Treatments and drugs
For PD.
Parkinson's disease can't be cured, but
medications can help control your symptoms, often dramatically. In some later
cases, surgery may be advised.
Your doctor may also recommend lifestyle
changes, especially ongoing aerobic exercise. In some cases, physical therapy
that focuses on balance and stretching also is important.
Medications
Medications can help you manage problems with
walking, movement and tremor by increasing your brain's supply of dopamine.
However, dopamine can't be given directly, as it can't enter your brain.
You may have significant improvement of your
symptoms after beginning Parkinson's disease treatment. Over time, however, the
benefits of drugs frequently diminish or become less consistent, although
symptoms usually can continue to be fairly well controlled.
Your doctor may prescribe medications, which
may include:
·
Carbidopa-levodopa. Levodopa, the most effective Parkinson's disease medication, is
a natural chemical that passes into your brain and is converted to dopamine.
Levodopa is combined with carbidopa (Parcopa, Sinemet), which
protects levodopa from premature conversion to dopamine outside your brain,
which prevents or lessens side effects such as nausea. In Europe, levodopa is
combined with a similar substance, benserazide (Madopar).
Side effects may include nausea or lightheadedness (orthostatic
hypotension).
After years, as your disease progresses, the benefit from
levodopa may become less stable with a tendency to wax and wane ("wearing
off").
Also, you may experience involuntary movements (dyskinesia)
after taking higher doses of levodopa. Your doctor may lessen your dose or
adjust the times of your doses to control these effects.
·
Dopamine agonists. Unlike levodopa, dopamine agonists don't change into dopamine.
Instead, they mimic dopamine effects in your brain.
They aren't as effective as levodopa in treating your symptoms.
However, they last longer and may be used with levodopa to smooth the sometimes
off-and-on effect of levodopa.
Dopamine agonists include pramipexole (Mirapex), ropinirole
(Requip) and rotigotine (given as a patch, Neupro). A short-acting injectable
dopamine agonist, apomorphine (Apokyn), is used for quick relief.
Some of the side effects of dopamine agonists are similar to the
side effects of carbidopa-levodopa, but also include hallucinations, swelling,
sleepiness and compulsive behaviors such as hypersexuality, gambling and
eating. If you're taking these medications and you behave in a way that's out
of character for you, talk to your doctor.
·
MAO-B inhibitors. These medications include selegiline (Eldepryl, Zelapar) and
rasagiline (Azilect). They help prevent the breakdown of brain dopamine by
inhibiting the brain enzyme monoamine oxidase B (MAO-B). This enzyme
metabolizes brain dopamine. Side effects may include nausea or headaches.
When added to carbidopa-levodopa, these medications increase the
risk of hallucinations.
These medications are not often used in combination with most
antidepressants or certain narcotics due to potentially serious but rare
reactions. Check with your doctor before taking any additional medications with
a MAO-B inhibitor.
·
Catechol O-methyltransferase (COMT) inhibitors.Entacapone (Comtan) is the primary medication
from this class. This medication mildly prolongs the effect of levodopa therapy
by blocking an enzyme that breaks down dopamine.
Side effects, including an increased risk of involuntary
movements (dyskinesias), mainly result from an enhanced levodopa effect. Other
side effects include diarrhea or other enhanced levodopa side effects.
Tolcapone (Tasmar) is another COMT inhibitor that is rarely
prescribed due to a risk of serious liver damage and liver failure.
·
Anticholinergics. These medications were used for many years to help control the
tremor associated with Parkinson's disease. Several anticholinergic medications
are available, including benztropine (Cogentin) or trihexyphenidyl.
However, their modest benefits are often offset by side effects
such as impaired memory, confusion, hallucinations, constipation, dry mouth and
impaired urination.
·
Amantadine. Doctors may prescribe
amantadine alone to provide short-term relief of symptoms of mild, early-stage
Parkinson's disease. It may also be given with carbidopa-levodopa therapy
during the later stages of Parkinson's disease to control involuntary movements
(dyskinesias) induced by carbidopa-levodopa.
Side effects may include a purple mottling of the skin, ankle
swelling or hallucinations.
