Medications and Drug Therapies
L-Dopa (Levodopa) has been prescribed for Parkinson's for over forty years now. It was first used as a treatment for PD in 1960. It is still considered, by mainstream doctors, as the most effective drug for treating the symptoms of Parkinson's. It may possibly be the first treatment your doctor recommends for you.
Here are some of the possible side-effects of this drug:
- Postural Hypotension (your blood pressure rises abnormally during standing)
- Sinus Tachycardia (your cardiac rate rises to greater than 100 beats per minute)
- Early morning inability to move
- Fidgetiness or restlessness
- Loss of refreshing effect of sleep
- Orange, black or brown color of urine.
Besides these side-effects, one major drawback with L-Dopa is that doesn't always work very well. The effectiveness varies from one person to another.
Also its effectiveness decreases over time, so your dosage would need to be increased periodically. And, that's a problem you need to be aware of - the higher dosage of L-Dopa eventually causes further undesirable side effects, such as dizziness, insomnia, nervousness, vague mental symptoms (psychosis), psychiatric and behavioral problems.
But these days, L-Dopa is almost always combined with another drug - Carbidopa. The combination of the two is called Sinemet®). So, your doctor will more likely prescribe Sinemet®), as it apparently helps avoid some of the side effects listed above.
However, there are still some side effects or complications that can arise with this drug therapy, and they are usually directly proportional to the duration of the treatment.
Some of the more serious adverse reactions commonly experienced with this drug therapy are:
- Orthostatic hypotension (a sudden fall in blood pressure that occurs when you stand up
- Cardiac arrhythmias
- Paranoid ideation and psychotic episodes
- Involuntary movements
- Bradykinetic episodes (slowed movement)
There is now a controlled-release version of the carbidopa/levodopa combination called Sinemet CR®). It prolongs the concentration of L-Dopa in your system, and seems to reduce those certain side-effects that involve problems with motor functions.
However, it takes a lot longer to begin working. So, in an attempt to overcome this major drawback, your doctor may prescribe a small dose of the regular Sinemet®) to be taken with the morning dose of Sinemet CR®).
1. Selegiline (Eldepryl®)This drug would be prescribed for you when L-Dopa stopped being an effective treatment.
It may also be prescribed on its own, without L-Dopa if you are in the early stage of PD.
Possible side effects of Selegiline are:
- May aggravate the side effects of L-Dopa
- Progressive deterioration of mental process of thought (including perception, reasoning, intuition and memory)
This drug is one of the treatments that can be used for PD patients who are under the age of 65. But not if they have any type of psychiatric disorder.
Selegiline may have some possible neuroprotective effects; however, it remains to be proven.
2. Continuous-release preparations of L-Dopa, like Sinemet CR®), which we described earlier on this page. These prolong the concentration of L-Dopa in your system.
3. Direct Dopamine Agonists...
- Pramipexole (Mirapex®)
- Ropinirole (Requip®)
- Pergolide (Permax®)
- Bromocriptine (Parlodel®)
These are drugs that will directly stimulate dopamine receptors in your brain. Some studies have shown there to be less motor function disturbances than those that occur with long term use of L-Dopa.
When your body metabolizes these drugs, they seem not to produce free radicals. Thus, they may be less toxic to your system than L-Dopa.
However, these drugs are comparatively expensive. And, if you have a psychiatric disorder - such as depression, psychosis, neurosis, a personality or behavior disorder - as can happen to many PD patients, you shouldn't take them.
Side effects you may experience when taking these types of pharmaceuticals could include:
- Sudden drop in blood pressure upon standing
- Abnormal sleepiness or drowsiness
- Motor disturbances
- Mental changes
Anyone with a history of mental illness, or who have had a heart attack recently should most definitely not take these direct dopamine agonistic drugs. The same goes for someone with a history of peripheral vascular disease, and those with peptic ulcer disease.
4. COMT Inhibitors ... (Catechol-O-methyltransferase)
- Tolcapone (Tasmar®)
- Entacapone (Comtan®)
When you take carbidopa/levodopa, there is a greater amount of L-Dopa available to your brain, than if you take just the L-Dopa alone. However, not all the L-Dopa makes it to the brain. Some of it is metabolized in your gut and in your liver.
These COMT Inhibitor drugs prevent this breakdown and so more of the L-Dopa is available to reach your brain.
The possible side effects from these inhibitor drugs are:
- leepiness and drowsiness
- Increase in a certain liver enzyme
- Motor disturbances
NOTE: Entacapone (Comtan®) is still only an investigational drug in America. Some of these pharmaceuticals are prescribed as stand-alone treatments, whereas others are prescribed in addition to carbidopa/levodopa.
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