Rasagiline (“Azilect”) & Selegiline Amantadine Parkinson's Disease Research Education & Clinical Centers (“Eldepryl”) How it works: This medication reduces How they work: These meds slow the body’s dyskinesia and can reduce symptoms of PD in breakdown of levodopa. Some studies suggest some patients that rasagiline & selegeline may slow down the progression of PD, but other studies have not Side Effects: supported this. - Confusion: can cause or worsen confusion Medications in patients with advanced PD Side Effects:
- Minimal. However, they can cause harmful - Hallucinations: can cause or worsen increases in blood pressure if you eat very hallucinations in patients with advanced PD large amounts of food containing tyramine, such as processed meats and some aged - Lower Extremity Edema cheeses, or are taking certain antidepressants or pain meds. Trihexyphenidyl ("Artane")
Entacapone (Comtan) How it works: Trihexphenidyl is used to treat tremor in PD How it works: Slows the body’s breakdown of levodopa and only works when taken with Side Effects: carbidopa-levodopa. This medication can cause or worsen the Side Effects: following problems in older patients: confusion, lightheadedness upon standing, - Can turn urine orange, and rarely can cause urinary retention, dry eyes, hallucinations diarrhea.
- Can worsen the side effects of carbidopa- levodopa.
Stalevo (“Entacapone +Levodopa”) PARKINSON'S DISEASE How it works: Combination of entacapone and levodopa in 1 pill. Reduces the amount of pills Parkinson’s Disease Research taken Education and Clinical Centers Side Effects: same as entacapone. (PADRECC) www.parkinsons.va.gov
1-800-949-1001x5769
Revised 5/2017
What causes Parkinson’s disease? Duopa Ropinirole (“Requip”) & Pramipexole
(“Mirapex”) How it works: Continuous infusion of Parkinson’s disease (PD) is a progressive carbidopa/levodopa through a PEG tube movement disorder caused by a reduction of How they work: These are called “dopamine inserted into the stomach. Eliminates need to specific neurons that produce a chemical called agonists” because they activate the part of the take pills, steady state of symptom control, dopamine. It is required for parts of the brain brain that starts the signal to get moving. that control movement and coordination. Many alternative to deep brain stimulation surgery. Agonists act like dopamine. of the treatments for PD are aimed at replacing Side Effects: abdominal pain, procedure pain, Side Effects: or prolonging dopamine activity. nausea, infection
Common:
Carbidopa-Levodopa (“Sinemet”) Rytary - Mild stomach upset and sleepiness. These tend to go away after a few weeks, and can How it works: Levodopa is converted into dopamine in your brain. Carbidopa stops the How it works: extended-release carbidopa and often be avoided by starting at a low dose and increasing slowly. breakdown of levodopa in blood so that it can levodopa treatment that stays in the blood for a get into the brain. It comes in several forms, longer time. It is in capsule form and contains Less Common: including immediate release (“IR”) and long both immediate-release and extended-release acting (“CR” or “SA”). beads. Used for significant on-off times or - “Sleep attacks:" when sleep comes on very dyskinesia, frequent Sinemet dosing, morning suddenly. Side Effects off symptoms. - Impulse control disorder: some patients - Nausea: It’s ok to take your carbidopa- Side Effects: Nausea, lightheadedness, develop compulsive behaviors like levodopa with a small snack like crackers. It hallucinations and delusions gambling, porn addiction, or overeating. should not be taken with meals, because it competes with protein for absorption, so it’s - Hallucinations and confusion: in patients best to wait an hour before and after meals. Parcopa with advanced PD - Wearing off: after several years of How it works: orally-dissolving form of treatment with carbidopa-levodopa, the carbidopa-levodopa. It comes as a tablet to be medicine can wear off sooner. This can Rotigotine (“Neupro Patch”) placed under the tongue. It is useful in situations result in the need for frequent dosing. How it works: Dopamine Agonist but the where patients cannot swallow medication is released slowly through an easy - Dyskinesia: Patients often develop patch system that only needs to be applied once Side Effects: Same as carbidopa-levodopa “wiggly” or swaying movements after a day. taking carbidopa-levodopa for many years. Side Effects: - Lightheadedness: carbidopa-levodopa can Apomorphine (“Apokyn”) Common lower your blood pressure and cause - Insomnia, nausea, vomiting, reaction at lightheadedness when you stand up How it works: Dopamine Agonist injected under the skin and provides a rapid-onset (about application site (burning, itching, redness, skin rash, swelling, soreness) quickly. 10 mins) that can help “rescue” from sudden off
times and severe freezing. - Hallucinations: carbidopa-levodopa can Less Common:
cause or worsen hallucinations in people - Dizziness, increased or decreased blood Side Effects: Nausea/vomiting, low blood pressure with advanced PD pressure