Parkinson’s Disease | Parkinson’s Disease Medication

HOME UNDERSTANDING PARKINSON'S Living with Parkinson's

There are treatments available to lessen the effects of Parkinsons symptoms for some window of time, but this is all they can do offer symptomatic relief. What we dont have is a disease-modifying treatment, something that would actually halt or slow the progression of the disease. Nevertheless, significant research is being performed in the pursuit of such treatments this is the top priority of The Michael J. Fox Foundation and many of its research partners.

While none is without side effects, available drugs can greatly enhance the quality of life of a Parkinson's patient, sometimes restoring function to nearly normal for some period of time. Over time, as the disease progresses, drug dosing is adjusted to best meet a patient's symptomatic needs.

Each Parkinsons patient experiences a different range of symptoms. For this reason, not all treatments are of equal value to all patients. It's essential to work closely with your doctor and all medical caregivers involved with your treatment regimen to develop the approach that's right for you. Decisions about which treatments to use, how long they can be expected to remain beneficial, and when to begin are highly individualized in Parkinsons disease. The table below offers an overview of some of the most commonly prescribed medications used to treat Parkinson's disease.

In the 1970s, Levodopa was the first drug approved specifically for Parkinson's disease. Levodopa is converted by enzymes in the brain to produce dopamine, thereby supplementing function that has been lost as dopamine-producing neurons die.

Levodopa is most frequently combined with Carbidopa to slow enzyme breakdown of Levodopa before it reaches the brain. In the United States, this Levodopa/ Carbidopa combination may be sold under the brand name Sinemet.

Sinemet is available in both standard release and controlled release preparations.

In most patients, Levodopa/Carbidopa significantly improves mobility and allows them to function relatively normally, at least in the early stages of the disease. Because Parkinson's disease worsens over time, increased doses must be taken to manage symptoms as they progress.

Levodopa/Carbidopa is widely recognized as the most effective treatment for motor symptoms of the disease.

Levodopa/Carbidopa has not been shown to slow disease progression. Additionally, the drug has significant side effects for some patients, including dyskinesia (involuntary movements and tics), hallucinations and illusions.

Over time, symptoms may begin to return before it is time for another dose of Levodopa/Carbidopa. This change in symptoms is called "wearing-off."

As "wearing-off" becomes more noticeable, the duration of good response to Levodopa/Carbidopa (known as "on" time) shortens, while the duration of poor response (known as "off" time) may lengthen.

High protein-diets may inhibit Levodopa/Carbidopa absorption in some people, thus impacting drug effectiveness.

Not effective at treating all symptoms of Parkinsons disease. Posture, depression and cognitive problems are not responsive to Levodopa-Carbidopa.

Dopamine agonists are drugs that do not convert to dopamine in the brain, but instead mimic the effect of dopamine on the brain. Dopamine agonists supplement function that has been lost as dopamine-producing neurons die.

While some dopamine agonists have been around for years, new dopamine agonists have been developed that attempt to better manage side effects.

Dopamine agonists can be used alone or in combination with Levodopa/Carbidopa.

Dopamine agonists cause motor fluctuations, including dyskinesias, less frequently than Levodopa/Carbidopa.

No protein effects as seen with Levodopa/Carbidopa.

Agonists offer potential for alternate forms of delivery (such as a skin patch) that may offer certain advantages over oral administration.

Dopamine agonists have not been shown to slow the progression of the disease.

Dopamine agonists are not as effective as Levodopa/Carbidopa for the treatment of motor symptoms.

They may also cause other side effects including daytime sleepiness, sudden unanticipated sleep ("sleep attacks"), hallucinations and risk-taking behavior, such as gambling and sexual obsessions.

Not effective at treating all symptoms of Parkinsons disease. Posture, depression and cognitive problems are not responsive to dopamine agonists.

MAO-inhibitors inhibit an enzyme that breaks down Levodopa, thus extending its action.

Used alone or in combination with Levodopa/Carbidopa.

Can prolong the action of Levodopa.

May have a mild antidepressant effect.

Research is ongoing, but these drugs may offer some neuroprotection.

Small symptomatic benefits.

The drugs may have interactions with other medications and foods:

Catechol O-methyltransferase (COMT) inhibitors allow a larger amount of Levodopa to reach the brain, thus raising dopamine levels there. They help provide a more stable, constant supply of Levodopa, which makes its beneficial effects last longer and manage off times better.

Used in conjunction with Levodopa/Carbidopa.

Can prolong the action of Levodopa.

By increasing the amount of Levodopa that reaches the brain, a COMT inhibitor also may increase some of the side effects associated with Levodopa use, including dyskinesia and hallucinations.

Tolcapone has caused some liver issues in some patients.

Amantadine reduces symptoms of fatigue, tremor, and bradykinesia in early Parkinson's disease and may reduce dyskinesias in more advanced Parkinsons disease.

Anti-cholinergics may be useful in treating people younger than 70 whose main symptom is tremor. People with slowness, stiffness and balance problems, and people without tremor usually do not benefit from these medications. They also may be useful in controlling drooling.

Side effects of Amantadine may include drowsiness and hallucinations.

Potential side effects of anticholinergics include memory and cognition problems, hallucinations, constipation, dry mouth and difficulty initiating urination. Anticholinergics usually are not used in people older than 70 or people who have developed mental impairment, such as memory problems, because these people are more likely to experience severe side effects, such as confusion and hallucinations.

You and your doctor should decide together on the right course of treatment for you, including when to begin with medications and what other forms of therapy you might wish to pursue. Decisions must be made about whether and which medications to try first. And to some extent, determining what is right for you is a process of trial and error.

Don't feel pressured into making a decision right away. If you have Parkinsons disease, you had it yesterday and you will have it tomorrow. You have time to educate yourself and decide how you want to treat your disease and yourself.

Things to take into consideration: Starting on medication right away can limit your ability to participate in clinical trials that urgently need newly-diagnosed, unmedicated Parkinsons patients. No drug on today's market has been proven to slow or stop Parkinsons disease. Available drugs only mask the symptoms. Weigh the importance of symptomatic relief against the side effects of the medications, your doctor's advice, and your own feelings about taking medication.

Link:
Parkinson's Disease | Parkinson's Disease Medication