio

• Try to schedule surgery in the early morning to avoid being off Parkinsons medications for long periods. Also, see if you can avoid general.
• ergic neurones in the substantia nigra the part of the mid-brain responsible for managing movement and the dopa
• Avoid abrupt withdrawal of antiparkinsonian therapy Be alert to the possibility of Parkinsonism-hyperpyrexia syndrome Seek early specialist help Key points KEY WORDS: delirium, dysphagia, falls, Parkinsons disease, palliative Fig 2. Maintaining Parkinsons disease drug therapy during perioperative period (no
• Because most of the anesthesia drugs used in surgery can slow respiratory function, Parkinsons patients are at higher risk for aspiration during surgery or recovery, she explains. can help a person with Parkinsons avoid potential complications like.

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Parkinsons Medication And Alcohol: The Final Word

Whether or not you should drink alcohol while being treated for Parkinsons disease will depend on the medication youre taking. It is worth discussing this issue with your doctor, especially if you have concerns about alcohol dependence or addiction.

General health guidelines state that you should avoid drinking alcohol with any medication that makes you drowsy, sleepy or impairs your concentration. That said, many people with Parkinsons disease find that the occasional glass of wine is not harmful, as long as their doctor has agreed that they can drink in moderation.

You should always speak to your doctor before you mix Parkinsons disease medication and alcohol for the first time. You should never drive or operate heavy machinery when you have been drinking alcohol, and you should make sure you are in safe surroundings to minimize the risk of falls or injury.

APA ReferenceSmith, E. . Can You Drink Alcohol with Parkinsons Disease Medication?, HealthyPlace. Retrieved on 2021, August 28 from https://www.healthyplace.com/parkinsons-disease/treatment/can-you-drink-alcohol-with-parkinsons-disease-medication

Basic Concepts Of The Mediterranean Diet

The components of a Mediterranean diet include:

• Eat mainlyplant-based foods, such as a variety of fruits and vegetables, along with whole grains, nuts, and legumes, including lentils, chickpeas, beans, and peas.
• Consume a small amount of low-fat protein, either chicken or fatty fish, such as salmon, albacore tuna, or mackerel, a few times per week.
• Limit red meat to a few times a month.
• Avoid salt and instead flavor your meals with spices and herbs.
• Drink red wine in moderation .
• Replace butter with a healthier fat like extra virgin olive oil.
• Limit dairy, including cream, milk, and ice cream.

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Disadvantages Of Regional Anesthesia Over General Anesthesia

Regional anesthesia will not eliminate Parkinsons symptoms, such as tremor or rigidity, except in the areas directly affected by the anesthetic.

Tremor can interfere with some monitoring device and makes it more difficult to interpret.

If the surgery is delicate, the surgeon may want the patient to be absolutely still.

The surgical procedure may not be possible under regional anesthesia.

Remember: Your Doctor Knows Best

It is worth noting that, when it comes to treating Parkinson’s disease, your doctor always knows best. He or she may decide that the risk of side-effects is minimal or that the benefits of the medication will outweigh the negatives. If you disagree with your doctor’s decision, or you think there are Parkinson’s disease medications you’d like to avoid, don’t be afraid to get a second opinion. Parkinson’s is a progressive illness, so it’s important that you find a medical provider you can trust who will provide care and support for the long-haul.

Many patients have to try several Parkinson’s disease medications before they find a combination that works for them. However, your doctor will always start you on the medication with the least side-effects to see if it can control your Parkinson’s symptoms. Your medicine will be increased gradually over time, and other drug combinations will be tried if your symptoms progress or a medication stops working.

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Medication Administration In The Management Of Parkinson Disease

A Position Paper Prepared by the Michigan Parkinson FoundationProfessional Advisory Board: May 2013

Persons with Parkinson disease consistently do not get their medications appropriately while hospitalized or in long term care facilities. Long-standing difficulties experienced center around the timing of medication administration and receiving drugs which interact with PD medications. The Professional Advisory Board of the Michigan Parkinson Foundation has studied this issue and joins several national and international Parkinsons disease organizations in recommending the development of programs and procedures to address care in these settings.

Thus far, the focus of programs to address these issues has targeted education of people with PD and their families to advocate for themselves when entering hospitals or long-term care facilities. This form of advocacy may assist in averting problems but does not address the root causes, which can add unnecessary stress to vulnerable individuals and families by forcing them to advocate for their own care. The Professional Advisory Board recommends that institutional level care should consider the following:

I must be given my medication promptly at the times specifiedThe timing of my medication is very important to help minimize my symptoms andoff times.For example: Sinemet often should be taken 30 minutes prior to or one hour after meals, because a meal sometimes delays the levodopa from reaching the brain.

Recommendations

Parkinsons Disease And Palliative Care

Management of palliative patients with Parkinsons disease approaching end of life who are normally maintained on oral PD medicines

Issues to consider:

• Administration of PD medicines when the oral route is no longer available
• Choice of anticipatory medicines in patients with PD

Plan for loss of the oral route

• A plan should be proactively put in place in advance and discussed with the patient, their family, and the PD and palliative care specialists.
• If the patient loses oral route and:
• Nasogastric tube in situ continue to administer suitable formulation of usual medicines via NG.

• NG tube not in situ or displaced – prescribe an appropriate dose of rotigotine patch.

Seek advice from pharmacist or PD specialist or follow GGC PD Nil By Mouth Guidance until PD specialist review.

Choice of anticipatory medicines in patients with PDIf a patient is in the last weeks or days of life, prescribe just in case anticipatory medication for end of life symptom control see below for appropriate choices:

• Agitation/restlessness

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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.

