Summary of medications for motor symptoms in Parkinson’s disease:
Levodopa –
Carbidopa/levodopa, immediate-release (Sinemet)
Dosages in Milligrams: 10/100, 25/100; 25/250
Typical Treatment Regimens: 150-1000mg of levodopa total daily dose (divided 3-4 times)
Potential Side Effects: Low blood pressure, nausea, confusion, dyskinesia
Indications for Usage: Monotherapy or adjunct therapy for slowness, stiffness, and tremor
Carbidopa/levodopa – oral disintegrating (Parcopa)
Dosages in Milligrams: 10/100; 25/100; 25/250
Typical Treatment Regimens: 150-1000 mg of levodopa total daily dose (divided 3-4 times)
Potential Side Effects: as above
Indications for Usage: as above, plus need for dissolvable medication in the mouth
Carbidopa/levodopa extended-release (Sinemet CR)
Dosages in Milligrams: 25/100; 50/200
Typical Treatment Regimens: 150-1000mg of levodopa total daily dose (divided 204 times)
Potential Side Effects: as above
Indications for Usage: Monotherapy or adjunct therapy for slowness, stiffness, and tremor
Carbidopa/levodopa/Entacapone (Stalevo)
Dosages in Milligrams: 12.5/50/200; 25/100/200; 37.5/150/200; 50/200/200
Typical Treatment Regimens: 150-1000mg of levodopa total daily dose (divided 3-4 times)
Potential Side Effects: Low blood pressure, nausea, confusion, dyskinesia, plus diarrhea and discoloured urine (due to entacapone)
Indications for Usage: Replacement for carbidopa/levodopa for motor fluctuations (benefit of entacapone)
--------------------------------------------------------------------------------------------------------------------------------------
Dopamine agonists
Ropinirole (Requip) Dosages in Milligrams: 0.25; 0.5; 1; 2; 3; 4; 5
Typical Treatment Regimens: 9-24mg total daily dose (divided 3-4 times)
Potential Side Effects: Low blood pressure, nausea, leg swelling & discolouration, confusion, sleep attacks, compulsive behaviour
Indications for Usage: Monotherapy or adjunct therapy for slowness, stiffness, and tremor
Pramipexole (Mirapex)
Dosages in Milligrams: 0.125; 0.25; 0.5; 1, 1.5
Typical Treatment Regimens: 0.5mg to 1.5mg total daily dose (divided 3-4 times)
Potential Side Effects: as above
Indications for Usage: as above
Apomorphine (Apokyn) Dosages in Milligrams: 30mg/3 ml vial
Typical Treatment Regimens: 2 – 6 mg
Potential Side Effects: Significant nausea, must take anti-nausea medication with dose, especially initially with therapy
Indications for Usage: Adjunct therapy for sudden wearing off
---------------------------------------------------------------------------------------------------------------------------------------
MAO-B inhibitors
Selegiline (I-deprenyl, Eldepryl) Dosages in Milligrams: 5
Typical Treatment Regimens: 5 mg twice a day
Potential Side Effects: Agitation, insomnia, vivid dreams, hallucinations, may worsen dyskinesia, possible rare interaction with anti-depressants and other drug classes
Indications for Usage: Monotherapy for slowness, stiffness, and tremor, adjunct therapy for motor fluctuations
Rasagiline (Azilect) Dosages in Milligrams: 0.5; 1.0
Typical Treatment Regimens: 1 mg once daily
Potential Side Effects: as above
Indications for Usage: as above
Zydis selegiline HCL Oral disintegrating (Zelapar)
Dosages in Milligrams: 1.25; 2.5
Typical Treatment Regimens: 1.25- 2.5mg once daily
Potential Side Effects: as above
Indications for Usage: as above
---------------------------------------------------------------------------------------------------------------------------------------
COMT-inhibitors
Entacapone (Comtan) Dosages in Milligrams: 200
Typical Treatment Regimens: 200 mg 3-4 times daily (with each levodopa dose)
Potential Side Effects: Diarrhea, discoloured urine, plus enhancing side effects of levodopa, especially dyskinesia
Indications for Usage: Adjunct therapy for motor fluctuations
Tolcapone (Tasmar) Dosages in Milligrams: 100
Typical Treatment Regimens: 100 mg up to 3 times daily
