Muscle Relaxers For Parkinson’s

What Should I Avoid While Taking Pramipexole

Do not drink alcohol. Dangerous side effects can occur when alcohol is combined with pramipexole.

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

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

Body Parts That Can Be Affected With Dystonia In Parkinsons

Eyes

Repetitive and sustained eye closure is known as blepharospasm. To the observer, this looks like increased blinking, which may increase in certain situations such as in bright light. The frequent blinking/eye closures can interfere with activities such as reading or driving. This can be associated with PD, but may also accompany other forms of parkinsonism such as Progressive Supranuclear Palsy. The most common treatment for this disorder is Botulinum toxin injections.

Neck

Trunk

In PD, the trunk can tilt to one side or flex forward. Forward flexion of the trunk is known as camptocormia. Similar to neck flexion, it is unclear whether the flexion is due to dystonia causing overactivity of muscles that pull the trunk down, or weakness of the muscles that keep the trunk upright. Typically, although the forward flexion may appear very profound when upright, the patient can lie flat in a bed or sometimes even straighten up against a wall, demonstrating that the flexion is not due to a permanent deformation. Treatment options are similar to those available for neck flexion. Spinal surgeries which attempt to straighten the torso have been reported in a handful of patients. Results were mixed including a very high rate of surgical complications. These surgeries are generally not performed.

Limbs

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How Should I Take Pramipexole

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

If you are taking immediate-release pramipexole you should not take extended-release pramipexole at the same time.

The dose and timing of pramipexole in treating Parkinson’s disease is different from the dose and timing in treating RLS. Follow the directions on your prescription label. Ask your pharmacist if you have any questions about the kind of pramipexole you receive at the pharmacy.

Pramipexole can be taken with or without food. Take the medication with food if it upsets your stomach.

Do not crush, chew, or break an extended-release tablet . Swallow it whole.

If you are taking this medication for RLS, tell your doctor if your symptoms get worse, if they occur in the morning or earlier than usual in the evening, or if you feel restless symptoms in your hands or arms.

Do not stop using pramipexole suddenly, or you could have unpleasant withdrawal symptoms. Follow your doctor’s instructions about tapering your dose.

Store at room temperature away from moisture, heat, and light.

Antispasmodics: Centrally Acting Skeletal Muscle Relaxants

Centrally acting SMRs are used in addition to rest and physical therapy to help relieve muscle spasms. Theyre thought to work by causing a sedative effect or by preventing your nerves from sending pain signals to your brain.

You should only use these muscle relaxants for up to 2 or 3 weeks. The safety of longer-term use is not yet known.

While antispasmodics can be used to treat muscle spasms, they have not been shown to work better than nonsteroidal anti-inflammatory drugs or acetaminophen. In addition, they have more side effects than NSAIDs or acetaminophen.

The more common side effects of centrally acting SMRs include:

• drowsiness

yes

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What Should I Discuss With My Healthcare Provider Before Taking Pramipexole

You should not use pramipexole if you are allergic to it.

Tell your doctor if you have ever had:

• kidney disease or
• problems controlling your muscle movements.

People with Parkinson’s disease may have a higher risk of skin cancer . Talk to your doctor about this risk and what skin symptoms to watch for.

It is not known whether pramipexole will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

It is not known whether pramipexole passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

How Might Dystonia Be Experienced

• Feet: people with Parkinsons mainly experience dystonia in their feet. Typically the toes curl up into a claw-like position, the foot turns inwards at the ankle, and occasionally the big toe sticks up. This position, caused by spasms in the calf muscles, can be very uncomfortable and makes it hard to fit feet into tight shoes.
• Hands: writers cramp in the hands only occurs during handwriting.
• Neck: cervical dystonia affects the neck muscles, which causes the head to twist to one side, forwards or occasionally backwards.
• Eyelids: the eyelid muscles may contract and make the eye close involuntarily . This is often experienced as excessive blinking, intolerance to light, a burning feeling in the eye or irritation.
• Vocal cords: dystonia affecting the vocal cords or speech muscles makes speaking difficult or strained.
• Jaw area and side of the face:oromandibular dystonia affects the jaw area, tongue, mouth or one side of the face. The jaw may be pulled either open or shut, and speech and swallowing can be difficult.

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What Does Dystonia Feel Like

For some people, dystonia feels like a Charlie horse, which can be so painful that it wakes you up at night. For some, it feels like opposing muscles, muscles that work in pairs, are competing with each other. For example, when your bicep muscle contracts, your tricep muscle relaxes or elongates. In dystonia, both muscles want to contract at the same time, and it feels like theyre fighting. For some people living with Parkinsons, dystonia is the most distressing symptom they experience.

Questions To Ask Your Doctor

• My mother had cervical dystonia. Am I at risk of getting it? Can I pass it to my children?
• Does cervical dystonia come on slowly or happen suddenly?
• How can physical therapy help cervical dystonia?
• What are the side effects of medicines that treat cervical dystonia?
• Will I need surgery to treat this condition? If so, what are the side effects?

