Parkinson's Disease (cont.)
Are there other medications available for managing Parkinson's disease symptoms?
Levodopa is not a perfect drug. Fortunately, physicians have other treatment
choices for particular symptoms or stages of the disease. Other therapies
include the following:
- Bromocriptine, pergolide, pramipexole and ropinirole. These four drugs mimic the role of dopamine in
the brain, causing the neurons to react as they would to dopamine. They can be
given alone or with levodopa and may be used in the early stages of the
disease or started later to lengthen the duration of response to levodopa in
patients experiencing wearing off or on-off effects. They are generally less
effective than levodopa in controlling rigidity and bradykinesia. Side effects
may include paranoia, hallucinations, confusion, dyskinesias, nightmares,
nausea, and vomiting.
- Selegiline. Studies supported by the NINDS have shown that the drug
(also known as deprenyl) delays the need for levodopa therapy by an average of
nine months. When selegiline is given with levodopa, it appears to enhance and
prolong the response to levodopa and thus may reduce wearing-off fluctuations.
Selegiline inhibits the activity of the enzyme monoamine oxidase B (MAO-B),
the enzyme that metabolizes dopamine in the brain, delaying the breakdown of
naturally occurring dopamine and of dopamine formed from levodopa and also
provides mild symptomatic relief from parkinsonism
in-and-of itself. Selegiline is an easy drug to take, although side effects may
include nausea, orthostatic hypotension, or insomnia (when taken late in the
day). Also, toxic reactions have occurred in some patients who took selegiline
with fluoxetine (an antidepressant) and meperidine (used as a sedative and an
analgesic).
- Anticholinergics. These drugs were the main treatment for
Parkinson's disease until the introduction of levodopa. Their benefit is
limited, but they may help control tremor and rigidity. They are particularly
helpful in reducing drug-induced parkinsonism. Anticholinergics appear to act by
blocking the action of another brain chemical, acetylcholine, whose effects
become more pronounced when dopamine levels drop. Only about half the patients
who receive anticholinergics respond, usually for a brief period and with only
a 30 percent improvement. Although not as effective as levodopa or
bromocriptine, anticholinergics may have a therapeutic effect at any stage of
the disease when taken with either of these drugs. Common side effects include
dry mouth, constipation, urinary retention, hallucinations, memory loss,
blurred vision, changes in mental activity, and confusion.
- Amantadine. An antiviral drug,
amantadine, helps reduce symptoms of Parkinson's disease. It is often used alone
in the early stages of the disease or with an anticholinergic drug or levodopa.
After several months amantadine's effectiveness wears off in a third to a half
of the patients taking it, although effectiveness may return after a brief
withdrawal from the drug. Amantadine has several side effects, including
mottled skin, edema, confusion, blurred vision, and depression.
Next: Is surgery ever used to treat Parkinson's disease? »
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