Potential Side Effects: Diarrhea, discoloured urine, plus enhancing side effects of levodopa, especially dyskinesia, plus increased risk of liver failure
Indications for Usage: Adjunct therapy for motor fluctuations (second-line due to side effects)
---------------------------------------------------------------------------------------------------------------------------------------
Other anti-parkinson medications
Amantadine (Symmetrel) Dosages in Milligrams: 100 mg capsules, 50mg/4ml suspension
Typical Treatment Regimens: 100 mg 2-3 times daily
Potential Side Effects: Nausea, confusion, leg discolouration (livido reticularis), mild anti-cholinergic effects (see Anti-cholinergies below)
Indications for Usage: Monotherapy for slowness, stiffness, and tremor, adjunct therapy for motor fluctuations, especially for dyskinesia
----------------------------------------------------------------------------------------------------------------------------------------
Anti-cholinergics
Trihexyphenidyl (formerly Artane) Dosages in Milligrams: 2.5
Typical Treatment Regimens: 1-2 mg 2 or 3 times daily
Potential Side Effects: Confusion, memory issues, hallucinations, dry mouth, blurry vision, urinary retention
Indications for Usage: Monotherapy or Adjunct therapy predominantly for tremor in younger people
Benztropine (Cogentin) Dosages in Milligrams: 0.5; 1; 2
Typical Treatment Regimens: 0.5 – 2mg 2 or 3 times daily
Potential Side Effects: as above
Indications for Usage: as above
----------------------------------------------------------------------------------------------------------------------------------------
Key: monotherapy = medication used alone.
Adjunct therapy = medication added to other medications
Typical treatment regimens should act only as a guide. The prescribed dosage by your doctor and your effective dose may vary from these dosages listed.
Parkinson’s Disease Medications – National Parkinson Foundation (4th edition)
Anticholinergic drugs block (antagonize) the action of the neurotransmitter acetylcholine. A neurotransmitter is a chemical released by nerve cells to send signals to other cells. Acetylcholine is involved in transmitting messages that affect muscle contractions in the body and learning and memory in the brain. Drugs with anticholinergic properties have been used in medicine for many decades in the treatment of such diverse conditions as:
Read more:- http://www.drugs.com/article/anticholinergic-drugs-elderly.html
also have a look at Drugs associated with Parkinson's Disease
http://www.drugs.com/condition/parkinson-s-disease.html
========================================================================
http://www.techtimes.com/articles/148080/20160409/commonly-prescribed-parkinsons-drugs-up-risk-of-compulsive-gambling-shopping-binge-eating-hyper-sexuality.htm
Commonly prescribed drugs for the treatment of Parkinson's disease have been linked to an increased risk of Impulse Control Disorder (ICD) in patients, according to a new study.
A class of Parkinson's drugs called dopamine agonists such as pramipexole and ropinirole, are the ones in caution. These drugs aid in controlling the tremors as well as other Parkinson's disease-related symptoms. - See more at: http://www.techtimes.com/articles/148080/20160409/commonly-prescribed-parkinsons-drugs-up-risk-of-compulsive-gambling-shopping-binge-eating-hyper-sexuality.htm#sthash.2IAoC08X.dpuf
This implies that the drug could bring about compulsive behavior, such as addictive gambling, hyper sexuality, compulsive shopping and binge eating.
The study also finds that men are more prone to ICDs and that they showed more inclination to gambling and hyper sexuality, whereas women indulged in compulsive shopping and eating.
ICDs can lead to detrimental situations such as employment issues, divorce, financial problems, not to forget increased health risks.