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Does Parkinsons Affect Muscles

In time, Parkinsons affects muscles all through your body, so it can lead to problems like trouble swallowing or constipation. In the later stages of the disease, a person with Parkinsons may have a fixed or blank expression, trouble speaking, and other problems. Some people also lose mental skills .

Pace Case: Improving Painful Symptoms Associated With Parkinsons Disease

An 81 y/o male with a history of Parkinsons disease, currently being treated for tremors with carbidopa/levodopa CR 25/100mg ER three times daily and rasagiline 1mg daily, was complaining of muscle spasms and pain. The physician contacted his CareKinesis clinical pharmacist, inquiring about initiating cyclobenzaprine as a muscle relaxant, however the pharmacist cautioned against this therapy addition due to a significant drug-drug interaction.

The participants other medications include:

aspirin 81mg daily insulin glargine 100units/ml twice daily levothyroxine 100mcg daily warfarin 4mg daily

CK INTERVENTIONWhile cyclobenzaprine is a muscle relaxant commonly used in patients experiencing these symptoms, because this participant is currently taking rasagiline for his Parkinsons disease, cyclobenzaprine is contraindicated. Cyclobenzaprine with rasagiline causes enhanced serotonergic effects of MAO inhibitors, and concomitant use has the potential to lead to serotonin syndrome. Serotonin syndrome results when high levels of serotonin accumulate in the body, causing symptoms from shivering and diarrhea to muscle rigidity and seizures.

For more information about our PharmD Support services, email .

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What Do Muscle Relaxers Do

Muscle relaxants can help relieve pain and other symptoms caused by muscle spasms and spasticity. They are unique because scientists and doctors still dont understand how many of them work.

There are two categories of muscle relaxants:

• Antispasmodics also known as centrally acting skeletal muscle relaxants are used, along with rest and physical therapy, to relieve muscle spasms.
• Antispastics are used to treat muscle spasticity, and shouldnt be used to treat spasms.

Doctors believe that spasms are caused by your nerves sending an excessive amount of signals to your brain. Muscle relaxants reduce the number of signals sent between your nerves and your brains. This is commonly referred to as a sedative effect.

When Can Dystonia Occur

Each persons experience with Parkinsons and dystonia is unique. Dystonia can occur unexpectedly or during repetitive actions, such as writing or golfing. It can be brief or prolonged. It can occur as a response to your levodopa therapy, even if your medication is working optimally. And, it can occur at different times throughout the day or can be cyclical.

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There Are Three Primary Categories Of Medications To Treat Motor Symptoms:

• Dopaminergic medications for movement. Dopaminergic medications replace lost dopamine and can be used to treat tremor, stiffness, slowness and problems walking. These medications may also have a beneficial impact on non-motor symptoms of Parkinsons related to sleep, mood and cognition. Dopaminergic medications, such as carbidopa-levodopa , make up the majority of medicines used to treat Parkinsons and can sometimes be used in combination with each other because of how they impact the body. As Parkinsons progresses and more of these dopaminergic medications are needed to address symptoms, you may experience motor fluctuations and frustrating side effects of the added or increased medication, like dyskinesia. Dyskinesia is uncontrollable, jerky movements of the arms and legs caused long-term use of levodopa.
• Muscle relaxants and pain medicines for painful spasms and rigidity.
• Anticholinergic medications for rest tremor. Anticholinergic medications are used to block the neurochemical acetylcholine, which can help reduce rest tremor. These medicines do not improve other motor symptoms such as rigidity, slowness or walking problems. Anticholinergic medications should be used cautiously as they can cause side effects such as dry mouth, blurred vision, dry eyes, constipation, memory problems and confusion, especially in people who are older.

How Can You Improve Aggressiveness And Hallucinations In Parkinsons

Hallucinations may spark anger or aggression in a person with Parkinsons disease. Some ways to help include:

• Reassure them, tell them they are safe.
• Speak slowly and calmly.
• Ask questions about the persons feelings.
• Listen to the person, dont interrupt.
• Avoid sudden movements.
• Give the person space and a way out, so they dont feel cornered or threatened.
• Make an emergency plan ahead of time for what you and others in the house will do if the person experiencing hallucinations becomes a danger to themselves, you, or anyone else.
• When it is safe, help the person speak with their healthcare provider about making a plan to address the hallucinations.

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What Are The Differences Between The Drug Interactions Of Baclofen Vs Flexeril

Baclofen drug interactions

• Use of baclofen with other drugs that also depress the function of nerves may lead to additional reduction in brain function.
• In addition to the risk of depressing brain function, the use of baclofen and tricyclic antidepressants together may cause muscle weakness.
• Use of baclofen and monoamine oxidase inhibitors can result in greater depression of brain function as well as low blood pressure.
• Because baclofen can increase blood sugar, doses of antidiabetic drugs may need to be adjusted when baclofen is started.