How Dopamine Agonists Are Used

Dopamine agonists are used at all stages of Parkinsons. You might take them alone when treatment is being started, or alongside levodopa to provide a more effective treatment with fewer side effects.

Treatment with dopamine agonists has to be started carefully to minimise the risk of side effects, with the dose gradually increasing until you and your specialist or Parkinsons nurse are happy that your symptoms are under control. Some dopamine agonists are available as one a day tablets. These can be a better option for the body and may help both movement and other symptoms of Parkinsons.

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Anesthetic Considerations Of Wp

• The goal during perioperative management of anesthesia was to avoid any factor that increases sympathetic activity such as pain, anxiety, fear, stress response of intubation/extubation, lighter plane of anesthesia, hypovolemia, and avoiding premedication with anticholinergic drugs. Patient was adequately counseled and reassured
• Effects of Anesthesia on Elderly Patients General anesthesia does carry a higher risk for the elderly population, admits Damon Raskin, MD, a board-certified internist and medical director for a hospice provider and two nursing homes in the Santa Monica, CA, area.According to Dr. Raskin, it takes longer for an older persons body to rid itself of the chemicals involved in anesthesia.
• off et al., 2011). This was confirmed by an influential Canadian study.
• Veterinary Anesthesia & Analgesia Support Group: Practical Information for the Compassionate Veterinary Practitioner: Avoid in anemic patients. vi) Avoid in splenic disease patients , also used to treat Parkinsons disease. b).
• This page includes the following topics and synonyms: Preoperative Guidelines for Medications Prior to Surgery, Preoperative Fasting Recommendation, Nothing by Mouth Prior to Surgery Guideline, Perioperative NPO Guidelines, Perioperative Medication Guidelines, Medication Management in the Perioperative Period, Medications to Avoid Prior to Surgery

Dont:

• Drink alcohol or coffee or any other caffeinated beverages to avoid having sleep issues.

Taking Care Of Business

The Parkinson’s Foundation has developed a thorough guide to getting your household and personal documents organized at www.parkinson.org

• Organize your medical histories
• Keep a journal of medications and dosages
• Organize your personal financial documents
• Insurance and long-term care plans
• Livings wills, durable power of attorney, advanced medical directives

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What Are The Risks With These Drugs

• Anti-Parkinsons drugs are used to reduce certain side effects of antipsychotics. But they can also cause side effects of their own. See our information on , and to find out about the possible side effects of each drug.
• These drugs also have a stimulant effect. For some people, they may cause an addiction.
• When you stop taking anti-Parkinsons medication, you should reduce your dose gradually. Otherwise your Parkinsonism symptoms may return.
• You may decide to stop taking anti-Parkinsons drugs and antipsychotics around the same time. In this case, guidelines suggest to come off the antipsychotic first, and then stop the anti-Parkinson’s drug.

You should be especially careful about taking these drugs if you have:

• a heart condition

Other Medication Safety Concerns

Even with correct administration timing based on the patients home medication schedule, dosing errors have been reported with carbidopa/levodopa. The drug is available in many different strengths and forms, from an orally disintegrating tablet to extended- and immediate-release formulations. Levodopa, which converts to dopamine in the brain, can cause episodes of acute psychosis and dyskinesia when given in large doses, which can unnecessarily extend hospitalization. Also, patients may take different strengths of carbidopa/levodopa each time throughout the day, increasing the risk for errors. Documenting a complex scheduleeven if well understoodmay be difficult and even more challenging in some electronic health records.

Dysphagia is another manifestation of Parkinsons disease and can affect the patients ability to swallow medications. The symptoms include frequent coughing while drinking and taking medications and a gurgling voice.7

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Is There A Cure For Parkinsons

Theres presently no cure for Parkinsons, an illness that is chronic and worsens in time. More than 50,000 new cases are reported in the United States each year. However there may be much more, because Parkinsons is often misdiagnosed.

Its reported that Parkinsons complications was the 14th major cause of death in the United States in 2016.

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Adjust Your Drug Dose

Side effects like dyskinesia might be due to the amount of levodopa youre taking. Ask your doctor whether you can lower your dose enough to prevent side effects while still managing your Parkinsons symptoms. It might take some trial and error to get the dose just right.

Another option is to switch to an extended-release form of dopamine. Because the drug releases more slowly into your blood, it prevents the dopamine spikes and valleys that can trigger dyskinesia.

You might also need to add more of a drug. For example, adding extra carbidopa to levodopa can cut down on nausea.

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Anesthetic Drugs May Interact With Medications Used For Parkinsons Disease

Lorri A. Lee, MD Tricia A. Meyer, PharmD, MS, FASHP

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An estimated one million people in the United States have been diagnosed with Parkinsons Disease making it one of the most common neurological disorders in patients. This number is estimated to double in the next 30 years as PD is associated with increasing age. PD patients have a deficiency of dopamine in their brain and many of their medications are used to increase this neurotransmitter. They are frequently very sensitive to missing even one dose of their Parkinson medications and may exhibit increased rigidity, loss of balance, agitation, and confusion if their dosing schedule is delayed. Neuroleptic malignant syndrome or parkinsonism-hyperpyrexia syndrome can develop if their medications are held too long or as a result of serious infection.1 Many drugs used in the perioperative period, such as metoclopramide, butyrophenones , and phenothiazines have anti-dopaminergic activity that can worsen the symptoms of PD.

PD patients may be prescribed selective MAOI-B medications such as selegiline and rasagiline that inhibit metabolism of dopamine. Though caution is still advised, several studies have demonstrated that the risk of serotonin syndrome with these selective MAOI-B drugs is extremely low, even in combination with serotonergic antidepressants.

The authors have no conflicts of interest to declare for this article.