DOCSLIB.ORG

Ropinirole Immediate Release (IR) and Modified Release (MR) ESCA: for the Treatment of Parkinson’S Disease AREAS of RESPONSIBILITY for the SHARING of CARE

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Ropinirole Immediate Release (IR) and Modified Release (MR) ESCA: for the Treatment of Parkinson’S Disease AREAS of RESPONSIBILITY for the SHARING of CARE Effective Shared Care Agreement (ESCA) Ropinirole Immediate Release (IR) and Modified Release (MR) ESCA: For the treatment of parkinson’s disease AREAS OF RESPONSIBILITY FOR THE SHARING OF CARE This shared care agreement outlines suggested ways in which the responsibilities for managing the prescribing of ropinirole IR/MR for parkinson’s disease can be shared between the specialist and general practitioner (GP). You are invited to participate however, if you do not feel confident to undertake this role, then you are under no obligation to do so. In such an event, the total clinical responsibility for the patient for the diagnosed condition remains with the specialist. Sharing of care assumes communication between the specialist, GP and patient. The intention to share care will be explained to the patient by the specialist initiating treatment. It is important that patients are consulted about treatment and are in agreement with it. Patients with parkinson’s disease are usually under regular specialist follow-up, which provides an opportunity to discuss drug therapy. The doctor who prescribes the medication legally assumes clinical responsibility for the drug and the consequences of its use. RESPONSIBILITIES and ROLES Specialist responsibilities 1. Confirm the diagnosis of parkinson’s disease can 2. Discuss the potential benefits, treatment side effects, and possible drug interactions with the patient 3. Ask the GP whether he or she is willing to participate in shared care before initiating therapy so that appropriate follow on prescribing arrangements can be made 4. Do baseline monitoring prior to initiation of ropinirole IR/MR 5. Initiate treatment and stabilise dose of ropinirole IR/MR 6. Review the patient's condition and monitor response to treatment regularly 7. A written summary to be sent promptly to the GP i.e. within 10 working days of a hospital outpatient review or inpatient stay 8. Report serious adverse events to the MHRA 9. Ensure clear backup arrangements exist for GPs, for advice and support (Please complete details below) General Practitioner responsibilities 1. Reply to the request for shared care as soon as practicable i.e. within 10 working days 2. Prescribe ropinirole IR/MR at the dose recommended 3. In the patient's notes, using the appropriate Read Code listed below, denote that the patient is receiving treatment under a shared care agreement GP Prescribing System Read Code Description GP Prescribing System Read Code Description EMIS and Vision 8BM5.00 Shared care prescribing SystmOne XaB58 Shared care 4. Monitor patient’s response to treatment; make dosage adjustments if agreed with specialist 5. Report to and seek advice from the specialist or clinical nurse specialist on any aspect of patient care that is of concern to the GP, patient or carer and may affect treatment 6. Refer back to specialist if condition deteriorates 7. Report serious adverse events to specialist and MHRA 8. Stop treatment on advice of specialist Patient's role 1. Report to the specialist, clinical nurse specialist or GP if he or she does not have a clear understanding of the treatment 2. Share any concerns in relation to treatment with ropinirole IR/MR with the specialist, clinical nurse specialist or GP 3. Report any adverse effects to the specialist or GP whilst taking ropinirole IR/MR 4. Attend regular outpatient appointments with the specialist BACK-UP ADVICE AND SUPPORT Trust Contact details Telephone No. Email address: Consultant:- Specialist Nurse Birmingham, Sandwell, Solihull and environs Area Prescribing Committee (BSSE APC) Based on MTRAC template Prepared by Satnaam Singh Nandra 1 Ropinirole Immediate Release (IR) and Modified Release (MR) ESCA Interface Lead Pharmacist Birmingham CrossCity CCG Date: July 2015 Review date: July 2018 SUPPORTING INFORMATION Indication Treatment of Parkinson's Disease under the following conditions: Initial treatment as monotherapy, in order to delay the introduction of levodopa In combination with levodopa, over the course of the disease, when the effect of levodopa wears off or becomes inconsistent and fluctuations in the therapeutic effect occur (“end of dose” or “on-off” type fluctuations) Dosage and Immediate release tablets Modified release tablets