Flexeril drug interactions

• Cyclobenzaprine is chemically related to the tricyclic class of antidepressants, for example, amitriptyline , nortriptylinePamelor). As such, it should not be taken with or within two weeks of any monoamine oxidase inhibitor, for example, isocarboxazid , phenelzine , tranylcypromine , and procarbazine . High fever, convulsions, and even death can occur when these drugs are used together.
• Cyclobenzaprine interacts with other medications and drugs that slow the brain’s processes, such as
• alcohol,

Treating Dystonia In Parkinsons

Treatment options for dystonia include:

• Dopaminergic medication adjustment as discussed above
• Botulinum toxin injections of the affected muscles
• Physical therapy to loosen and strengthen the dystonic body part
• Trying other medications that target the dystonia directly such as muscle relaxants or anti-cholinergic medications
• Use of a device to provide a sensory trick*.
• Deep brain stimulation can be considered in difficult-to-treat situations

*To minimize their dystonia, some people have success using an interesting tactic called a sensory trick. A sensory trick is defined as a physical gesture that mitigates the production of the dystonia. For example, touching the eyebrow may help keep the eyes open, or touching the chin may keep the neck from twisting. In my clinical practice, one woman wears metals rings on her dystonic fingers to help them assume a more normal position. Another man wears 5-toed shoes to prevent dystonic toe curling

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Physical Therapy And Exercise

In addition to medication, physical therapy can help with muscle cramps, and regular exercise and stretching are beneficial to strengthen muscles and maintain flexibility.

Trying to move throughout the day can reduce symptoms. Exercises such as yoga, tai chi, and weight lifting have also been shown to help. The more high intensity the exercise is, the more beneficial it is at alleviating symptoms. Assistive devices such as walkers or canes can also be helpful.

For some people with PD whose symptoms are not adequately controlled with medication and/or exercise, surgery to perform deep brain stimulation may be an option. As with medication and exercise, surgery does not cure or change the course of the disease progression, but it may help with the symptoms of PD.5

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What Is A Muscle Relaxer

Muscle relaxers, or muscle relaxants, are medications that treat muscle spasms or muscle spasticity by decreasing the bodys muscle tone.

• Muscle spasms, commonly referred to as cramps, are quick and unexpected contractions of a muscle or group of muscles.
• Muscle spasticity is a continuous spasm that causes muscle stiffness or tightness.
• Muscle tone refers to the muscles resistance to stretch in a relaxed state.

Skeletal muscle spasms are the most common type of cramp and come from overuse, muscle fatigue, dehydration, or electrolyte abnormalities. Spasms are usually abrupt, painful, and short-lived.

Causes of Muscle Spasms

Conditions that lead to muscle spasms include:

• Back pain

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Tremors Can Interfere With Everyday Tasks Such As Eating And Writing

A tremor is an uncontrollable, rhythmic trembling or shaking of the muscles. There are many different types of tremor, but the most common form is benign essential tremor. The most common risk factor for developing essential tremor is a family history of tremor. Age is another risk factor for essential tremor, which is more common in people aged 40 years and older.

There are many areas of the body in which a tremor can develop, but most commonly the hands are affected. Although tremors are not dangerous, they can make it difficult to perform everyday tasks, such as eating and drinking, tying shoelaces, walking, and even speaking. Often, the individual feels self-conscious about the tremor. The tremor may remain mild throughout the persons life or become increasingly severe over time. Tremors can be triggered or worsened by lack of sleep, low blood sugar, stress, fever, extreme hot or cold environments, or stimulants. Depending upon the cause, some tremors worsen with deliberate actions, while others become worse at rest.

Drug Used To Treat Parkinson’s Disease May Be Beneficial In Treating Fibromyalgia

Date:

John Wiley & Sons, Inc.

Summary:

Recently, researchers set out to investigate whether the dopamine receptor agonist pramipexole was safe and effective in treating fibromyalgia. Normally used to treat Parkinson’s disease, this drug stimulates dopamine production by binding to dopamine receptor sites and is thought to inhibit sensory nerve-mediated responses. This is the first trial of pramipexole and only the second trial for this type of dopamine receptor agonist for the treatment of fibromyalgia.

The mechanism of fibromyalgia, a chronic illness characterized by muscle pain, fatigue, and sleep disturbances, is unknown and medications used to treat it have had limited success. New research findings indicate that the pain associated with this disease may be due to abnormal sensory processing in the central nervous system.

Recently, researchers from Pacific Rheumatology Associates in Renton, Washington set out to investigate whether the dopamine receptor agonist pramipexole was safe and effective in treating fibromyalgia. Normally used to treat Parkinson’s disease, this drug stimulates dopamine production by binding to dopamine receptor sites and is thought to inhibit sensory nerve-mediated responses. This is the first trial of pramipexole and only the second trial for this type of dopamine receptor agonist for the treatment of fibromyalgia. The findings are published in the August 2005 issue of Arthritis & Rheumatism .

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