---------------------------
25th March 2017 - News release
XADAGO APPROVED FOR PARKINSON'S DISEASE
Newron Pharmaceuticals have announced that the U.S. Food and Drug Administration has approved its Parkinson's Disease treatment Xadago as an add-on therapy to L-dopa. Xadago is safinamide, which has dopaminergic properties (highly selective and reversible inhibition of monoamine oxidase-B) and also non-dopaminergic properties (selective sodium channel blockade and calcium channel modulation). For more information go to Xadago
Food and Drug Administration (FDA) has approved the use of Xadago® (safinamide) for the treatment of Parkinson’s disease as add-on therapy to levodopa/carbidopa, on March 21, 2017.
---------------------------
17th May 2017 - New research
LIQUID L-DOPA FOR PARKINSON'S DISEASE
Liquid L-dopa is usually taken as a combination of L-dopa, carbidopa, and ascorbic acid (vitamin C) in a solution called LCAS. Therapy with liquid L-dopa has been used in people with advanced Parkinson's Disease for many years. However, long-term follow-up information is scarce. The present study aimed to determine the long-term retention rate for LCAS therapy, and to identify the causes of LCAS therapy withdrawal.
People with Parkinson's Disease were assessed who had undergone LCAS treatment to alleviate motor complications that were not controlled by optimised conventional Parkinson's Disease treatments. The three main reasons for discontinuation of LCAS treatment were worsening of wearing-off symptoms, persistent dyskinesia, and poor drug adherence. However, there were a small number of each of these. Around 37% of people maintained the LCAS treatment after 12 months. In those people, on time without dyskinesia significantly increased from 33% to 57% after the initiation of LCAS treatment. Around 31% of patients were still receiving LCAS treatment after 30 months. In order to refer to this article on its own click here
Reference : Journal of Neurological Science [2017] 377 : 6-11 (H.J.Yang, G.Ehm, Y.E.Kim, J.Y.Yun, W.W.Lee, A.Kim, H.J.Kim, B.Jeon) Complete abstract
----------------------------
31st December 2018 - News report
THE FDA APPROVE THEIR FIRST INHALED L-DOPA
The FDA have approved INBRIJA, which is the first and only FDA approved L-dopa inhaler for intermittent treatment of OFF episodes in people with Parkinson's Disease taking carbidopa/levodopa. It is expected to be available in the first quarter of 2019. It is based on ARCUS® Technology Platform for Inhaled Drug Delivery. For more information go to : http://ir.acorda.com/investors/investor-news/investor-news-details/2018/Acorda-Therapeutic s-Announces-FDA-Approval-of-INBRIJA-levodopa-inhalation-powder/default.aspx
= - = - = - = - = - = - = - = - = - = - = - =
31st December 2017 - New research
CAMICINAL INCREASES L-DOPA LEVELS IN PARKINSON'S DISEASE
http://www.viartis.net/parkinsons.disease/news/171231.pdf
Delayed gastric emptying can impair absorption of L-dopa, thereby contributing to motor fluctuations. Camicinal (GSK962040), is a gastroprokinetic, which is being assessed for its effect on the absorption of L-dopa and the symptoms of Parkinson's Disease. Gastroprokinetic drugs increase the movement of ingested material through the GI tract.
Patients were given either 50mg camicinal daily for 7 to 9 days or were taking a placebo. Average time to reach maximum L-dopa concentration by taking camicinal was reduced, indicating more rapid absorption of L-dopa.
Camicinal resulted in significant reduction in OFF time, reducing it by 2 hours 18 minutes. There was a significant increase in ON time, increasing it by 1 hour 52 minutes. There was also a significant decrease in mean total MDS-UPDRS score (Parkinson's Disease symptoms). Camicinal treatment was generally well tolerated.
Parkinson's Disease symptom improvement with the use of camicinal occurred in parallel with a more rapid absorption of L-dopa. This study provides evidence of an improvement of the motor response to L-dopa in people with Parkinson's Disease treated with camicinal.
