There are so many types of medication for PD. Let's review the most common medications and their effects.
Levodopa
Absorbed in the blood from the small intestines, then travels to the brain where it is converted into dopamine
Carbidopa prevents levodopa from being broken down before it reaches the brain
Common types
Immediate release tablets - Sinemet
Extended release capsules - Crexont and Rytary
Enteral Suspension version - Duopa
Inhaler version - Inhbrija (emergency use)
Vyalev- foscarbidopa/foslevodopa for continuous transdermal infusion
Most common side effects are nausea and vomiting, followed by drowsiness, low blood pressure, or hallucinations
With long term use, complication such as dyskinesia may develop, in normal onset PD
Very common in YOPD
Protein can impact effectiveness
Dopamine Agonist
Dopamine agonists mimic the effects of dopamine without having to be converted into dopamine
Not as potent as carbidopa-levodopa and through to cause less dyskinesias
Common types
Mirapex (Pramipexole) and Requip (Ropinirole)
Extended release form - Mirapex ER and Requip AL
Patch transdermal system - Neupro (Rotigotine)
Thought to be less effective than levodopa for treating motor symptoms
Similar side effects to levodopa
Can cause “sleep attacks” and leg swelling
Can lead to impulse control disorders
Amantadine
Traditionally used for tremors but is now being used in combination with levodopa for levodopa-induced dyskinesia
Extended release amantadine can be used to help with “off” times
Common types
Symmetrel
Extended-release - Gocovri and Osmolex ER
Most common side effects are insomnia, nausea, dizziness, and purple-red blotchy spots on the skin (Livedo reticularis - non-harmful “lacy” appearance of skin, typically legs)
Adenosine A2A Antagonist
Adenosine A2A receptors are receptors in the brain that are located next to dopamine receptors. Blocking these receptors from being active creates a similar effect to levodopa
Thought to reduce “off” time by 30-60 minutes per day without worsening dyskinesia
Common type
Nourianz
Common side effects include dyskinesia, dizziness, constipation, nausea, and hallucinations
COMT Inhibitors
COMT is a body enzyme that deactivates levodopa before it enters the brain
The medication is used to inhibit this enzyme, prolong the effects of levodopa by blocking its break down
Thought to extend “on” time
Common types
Comtan (Entacapone) and Tasmar
Combination drug - Stalevo
Ongentys - taken at night to help with night time “off” times
Side effects include diarrhea and urine discoloration
Anticholinergic Drugs
Blocks acetylcholine in the brain. Acetylcholine depletes dopamine in the brain
Thought to be helpful for tremor and dystonia, especially those who are younger with PD (partly due to side effects)
Has little effect on other PD symptoms
Common types
Cogentin and Artane
Common side effects include blurred vision, dry eyes and mouth, constipation, and cognitive problems.
MAO-B Inhibitors
MAO-B is an enzyme that breaks down dopamine
Inhibiting this enzyme makes more dopamine available to the brain
Thought to reduce motor fluctuations when paired with levodopa - minimizes “off” time and extends “on” time
Common types
Eldepryl, Azilect, Xadago
Oral disintegrating - Zelapar
Side effects include flu-like symptoms, joint pain, and blood pressure changes.
Thought to be neuroprotective until new data came along
Can lead to hallucinations or insomnia in older individuals
Serotonin syndrome - life threatening reaction when people have too much serotonin in their system
Specific antidepressants, muscle relaxants, pain medications, herbal supplements like St. John’s Wort
Muscle stiffness, inc tremor, high blood pressure, sweating, diarrhea, fever, shivering, confusion, agitation
If you have questions about your medications, talk with your movement disorder specialist.
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