Administration Individual dose titration against efficacy and tolerability is recommended. Individual dose titration against efficacy and tolerability is recommended. Ropinirole should be taken three times a day, preferably with meals to improve Ropinirole prolonged-release tablets should be taken once a day and at a similar gastrointestinal tolerance. time each day. The tablets must be swallowed whole and must not be chewed, crushed or divided. The tablets may be taken with or without food. Treatment initiation: The initial dose should be 0.25 mg three times daily for 1 week. Thereafter, the dose of ropinirole can be increased in 0.25 mg three times Initial titration daily increments, according to the following regimen: The starting dose of ropinirole prolonged-release tablets is 2 mg once daily for the first week; this should be increased to 4 mg once daily from the second week of Week treatment. A therapeutic response may be seen at a dose of 4 mg once daily of ropinirole prolonged-release tablets. 1 2 3 4 Unit dose (mg) of ropinirole 0.25 0.5 0.75 1.0 Patients who initiate treatment with a dose of 2 mg/day of ropinirole prolonged- Total daily dose (mg) of ropinirole 0.75 1.5 2.25 3.0 release tablets and who experience side effects that they cannot tolerate, may benefit from switching to treatment with ropinirole film-coated (immediate Therapeutic regimen: After the initial titration, weekly increments of 0.5 to 1 mg release) tablets at a lower daily dose, divided into three equal doses. three times daily (1.5 to 3 mg/day) of ropinirole may be given. Therapeutic regimen A therapeutic response may be seen between 3 and 9 mg/day of ropinirole. If Patients should be maintained on the lowest dose of ropinirole prolonged-release sufficient symptomatic control is not achieved, or maintained after the initial tablets that achieves symptomatic control. titration as described above, the dose of ropinirole may be increased up to 24 mg/day. If sufficient symptomatic control is not achieved or maintained at a dose of 4 mg once daily of ropinirole prolonged-release tablets, the daily dose may be increased Doses of ropinirole above 24 mg/day have not been studied. by 2 mg at weekly or longer intervals up to a dose of 8 mg once daily of prolonged- release tablets. If treatment is interrupted for one day or more re-initiation by dose titration should be considered (see above). If sufficient symptomatic control is still not achieved or maintained at a dose of 8 mg once daily of ropinirole prolonged-release tablets, the daily dose may be When ropinirole is administered as adjunct therapy to L-dopa, the concurrent increased by 2 mg to 4 mg at two weekly or longer intervals. The maximum daily dose of L-dopa may be reduced gradually according to the symptomatic response. dose of ropinirole prolonged-release tablets is 24 mg. In clinical trials, the levodopa dose was reduced gradually by around 20% in patients treated with ropinirole as adjunct therapy.. In patients with advanced It is recommended that patients are prescribed the minimum number of ropinirole Birmingham, Sandwell, Solihull and environs Area Prescribing Committee (BSSE APC) Based on MTRAC template Prepared by Satnaam Singh Nandra 2 Ropinirole Immediate Release (IR) and Modified Release (MR) ESCA Interface Lead Pharmacist Birmingham CrossCity CCG Date: July 2015 Review date: July 2018 Parkinson's disease receiving ropinirole in combination with L-dopa, dyskinesias prolonged-release tablets that are necessary to achieve the required dose by can occur during the initial titration of ropinirole. In clinical trials it was shown that utilising the highest available strengths of ropinirole prolonged-release tablets. a reduction of the L-dopa dose may ameliorate dyskinesia When ropinirole prolonged-release tablets are administered as adjunct therapy to When switching treatment from another dopamine agonist to ropinirole, the levodopa, it may be possible to gradually reduce the levodopa dose, depending on manufacturer's guidance on discontinuation should be followed before initiating the clinical response. In clinical trials, the levodopa dose was reduced gradually by ropinirole. approximately 30% in patients receiving ropinirole prolonged-release tablets concurrently. In patients with advanced Parkinson's disease receiving ropinirole As with other dopamine agonists, it is necessary to discontinue ropinirole prolonged-release tablets in combination with L-dopa, dyskinesias can occur treatment gradually by reducing the number of daily doses over the period of one during the initial titration of ropinirole prolonged-release