Drug Treatment for Parkinson's Disease
Dopamine agonists are drugs that activate the dopamine receptor. They mimic or copy the function of dopamine in the brain.
Requip, Mirapex, and Neupro 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.
However, dopamine agonists do carry a higher risk of short-term side effects such as nausea, vomiting, dizziness, light-headedness, confusion, and hallucinations.
Symmetrel may be a helpful treatment for people with mild Parkinson's disease, but it often causes significant 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 and Azilect 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 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.