There have been rapid and remarkable changes over the recent past in treating Parkinson's disease. The development of new drugs and an understanding of how best to use them and the older drugs have significantly improved the quality of life of people with the disease.
There are two general approaches to the treatment of Parkinson's disease with medication. The first approach attempts to increase the levels of dopamine in the brain and the second approach attempts to improve the symptoms of Parkinson's disease by other means.
Most patients with Parkinson's disease can initially be treated with drugs that adequately alleviate their symptoms. If or when medications are not sufficiently effective, new, highly effective and safe surgical treatments are also available.
Choices about medications made early in the course of the disease have a strong impact on the long-term course of the illness. Therefore, you should seek the advice of a neurologist, even if the illness is only suspected. There are also movement disorders specialists who have completed their training in neurology (brain and nerve problems) and have received special advanced training in treating Parkinson's disease and other related diseases.
What Are the Most Common Drugs Used to Treat Parkinson's Disease?
Levodopa (also called L-dopa) is the most commonly prescribed and most effective drug for controlling the symptoms of Parkinson's disease, particularly bradykinesia and rigidity.
Levodopa is transported to the nerve cells in the brain that produce dopamine. It is then converted into dopamine for the nerve cells to use as a neurotransmitter.
Sinemet (carbidopa levodopa) is made up of levodopa and another drug called carbidopa. Levodopa enters the brain and is converted to dopamine while carbidopa increases its effectiveness and prevents or lessens many of the side effects of levodopa, such as nausea, vomiting, and occasional heart rhythm disturbances. It is generally recommended that patients take Sinemet on an empty stomach, at least 30 minutes before, or one hour after meals.
There are two forms of Sinemet, controlled-release or immediate-release Sinemet. Controlled-release (CR) Sinemet and immediate-release Sinemet are equally effective in treating the symptoms of Parkinson's disease, but some people prefer the controlled release version. Ask your doctor which approach is best for you.
While Sinemet is the most effective medication and has the least short-term side effects, it is associated with risks of long-term side effects, such as involuntary movements (dyskinesia). Used on a long-term basis, levodopa may also cause restlessness, confusion, or abnormal movements. Changes in the amount or timing of the dose will usually prevent these side effects, but most experts now recommend starting with alternatives to Sinemet, such as the dopamine agonists, and use Sinemet when the alternatives fail to provide sufficient relief.
Dopamine agonists are drugs that activate the dopamine receptor. They mimic or copy the function of dopamine in the brain.
Requip (ropinirole), Mirapex (pramipexole), and Neupro (rotigotine) are dopamine agonists. These medications may be taken alone or in combination with Sinemet. Generally, dopamine agonists are prescribed first and levodopa is added if the patient's symptoms cannot be controlled sufficiently.
Because dopamine agonists are better tolerated and do not have the same risks of long-term complications as levodopa therapy, dopamine agonists are often the first choice of treatment for Parkinson's disease.
Symmetrel (Amantadine) may be a helpful treatment for people with mild Parkinson's disease, but it may cause side effects including confusion and memory problems. Symmetrel increases the amount of dopamine available for use in the brain, therefore reducing symptoms of Parkinson's. There have been recent reports that Symmetrel may help reduce the involuntary movements (dyskinesia) associated with levodopa therapy.
Anticholinergics (Artane, Cogentin)
Anticholinergics are used to restore the balance between the two brain chemicals, dopamine and acetylcholine, by reducing the amount of acetylcholine. This acts to reduce tremor and muscle stiffness in people with Parkinson's. These medications, however, can impair memory and thinking, especially in older people; therefore, they are rarely used today.
Eldepryl and Azilect
Eldepryl (selegiline) and Azilect (rasagiline) work by helping to conserve the amount of dopamine available by preventing the dopamine from being destroyed. While controversial, there is some evidence that Eldepryl may slow the progression of Parkinson's disease, particularly early in the course of the disease. Eldepryl is well-tolerated by most people, so many experts recommend using it. Common side effects include nausea, dizziness/fainting, and stomach pain.