tablets. In clinical trials it week. was shown that a reduction of the L-dopa dose may ameliorate dyskinesia When switching treatment from another dopamine agonist to ropinirole, the marketing authorisation holder's guidance on discontinuation should be followed before initiating ropinirole. As with other dopamine agonists, it is necessary to discontinue ropinirole treatment gradually by reducing the daily dose over the period of one week. Switching from ropinirole immediate release tablets to ropinirole prolonged- release tablets Patients may be switched overnight from ropinirole immediate release tablets to ropinirole prolonged-release tablets. The dose of ropinirole prolonged-release
Load more

Recommended publications
  • Apo-Ropinirole
    New Zealand Data Sheet APO-ROPINIROLE 1. PRODUCT NAME APO-ROPINIROLE 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg and 5mg tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Ropinirole hydrochloride 0.25mg Ropinirole hydrochloride 0.5mg Ropinirole hydrochloride 1mg Ropinirole hydrochloride 2mg Ropinirole hydrochloride 3mg Ropinirole hydrochloride 4mg Ropinirole hydrochloride 5mg Excipient(s) with known effect Contains lactose. For the full list of excipients, see section 6.1 3. PHARMACEUTICAL FORM APO-ROPINIROLE is available as oral, film coated tablets in the following strengths: APO-ROPINIROLE 0.25mg tablets are white, pentagonal, biconvex film-coated tablet identified by an engraved “ROP” over “.25” on one side and “APO’ on the other side. Each tablet typically weighs about 153mg. APO-ROPINIROLE 0.5mg tablets are yellow, pentagonal, biconvex film-coated tablet identified by an engraved “ROP” over “.5” on one side and “APO’ on the other side. Each tablet typically weighs about 153mg. APO-ROPINIROLE 1mg tablets are green, pentagonal, biconvex film-coated tablet identified by an engraved “ROP” over “1” on one side and “APO’ on the other side. Each tablet typically weighs about 153mg. APO-ROPINIROLE 2mg tablets are pink, pentagonal, biconvex film-coated tablet identified by an engraved “ROP” over “2” on one side and “APO’ on the other side. Each tablet typically weighs about 153mg. APO-ROPINIROLE 3mg tablets are purple, pentagonal, biconvex film-coated tablet identified by an engraved “ROP” over “3” on one side and “APO’ on the other side. Each tablet typically weighs about 153mg. APO-ROPINIROLE 4mg tablets are pale brown, pentagonal, biconvex film-coated tablet identified by an engraved “ROP” over “4” on one side and “APO’ on the other side.
    [Show full text]
  • Integrated Approaches for Genome-Wide Interrogation of The
    MINIREVIEW THE JOURNAL OF BIOLOGICAL CHEMISTRY VOL. 290, NO. 32, pp. 19471–19477, August 7, 2015 © 2015 by The American Society for Biochemistry and Molecular Biology, Inc. Published in the U.S.A. 5-HT serotonin receptor agonism have long been docu- Integrated Approaches for 2B mented to induce severe, life-threatening valvular heart disease Genome-wide Interrogation of (6–8). Indeed, based on the potent 5-HT2B agonist activity of the Druggable Non-olfactory G certain ergot derivatives used in treating Parkinson disease and migraine headaches (e.g. pergolide, cabergoline, and dihydroer- Protein-coupled Receptor gotamine), we correctly predicted that these medications * would also induce valvular heart disease (7, 8). Two of these Superfamily drugs (pergolide and cabergoline) were withdrawn from the Published, JBC Papers in Press, June 22, 2015, DOI 10.1074/jbc.R115.654764 Bryan L. Roth1 and Wesley K. Kroeze international market following large-scale trials demonstrating From the Department of Pharmacology, University of North Carolina their life-threating side effects (8, 9). In follow-up studies, we Chapel Hill School of Medicine, Chapel Hill, North Carolina 27514 surveyed 2200 FDA-approved and investigational medications, finding that 27 had potentially significant 5-HT2B agonism, of G-protein-coupled receptors (GPCRs) are frequent and fruit- which 6 are currently FDA-approved (guanfacine, quinidine, ful targets for drug discovery and development, as well as being xylometazoline, oxymetazoline, fenoldopam, and ropinirole) off-targets for the side effects of a variety of medications. Much (10). Interestingly, of the 2200 drugs screened, around 30% dis- of the druggable non-olfactory human GPCR-ome remains played significant 5-HT2B antagonist activity (10), indicating under-interrogated, and we present here various approaches that 5-HT2B receptors represent a “promiscuous target” for that we and others have used to shine light into these previously approved and candidate medications.