Levodopa –
Carbidopa/levodopa, immediate-release (Sinemet)
Dosages in Milligrams: 10/100, 25/100; 25/250
Typical Treatment Regimens: 150-1000mg of levodopa total daily dose (divided 3-4 times)
Potential Side Effects: Low blood pressure, nausea, confusion, dyskinesia
Indications for Usage: Monotherapy or adjunct therapy for slowness, stiffness, and tremor
Carbidopa/levodopa – oral disintegrating (Parcopa)
Dosages in Milligrams: 10/100; 25/100; 25/250
Typical Treatment Regimens: 150-1000 mg of levodopa total daily dose (divided 3-4 times)
Potential Side Effects: as above
Indications for Usage: as above, plus need for dissolvable medication in the mouth
Carbidopa/levodopa extended-release (Sinemet CR)
Dosages in Milligrams: 25/100; 50/200
Typical Treatment Regimens: 150-1000mg of levodopa total daily dose (divided 204 times)
Potential Side Effects: as above
Indications for Usage: Monotherapy or adjunct therapy for slowness, stiffness, and tremor
Carbidopa/levodopa/Entacapone (Stalevo)
Dosages in Milligrams: 12.5/50/200; 25/100/200; 37.5/150/200; 50/200/200
Typical Treatment Regimens: 150-1000mg of levodopa total daily dose (divided 3-4 times)
Potential Side Effects: Low blood pressure, nausea, confusion, dyskinesia, plus diarrhea and discoloured urine (due to entacapone)
Indications for Usage: Replacement for carbidopa/levodopa for motor fluctuations (benefit of entacapone)
--------------------------------------------------------------------------------------------------------------------------------------
Dopamine agonists
Ropinirole (Requip) Dosages in Milligrams: 0.25; 0.5; 1; 2; 3; 4; 5
Typical Treatment Regimens: 9-24mg total daily dose (divided 3-4 times)
Potential Side Effects: Low blood pressure, nausea, leg swelling & discolouration, confusion, sleep attacks, compulsive behaviour
Indications for Usage: Monotherapy or adjunct therapy for slowness, stiffness, and tremor
Pramipexole (Mirapex)
Dosages in Milligrams: 0.125; 0.25; 0.5; 1, 1.5
Typical Treatment Regimens: 0.5mg to 1.5mg total daily dose (divided 3-4 times)
Potential Side Effects: as above
Indications for Usage: as above
Apomorphine (Apokyn) Dosages in Milligrams: 30mg/3 ml vial
Typical Treatment Regimens: 2 – 6 mg
Potential Side Effects: Significant nausea, must take anti-nausea medication with dose, especially initially with therapy
Indications for Usage: Adjunct therapy for sudden wearing off
---------------------------------------------------------------------------------------------------------------------------------------
MAO-B inhibitors
Selegiline (I-deprenyl, Eldepryl) Dosages in Milligrams: 5
Typical Treatment Regimens: 5 mg twice a day
Potential Side Effects: Agitation, insomnia, vivid dreams, hallucinations, may worsen dyskinesia, possible rare interaction with anti-depressants and other drug classes
Indications for Usage: Monotherapy for slowness, stiffness, and tremor, adjunct therapy for motor fluctuations
Rasagiline (Azilect) Dosages in Milligrams: 0.5; 1.0
Typical Treatment Regimens: 1 mg once daily
Potential Side Effects: as above
Indications for Usage: as above
Zydis selegiline HCL Oral disintegrating (Zelapar)
Dosages in Milligrams: 1.25; 2.5
Typical Treatment Regimens: 1.25- 2.5mg once daily
Potential Side Effects: as above
Indications for Usage: as above
---------------------------------------------------------------------------------------------------------------------------------------
COMT-inhibitors
Entacapone (Comtan) Dosages in Milligrams: 200
Typical Treatment Regimens: 200 mg 3-4 times daily (with each levodopa dose)
Potential Side Effects: Diarrhea, discoloured urine, plus enhancing side effects of levodopa, especially dyskinesia
Indications for Usage: Adjunct therapy for motor fluctuations
Tolcapone (Tasmar) Dosages in Milligrams: 100
Typical Treatment Regimens: 100 mg up to 3 times daily