Azilect is taken once daily and can be taken alone early in the disease or with other Parkinson's drugs as the disease progresses. Early animal studies suggest Azilect may also slow progression of Parkinson's. Side effects include headache, joint pain, indigestion, and depression.
Tasmar, Comtan (COMT Inhibitors)
When COMT is blocked, dopamine can be retained and used more effectively, reducing Parkinson's symptoms. COMT inhibitors like Tasmar (tolcapone) and Comtan (entacapone) can also increase the effectiveness of levodopa.
Medication Guidelines for Parkinson's Disease
There is no "cookbook" approach to the successful use of medications. You and your doctor will have to determine the best treatment approach for you.
Below are general guidelines to taking your medication. Be sure to ask your doctor or pharmacist for guidelines specific to your treatment.
- Do not split pills, or pull capsules apart unless directed by your doctor.
- Drink six to 10 glasses of water a day.
- Warm baths or physical activity may help with digestion and absorption of your medication.
- Know the names of your medications and how they work. Know the generic and brand names, dosages, and potential side effects. Always keep a list of your medications and their dosages with you, and exactly how you are taking them. Keep the list with you in your wallet or purse.
- Take your medications exactly as prescribed by your doctor.
- Do not stop taking or change your medications unless you talk to your doctor first. Even if you feel good, continue to take your medications. Stopping your medications suddenly can make your condition worse.
- Do not double the dose of your medication.
- Have a routine for taking your medications. Take them at the same time each day. Get a pillbox that is marked with the days of the week, and fill it at the beginning of the week to make it easier to remember.
- Keep a drug calendar and note every time you take a dose.
- If you miss a dose of your medication at the scheduled time, don't panic. Take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and return to your regular medication schedule. Set an alarm clock if necessary.
- Do not keep outdated drugs. Dispose of unused medications as instructed on the drug label or patient information sheet. You can also check with your pharmacist about proper disposal methods.
- Store drugs in a dry area away from moisture (unless your doctor or pharmacist tells you the medicine needs to be refrigerated).
- Always keep medications out of the reach of children.
- Know what side effects to expect from your medications. Contact your doctor immediately if you experience any unusual or unexpected side effects after taking your medication.
- Do not share your medications with others.
- Keep your medications in your carry-on luggage when you travel. Do not pack your medications in a suitcase that is checked, in case the suitcase is lost.
- Take extra medication with you when you travel in case your flight is delayed and you need to stay away longer than planned.
- Do not wait until you are completely out of medication before filling your prescriptions; call the pharmacy at least 48-hours before running out. If you have trouble getting to the pharmacy, have financial concerns or have other problems that make it difficult for you to get your medications, let your doctor know. A social worker may be available to help you.
Avoiding Interactions With Other Medications
Read all labels carefully.
- Make all health care providers aware of all the drugs you are taking.
- Know your drug and food allergies.
- Make a list of your medications and dosages. Eye drops, vitamins, herbal supplements, and certain skin products are considered medications and should be included on your list. Keep this with you and update it as necessary.
- Review possible drug side effects. Most reactions will occur when a new drug is started, but this is not always the case. Some reactions may be delayed or may occur when a new drug is added.
- Use one pharmacy if possible. Try to fill all your prescriptions at the same pharmacy, so the pharmacist can monitor for interactions and provide proper dosing and refills. Your pharmacist should be able to catch most drug interactions.
- The Internet has web sites that allow you to enter the names of your medications and check for drug interactions.
You have the right and responsibility to know what medications are being prescribed for you. The more you know about your medications and how they work, the easier it will be for you to control your symptoms. You and your doctor are partners in developing, adjusting, and following an effective medication plan. Make sure that you understand and share the same treatment goals as your doctor. Talk about what you should expect from medications so that you can know if your treatment plan is working.