Parkinson’s disease is a degenerative disorder of the central nervous system that results in shaking, unsteady gait, and difficulty with walking, coordination and movement. It is caused by degeneration of the neurons in the Substantia Nigra of the brain. Over the last few years, there have been changes in the treatment of Parkinson’s disease. There are two different approaches for the diseases treatment using medication. The first approach involves slowing the loss of dopamine in the brain while the second attempts to improve the symptoms of Parkinson.
The main Parkinson’s drug is Sinemet (Levodopa/carbidopa). It is the most prescribed and most effect in controlling Parkinson’s symptoms. Sinemet is a combination of both levodopa and another drug called carbidopa. Levodopa enters the brain and is converted. Carbidopa helps to increase Levodapa’s effectiveness and to help lessen the side effects of the Levodopa such as nausea, vomiting, and irregular heart rhythms. When used over a long period of time, Sinemet can cause restlessness, confusion, and involuntary movements.
Requip (Ropinirole) and Mirapex (Pramipexole) are dopamine agonist. These drugs activate the dopamine receptors. These medications can be taken alone or with Sinemet. Dopamine agonists are usually the first choice when dealing with Parkinson’s disease because the side effects are not as severe as those with Sinemet. They are often used with younger patients. Dopamine agonists do have increased incidents of nausea, vomiting, dizziness, headache fatigue, hypotension, and confusion.
Symmetrel (Amantadine) is antiviral with dopaminergic agonist activity. It is used in the treatment of people with mild Parkinson’s. It helps to increase the amount of dopamine available for use which decreases the symptoms of the disease. The side effects of the drug includes confusion and memory problems.
Tasmar (Tolcapone) and Comtan (Entacopone) are Catechol-O-transferase (COMT) inhibitors. These drugs help to retain dopamine. This reduces the symptoms of Parkinson’s disease. Tasmar and Comtan can also be used in combination with Sinemet to increase the effectiveness of levodopa. The side effects to these are vivid dreams, muscle cramps, nausea, and vomiting.
Eldepryl and Deprenyl (Selegiline) are actually the same drug. They work by inhibiting Monoamine oxidase (MAO) which metabolizes dopamine tin the brain. They are used to treat early Parkinson’s disease. The side effects of MAO inhibitors include nausea, dizziness, confusion, hallucinations, vivid dreams, dry mouth and ankle edema.
Cogentin (Benztropine) and Artane (Trihexyphenidyl) are anticholinergic agents. They are used to control tremors and relieve rigidity. They are used to treat younger patients because they are not tolerated well in patients over 60 because of their adverse side effects. The side effects of anticholinergic agents are constipation, dry mouth, urinary retention, confusion, hallucinations, and urinary retention.
Dr. James Parkinson first described the major symptoms of the disease in 1817. Parkinson called the disease “Shaking Palsy.” The pathological and biochemical changes in the brain of patients were identified in the 1960’s. New and more effective medicines are being discovered all the time. At this time, the current medicines are used to treat the symptoms of Parkinson’s and to slow the loss of dopamine.