Potential Side Effects: Diarrhea, discoloured urine, plus enhancing side effects of levodopa, especially dyskinesia, plus increased risk of liver failure
Indications for Usage: Adjunct therapy for motor fluctuations (second-line due to side effects)
---------------------------------------------------------------------------------------------------------------------------------------
Other anti-parkinson medications
Amantadine (Symmetrel) Dosages in Milligrams: 100 mg capsules, 50mg/4ml suspension
Typical Treatment Regimens: 100 mg 2-3 times daily
Potential Side Effects: Nausea, confusion, leg discolouration (livido reticularis), mild anti-cholinergic effects (see Anti-cholinergies below)
Indications for Usage: Monotherapy for slowness, stiffness, and tremor, adjunct therapy for motor fluctuations, especially for dyskinesia
----------------------------------------------------------------------------------------------------------------------------------------
Anti-cholinergics
Trihexyphenidyl (formerly Artane) Dosages in Milligrams: 2.5
Typical Treatment Regimens: 1-2 mg 2 or 3 times daily
Potential Side Effects: Confusion, memory issues, hallucinations, dry mouth, blurry vision, urinary retention
Indications for Usage: Monotherapy or Adjunct therapy predominantly for tremor in younger people
Benztropine (Cogentin) Dosages in Milligrams: 0.5; 1; 2
Typical Treatment Regimens: 0.5 – 2mg 2 or 3 times daily
Potential Side Effects: as above
Indications for Usage: as above
----------------------------------------------------------------------------------------------------------------------------------------
Key: monotherapy = medication used alone.
Adjunct therapy = medication added to other medications
Typical treatment regimens should act only as a guide. The prescribed dosage by your doctor and your effective dose may vary from these dosages listed.
Parkinson’s Disease Medications – National Parkinson Foundation (4th edition)
Anticholinergic drugs block (antagonize) the action of the neurotransmitter acetylcholine. A neurotransmitter is a chemical released by nerve cells to send signals to other cells. Acetylcholine is involved in transmitting messages that affect muscle contractions in the body and learning and memory in the brain. Drugs with anticholinergic properties have been used in medicine for many decades in the treatment of such diverse conditions as:
Read more:- http://www.drugs.com/article/anticholinergic-drugs-elderly.html
also have a look at Drugs associated with Parkinson's Disease
http://www.drugs.com/condition/parkinson-s-disease.html
========================================================================
http://www.techtimes.com/articles/148080/20160409/commonly-prescribed-parkinsons-drugs-up-risk-of-compulsive-gambling-shopping-binge-eating-hyper-sexuality.htm
Commonly prescribed drugs for the treatment of Parkinson's disease have been linked to an increased risk of Impulse Control Disorder (ICD) in patients, according to a new study.
A class of Parkinson's drugs called dopamine agonists such as pramipexole and ropinirole, are the ones in caution. These drugs aid in controlling the tremors as well as other Parkinson's disease-related symptoms. - See more at: http://www.techtimes.com/articles/148080/20160409/commonly-prescribed-parkinsons-drugs-up-risk-of-compulsive-gambling-shopping-binge-eating-hyper-sexuality.htm#sthash.2IAoC08X.dpuf
This implies that the drug could bring about compulsive behavior, such as addictive gambling, hyper sexuality, compulsive shopping and binge eating.
The study also finds that men are more prone to ICDs and that they showed more inclination to gambling and hyper sexuality, whereas women indulged in compulsive shopping and eating.
ICDs can lead to detrimental situations such as employment issues, divorce, financial problems, not to forget increased health risks.
