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Derby Parkinson's Disease Services

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Drug treatments

Levo-dopa.The most effective treatment for PD is Levo-dopa which is available as co-careldopa (brand name Sinemet) or co-beneldopa (brand name Madopar). Levo-dopa (L-dopa) is converted to dopamine in the brain. It can help reduce symptoms of tremor, muscle stiffness and slowness. Most patients have no unwanted effects. Unwanted effects may include: nausea, dizziness on standing, hallucinations and excessive daytime sleepiness. After long term treatment, say for 5-10 years, some patients experience fidgety movements called dyskinesia. Often these are not troublesome.

PARKINSON'S DRUGS

L-DOPA DRUGS
SINEMET (co-careldopa)
MADOPAR (co-beneldopa)
STALEVO

DOPAMINE AGONISTS
ROPINEROLE
PRAMIPEXOLE
ROTIGOTINE
CABERGOLINE
PERGOLIDE
BROMOCRIPTINE
LISURIDE
APOMORPHINE

COMT INHIBITORS
ENTACOPONE
TOLCAPONE

OPICAPONE

MONOAMINE OXIDASE INHIBITORS
SELEGILINE
RASAGILINE

ANTI-CHOLINERGICS
TRIHEXYPHENIDYL
BENZTROPINE

AMANTADINE

 


 

Dopamine agonists, such as ropinerole and pramipexole, also work on the dopamine system. They are not as effective as Levo-dopa but have the advantage of causing less dyskinesia (fidgeting). Positive effects of these drugs include lessening of tremor, stiffness and slowness. Pramipexole may also improve mood. Most patients will not get unwanted effects. This said, unwanted effects may again include nausea, dizziness on standing, hallucinations and excessive daytime sleepiness. Rarely patients may experience a side effect called Impulse Control Disorder. This can lead to excessive gambling or shopping, and altered sex drive. Rotigotine is a newer dopamine agonist. It is given as a patch which is stuck to the skin like a plaster. When rotigotine was compared to ropinerole, ropinerole was found to be slightly more effictive. But some patients will find the rotigotine patches more convenient to use than tablets, and its steady absorption even during the night may be an advantage. It has similar side effects to ropinerole. Some patients may get skin irritation. Cabergoline and pergolide are also dopamine agonist drugs. These drugs are now less often used in Derby because of links to cardiac valve problems and scarring of the lungs. Some patients however find cabergoline or pergolide suits them better than the available alternatives. In this case the drug can be used with caution and with monitoring: eg Echocardiogram.

Entacapone is a helper drug. It is sometimes added to L-dopa treatment to help the L-dopa last longer. It can cause dyskinesia but this often improves if the dose of L-dopa is reduced. It may cause discolouration of the urine. Entacapone can be given with Sinemet or Madopar. It is also available combined with Sinemet in a single tablet: Stalevo. Opicapone is a new COMT inhibitor that is taken once daily and tends to cause less diarrhoea than entacapone.

Selegiline and rasagiline belong to a class of drugs called monoamine oxidase inhibitors (MAOIs). They slow the breakdown of dopamine in the brain. They have a fairly mild anti-Parkinsonian effect. They are sometimes used early in PD or they can be added in later on to help smooth the effect of L-dopa. Selegiline has an amphetamine-like metabolite (by-product). This means it can cause insomnia and hallucinations in some people.

Trihexyphenidyl (formerly benzhexol) does not work on the dopamine system. It works on a different chemical messenger system in the brain: the cholingeric system. In younger patients with predominant tremor it can be helpful. It is not often used for the elderly because it can cause confusion and other side effects.

Apomorphine is a dopamine agonist that is given by injection. It can cause severe nausea so it is usually given with the anti-sickness drug domperidone. Apomorphine can be difficult to use. It is generally only used in patients with more advanced Parkinson's where other treatments have not worked adequately. Patients considered for apomorphine therapy will usually be admitted to hospital for a short period so the effect of treatment can be observed before long term treatment is started.

This is by no means an exhaustive list of the drugs available to treat the symptoms of Parkinson's Disease. Your Parkinson's doctor will recommend a treatment based on your individual needs and preferences. The Parkinson's UK Website has more information about PD drugs.

Disclaimer: The author has made every effort to ensure the accuracy of the above infromation. Informal language is used to aid patient and carer understanding. This information does not replace the need for patients to consult their doctor about their medications and potential side effects. The side effects listed do not constitute an exhaustive list but are an indication of the commonly seen problems.

 

Drugs to avoidSinemetMadoparApomorphine syringe pump
Apomorphine syringe driver