Medications for Treatment of Parkinson’s Symptoms

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The main aim of Parkinson’s Disease medication is to compensate for the lack of dopamine in the brain that is the underlying cause of Parkinson’s Disease symptoms. The complexity of Parkinson’s and number of possible prescribed medications dictates that you must include your personal physician and neurologist in selecting medications for your treatment. They are most familiar with your Parkinson’s Disease symptoms and medications that will improve your response to the Parkinson’s Disease.

The information provided herein by the Parkinson’s Disease Support Group of Southern New Mexico will provide you with preliminary a view of the many areas for which you will need to seek professional medical support and advice from licensed professionals to ensure the right medication is prescribed for your specific combination of Parkinson’s symptoms. It is always a good idea to check for pharmaceuticals interacting with a trusted pharmacist.

Although there are currently no medications that can cure or slow the progression of Parkinson’s Disease. There are several treatments that can help relieve symptoms, including the primary motor symptoms of Parkinson’s Disease. Treatment approaches include medications, surgery (deep brain stimulation), and complementary or alternative medicines. TOP

Levodopa/Carbidopa

The primary drug to treat Parkinson’s symptoms is Levodopa combined with Carbidopa.  The Carbidopa allows the Levodopa to more easily pass through the blood brain barrier.  It only treats symptoms, mostly tremors, and has a life span of about 20 years to work effectively with the disease. Long-term use and over-dosing have also been associated with dyskinesia, hallucinations, restlessness, and confusion.

The patient is given Levodopa and / or an agonist drug used to treat the symptoms of Parkinson’s. If it appears that the drug allows the person to function better and reduce tremor, then it is thought that they do, in fact, have Parkinson’s. There is no blood test to determine whether or not you have the disease.

The combination of Levodopa / Carbidopa helps the medication go through the blood brain barrier and make it more palatable to the digestive system, as it can cause nausea and vomiting.  Levodopa is a man-made replacement for the neurotransmitter, dopamine, that has declined in the brain. 

The man-made dopamine is, like the dopamine produced by the body naturally, an amino acid.  It combines with food for absorption in the stomach, so it is best to take it 30 minutes before a meal or two hours after eating.  This can pose problems for some people who are on doses scheduled every 2 hours. There are Dopamine agonists and different forms of Levodopa like time-released, the patch, and the pump that regulate the release of the Levodopa into your system. TOP

Other Medications

Several medications are available that can help relieve the primary motor symptoms. Initial therapy is usually levodopa (administered with carbidopa), dopamine agonists, and or monoamine oxidase-B (MAO-B) inhibitors.

The combination of levodopa and carbidopa is the most effective treatment available for the management of motor symptoms of Parkinson’s Disease. However, it can cause a side effect known as dyskinesia that is an abnormal involuntary movement. Dopamine agonists are less effective on the motor symptoms of Parkinson’s Disease, but have a lower incidence of causing dyskinesia, although they may have other side effects.

MAO-B inhibitors are less effective than levodopa or dopamine agonists, however they have fewer side effects. Choice of therapy should be customized to the individual patient with an understanding of the risks and benefits of each class of medication.

A variety of medications may cause a decrease in the production of saliva or cause dry mouth (xerostomia).   Dry mouth is a common side effect of anticholinergic Parkinson’s medications, it can be a side effect of carbidopa / levodopa and related Parkinson’s medications. Dry mouth may also occur with use of medications prescribed for depression, anxiety, sleep issues, urinary issues and orthostatic hypotension.

Saliva is important as it helps prevent tooth decay by neutralizing acids produced by bacteria  and by washing away food debris in your mouth. Dry mouth is a common problem with Parkinson’s patients. The effects of which can range from being a minor nuisance to something that has a major impact on your oral health, your overall health and your quality of life. Parkinson’s Disease can also cause an alternate result with the production of too much saliva and subsequent drooling.

ANTICHOLINERGICS  This class of drugs is used to control the relationship between the two neurotransmitters dopamine and acetylcholine.  Acetylcholine is a chemical released by nerve cells to send signals to other cells. Its name is derived from its chemical structure: it is an ester of acetic acid and choline.  Side effects:  nausea, headache, insomnia, and dizziness may occur.  It could also complicate pulmonary issues.

MAO B INHIBITOR’s Monoamine oxidase inhibitors (MAOIs) are a class of drugs that inhibit the activity of one or both monoamine oxidase enzymes: monoamine oxidase A (MAO-A) and monoamine oxidase B (MAO-B). They have a long history of use as medications prescribed for the treatment of depression.