---------------------------
25th March 2017 - News release
XADAGO APPROVED FOR PARKINSON'S DISEASE
Newron Pharmaceuticals have announced that the U.S. Food and Drug Administration has approved its Parkinson's Disease treatment Xadago as an add-on therapy to L-dopa. Xadago is safinamide, which has dopaminergic properties (highly selective and reversible inhibition of monoamine oxidase-B) and also non-dopaminergic properties (selective sodium channel blockade and calcium channel modulation). For more information go to Xadago
Food and Drug Administration (FDA) has approved the use of Xadago® (safinamide) for the treatment of Parkinson’s disease as add-on therapy to levodopa/carbidopa, on March 21, 2017.
---------------------------
17th May 2017 - New research
LIQUID L-DOPA FOR PARKINSON'S DISEASE
Liquid L-dopa is usually taken as a combination of L-dopa, carbidopa, and ascorbic acid (vitamin C) in a solution called LCAS. Therapy with liquid L-dopa has been used in people with advanced Parkinson's Disease for many years. However, long-term follow-up information is scarce. The present study aimed to determine the long-term retention rate for LCAS therapy, and to identify the causes of LCAS therapy withdrawal.
People with Parkinson's Disease were assessed who had undergone LCAS treatment to alleviate motor complications that were not controlled by optimised conventional Parkinson's Disease treatments. The three main reasons for discontinuation of LCAS treatment were worsening of wearing-off symptoms, persistent dyskinesia, and poor drug adherence. However, there were a small number of each of these. Around 37% of people maintained the LCAS treatment after 12 months. In those people, on time without dyskinesia significantly increased from 33% to 57% after the initiation of LCAS treatment. Around 31% of patients were still receiving LCAS treatment after 30 months. In order to refer to this article on its own click here
Reference : Journal of Neurological Science [2017] 377 : 6-11 (H.J.Yang, G.Ehm, Y.E.Kim, J.Y.Yun, W.W.Lee, A.Kim, H.J.Kim, B.Jeon) Complete abstract
----------------------------
31st December 2018 - News report
THE FDA APPROVE THEIR FIRST INHALED L-DOPA
The FDA have approved INBRIJA, which is the first and only FDA approved L-dopa inhaler for intermittent treatment of OFF episodes in people with Parkinson's Disease taking carbidopa/levodopa. It is expected to be available in the first quarter of 2019. It is based on ARCUS® Technology Platform for Inhaled Drug Delivery. For more information go to : http://ir.acorda.com/investors/investor-news/investor-news-details/2018/Acorda-Therapeutic s-Announces-FDA-Approval-of-INBRIJA-levodopa-inhalation-powder/default.aspx
= - = - = - = - = - = - = - = - = - = - = - =
31st December 2017 - New research
CAMICINAL INCREASES L-DOPA LEVELS IN PARKINSON'S DISEASE
http://www.viartis.net/parkinsons.disease/news/171231.pdf
Delayed gastric emptying can impair absorption of L-dopa, thereby contributing to motor fluctuations. Camicinal (GSK962040), is a gastroprokinetic, which is being assessed for its effect on the absorption of L-dopa and the symptoms of Parkinson's Disease. Gastroprokinetic drugs increase the movement of ingested material through the GI tract.
Patients were given either 50mg camicinal daily for 7 to 9 days or were taking a placebo. Average time to reach maximum L-dopa concentration by taking camicinal was reduced, indicating more rapid absorption of L-dopa.
Camicinal resulted in significant reduction in OFF time, reducing it by 2 hours 18 minutes. There was a significant increase in ON time, increasing it by 1 hour 52 minutes. There was also a significant decrease in mean total MDS-UPDRS score (Parkinson's Disease symptoms). Camicinal treatment was generally well tolerated.
Parkinson's Disease symptom improvement with the use of camicinal occurred in parallel with a more rapid absorption of L-dopa. This study provides evidence of an improvement of the motor response to L-dopa in people with Parkinson's Disease treated with camicinal.