Medical Treatments

There are a number of drugs that are used to treat the symptoms of PD, and multiple other drugs used in parallel to treat the inevitable side effects of Parkinson’s drug treatment.  

Every person living with Parkinson's disease experiences a different range of symptoms. For this reason, not all treatments are of equal value to all patients. A PWP must work closely with the doctor and all medical caregivers involved with their treatment regimen to develop a workable approach. Decisions about which treatments to use, how long they can be expected to remain beneficial, and when to begin treatment are highly individualized in PD. The section below offers an overview of some of the most commonly prescribed medications currently used to treat Parkinson's. 

Drugs Used to Treat Parkinson's disease

Dopamine Replacement Therapies (Examples: Levodopa/Carbidopa)

Overview

  • Approved in the 1970s, levodopa was the first drug used specifically for Parkinson's. When taken orally, levodopa travels to the brain, crosses the blood-brain barrier, and is converted to dopamine by brain enzymes.  This extra dopamine compensates for low levels caused by the death of substantia nigra cells.
  • Levodopa is most frequently combined with carbidopa to slow premature conversion of levodopa before it reaches the brain. In the United States, this levodopa/carbidopa combination is available either generically or under the brand name Sinemet.
  • Sinemet is available in both standard release and controlled release preparations, and mixed with entacapone to delay decomposition of dopamine in a medication called Stalevo.

Pros

  • In most patients, levodopa/carbidopa significantly improves mobility and allows relatively normal function in the early stages of the disease. Because Parkinson's worsens over time, increasing 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.

Cons and Complications

  • 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), nausea and vomiting, and hallucinations.
  • Over time, symptoms may begin to come back 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.
  • Levodopa/carbidopa is not effective at treating all symptoms of PD.  Posture, depression and cognitive problems are not responsive to levodopa/carbidopa.

Dopamine Agonists (Example: Pramipexole, Ropinerole, Bromocriptine)

About

  • 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.

Pros

Dopamine agonists cause motor fluctuations including dyskinesia less frequently than levodopa/carbidopa.

  • No protein effects as seen with levodopa/carbidopa.

Cons and Complications

  • 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 PD. Posture, depression and cognitive problems are not responsive to dopamine agonists.

 

MAO-inhibitors (Brand names: Selegiline, Rasagiline)

About

  • MAO-inhibitors inhibit an enzyme that breaks down Levodopa, thus extending its action.
  • Used alone or in combination with Levodopa/Carbidopa.

Pros

  • Can prolong the action of levodopa.
  • May have a mild antidepressant effects

COMT-inhibitors (Examples: Entacapone, Tolcapone)

About

  • 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 in a brand-name medication called Stalevo

Pros

  • Can prolong the action of levodopa.

Cons and Complications

  • By increasing the amount of levodopa that reaches the brain, a COM-T inhibitor also may increase some of the side effects associated with levodopa use, including dyskinesia and hallucinations.
  • Tolcapone has caused liver complications in some patients.

Other Pharmacological Approaches (used in conjunction with Levodopa/Carbidopa and dopamine agonists)

About

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

Pros

  • Varies

Cons and Complications

  • Side effects of amantadine may include drowsiness and hallucinations, swelling of extremities, and skin discoloration.
  • 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 have severe side effects such as confusion and hallucinations.

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The Crooked Path Blog

The Crooked Path is a blog written by Corey King, a CCPSG member and diagnosed with PD at the age of 47.  

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