Parkinson's disease is a long term degenerative
disease which influences the central nervous system. Until today, there is no
remedy for the condition, yet there are medicines and treatments accessible to
address a portion of the signs and improve the life of patients.
Drugs and therapies used in the treatment of Parkinson’s
disease:
Increasing dopamine levels
The
symptoms of PD are mainly due to low levels of dopamine in the brain. Dopamine
is a chemical messenger or neurotransmitter. Most drugs for the condition aim
to either replenish dopamine levels or mimic its action. These are called
dopaminergic drugs.
Dopaminergic
medications can:
·
reduce rigidity and muscle stiffness
·
improve the speed of movement
·
help with coordination
·
lessen tremor
Levodopa
Levodopa
is the most effective medication for PD. Nerve cells in the brain absorb the
drug and turn it into dopamine.
The person will take levodopa orally in either tablet or liquid form.
Its
side effects include:
·
nausea
·
vomiting
·
fatigue
·
dizziness
Carbidopa-levodopa
This
combination drug, which is available under the brand name Sinemet, contains
both carbidopa and levodopa.
Carbidopa
prevents the destruction of levodopa by enzymes in the digestive tract and
reduces some of its side effects, including nausea.
As
Parkinson's disease progresses, long-term treatment with levodopa may become
less effective.
The doctor may have to change the dosage by amending the size or frequency of the
doses. However, the individual will need to continue using the drug because
stopping it suddenly can result in withdrawal symptoms.
The
side effects of this combination drug may include:
·
mental disturbances, such as confusion, delusions, and
hallucinations
·
involuntary movements, such as jerking or twisting
People
taking this drug may also have a higher risk of liver, kidney, and cardiovascular
problems and be more likely to develop glaucoma.
The
long-term use of levodopa, either alone or in combination with carbidopa,
increases the risk of:
·
fluctuating motor responses
·
uncontrolled, involuntary movements known as dyskinesia
For
this reason, a doctor may prescribe a dopamine agonist instead.
Dopamine agonists
These
drugs mimic the effects of dopamine in the brain. The neurons react to them as
they would to dopamine.
Dopamine
agonists can be a good alternative to levodopa as they have a lower risk of
long-term complications.
However,
they can have similar side effects to carbidopa-levodopa.
The
side effects may include:
·
mental confusion
·
nausea
·
low blood pressure
·
sleepiness
·
muscle cramps
Dopamine
agonists may not be suitable for people with a history of cardiovascular
disease, depression, or psychosis.
Monoamine oxidase-B inhibitors (MAO-B inhibitors)
MAO-B
inhibitors are another alternative to levodopa. Examples include selegiline and
rasagiline.
These
drugs work by blocking the effects of an enzyme called monoamine oxidase-B
(MAO-B), which destroys dopamine in the brain. Blocking MAO-B allows the
dopamine to last for longer in this organ.
MAO-B
inhibitors have a less significant effect than levodopa, but it is possible to
take them together with levodopa or dopamine agonists.
There
is a risk that MAO-B inhibitors will have adverse interactions with some
depression medications and certain narcotics. They also have some side effects,
including:
·
dizziness
·
headache
·
stomach pain
·
vivid dreams
·
fever
·
conjunctivitis
Catechol O-methyltransferase (COMT) inhibitors
This
type of medication blocks COMT, an enzyme that breaks down levodopa. By doing
this, it can prolong the effect of carbidopa-levodopa therapy.
Anticholinergics
These
medications control tremor. Examples include trihexyphenidyl (Artane) and
benztropine (Cogentin).
However,
some people prefer not to use these drugs because of the side effects, which
can include:
·
urine retention, especially in people with an enlarged prostate
·
severe constipation
·
nausea
·
Depression, psychosis, and dementia
Depression
is a common problem for people with PD.
The
Neurosurgeons recommend amitriptyline for treating depression, stating that
there is currently insufficient evidence to support the use of other
treatments.
Psychosis
can also occur, and this becomes more severe as the disease progresses.
Clozapine (Clozaril) can treat psychosis, but doctors should monitor the person
carefully as this medication can have severe adverse effects.
Dementia
develops over time in many people with PD, especially if they have PD with Lewy
bodies.
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