MAO B Inhibitors block the breakdown of dopamine in the brain, thus making more available for use.  They can be used early as mono therapy or later as adjunct therapy with other treatments.  Side effects are dry mouth, dizziness, nausea and headaches.

COMT INHIBITORS One of the most important enzymes in the catecholamine cycle, catecholamine-O-methyltransferase (COMT), plays a critical role in the extracellular metabolism of dopamine and norepinephrine, both in the periphery and the central nervous system. Several clinical genetic studies have shown that variants of COMT gene contribute to the manifestations or treatment responses of this disorder. Side effects are nausea, vomiting, diarrhea and sleepiness.

BOTULIM TOXIN  (Botox® ) Injections to control drooling (sialorrhea) can sometimes be too effective at reducing excess saliva production, resulting in symptoms of dry mouth.

DOPAMINE AGONISTS – Dopamine agonists activate or antagonize the dopamine receptors in the brain and mimic the effectiveness of dopamine.  There are several medications found in this class of drugs. They are generally well tolerated, however they can have side effects.

DYSKINESIA – In Parkinson’s Disease, one of the most troubling clinical issues for prevention and management is drug-induced dyskinesia. Dyskinesia is the abnormal and involuntary movements that relate in part to underlying Parkinson’s disease itself and to drugs used to treat Parkinson’s disease.

Over the last two decades numerous research efforts have focused on understanding the regions of the brain responsible for dyskinesia and the brain chemicals involved. As a result, new treatments, both medical and surgical, have been developed and are currently being tested.

AMANTADINE (GOCOVRI) and (SYMMEREL) are used to treat dyskinesia in Parkinson’s Disease by increasing dopamine available to the brain. This is the first drug indicated specifically for dyskinesia, uncontrolled, involuntary movements that can develop with long-term levodopa use. Extended-release Amantadine can control dyskinesia during the day, when it typically is most prevalent.  In addition to easing dyskinesia. Amantadine also may lessen total daily “off” time, when Parkinson’s symptoms return because medication is not working optimally.

ROPINIROLE  is used alone or with other medications to treat the symptoms of Parkinson’s Disease such as difficulties with movement, muscle control, slowed movement, balance, and restless leg syndrome.  Ropinirole is in a class of medications called dopamine agonists. It works by acting in place of dopamine.

Anti-Depressant Medication – The same pathways in the brain that create dopamine create another neurotransmitter, serotonin.  It is thought that serotonin can affect mood and social behavior, appetite and digestion, sleep, memory, sexual desire and function.  Most of the serotonin produced in our bodies is produced in the gastrointestinal system.  The serotonin that is used in the brain appears to be produced in the brain.  It is important to treat depression and anxiety so that the other symptoms of Parkinson’s can be successfully treated. Side effects of anti-depressant medications are nausea, dizziness and sleepiness.

Anti-Anxiety Medications – Benzodiazepines are a group of medications that target the brain chemical GABA. GABA is a chemical messenger that is widely distributed in the brain. GABA’s natural function is to reduce availability of the neurons to which it binds. Some researchers believe that one of the purposes that GABA serves is to control fear of anxiety experiences when neurons are overexcited.

Parkinson’s Medications Research – There is ongoing significant high-level research ongoing at the national and international level at the Parkinson’s Foundation, The Michael J. Fox Foundation, PDM Alliance, the Mayo Clinics and the Cleveland Clinics new medications and procedures are being researched to slow the progression of Parkinson’s Disease and find a cure.

RULES TO REMEMBER ABOUT MEDICATIONS

  1. Take your medications exactly as prescribed.  Timing is particularly important with regard to the actual Parkinson’s Disease drugs.
  2. Never split extended-release pills or capsules.
  3. Drink 6 to 10 glasses of fluid daily to help with digestion and metabolism of medications. 
  4. Exercise to improve digestion and the metabolism of medications.  Exercise has been shown to help slow disease progression.
  5. Keep a complete list of all of your medications with you at all times.  It is a good idea to have a list on the refrigerator in case you would have to have EMTs at your home.  They will look for it there.  Some areas have the “yellow dot” program for your car.  That would alert officials that you have a condition that requires specific medications, and a list is in your glove compartment. 
  6. Don’t stop taking medications without speaking to your doctor first.
  7. Try to take your medications as close to the same time every day as possible for the best results.  If you do miss a dose, take it as soon as you can unless it is too close to your next scheduled dose.
  8. Use alarms to remember to take your medications on time.  You can find pillboxes that have alarms, or you can use watch alarms or phone alarms.
  9. Plan ahead!  If you are going to be away from home, take additional medication and water with you.
  10. Be prepared before you have to make a hospital visit. The Parkinson’s Foundation has free hospital planning kits