    [Show full text]
  • Neuronal Dopamine D3 Receptors: Translational Implications for Preclinical Research and CNS Disorders
    biomolecules Review Neuronal Dopamine D3 Receptors: Translational Implications for Preclinical Research and CNS Disorders Béla Kiss 1, István Laszlovszky 2, Balázs Krámos 3, András Visegrády 1, Amrita Bobok 1, György Lévay 1, Balázs Lendvai 1 and Viktor Román 1,* 1 Pharmacological and Drug Safety Research, Gedeon Richter Plc., 1103 Budapest, Hungary; [email protected] (B.K.); [email protected] (A.V.); [email protected] (A.B.); [email protected] (G.L.); [email protected] (B.L.) 2 Medical Division, Gedeon Richter Plc., 1103 Budapest, Hungary; [email protected] 3 Spectroscopic Research Department, Gedeon Richter Plc., 1103 Budapest, Hungary; [email protected] * Correspondence: [email protected]; Tel.: +36-1-432-6131; Fax: +36-1-889-8400 Abstract: Dopamine (DA), as one of the major neurotransmitters in the central nervous system (CNS) and periphery, exerts its actions through five types of receptors which belong to two major subfamilies such as D1-like (i.e., D1 and D5 receptors) and D2-like (i.e., D2, D3 and D4) receptors. Dopamine D3 receptor (D3R) was cloned 30 years ago, and its distribution in the CNS and in the periphery, molecular structure, cellular signaling mechanisms have been largely explored. Involvement of D3Rs has been recognized in several CNS functions such as movement control, cognition, learning, reward, emotional regulation and social behavior. D3Rs have become a promising target of drug research and great efforts have been made to obtain high affinity ligands (selective agonists, partial agonists and antagonists) in order to elucidate D3R functions. There has been a strong drive behind the efforts to find drug-like compounds with high affinity and selectivity and various functionality for D3Rs in the hope that they would have potential treatment options in CNS diseases such as schizophrenia, drug abuse, Parkinson’s disease, depression, and restless leg syndrome.
    [Show full text]
  • Early Piribedil Monotherapy of Parkinson's Disease
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Repositório Científico do Centro Hospitalar do Porto Movement Disorders Vol. 21, No. 12, 2006, pp. 2110–2115 © 2006 Movement Disorder Society Early Piribedil Monotherapy of Parkinson’s Disease: A Planned Seven-Month Report of the REGAIN Study Olivier Rascol, MD, PhD,1* Bruno Dubois, MD,2 Alexandre Castro Caldas, MD,3 Stephen Senn, MD,4 Susanna Del Signore, MD,5 and Andrew Lees, MD,6 on behalf of the Parkinson REGAIN Study Group 1INSERM U455, Clinical Investigation Center and Departments of Clinical Pharmacology and Neurosciences, Faculte´deMe´decine, Toulouse, France 2INSERM U610/Groupe Hospitalier Pitie´-Salpeˆtrie`re, Paris, France 3Instituto de Cie¨nsas da Sau`de, Lisbon, Portugal 4Department of Statistics, University of Glasgow, Glasgow, United Kingdom 5Institut de Recherches Internationales Servier, Courbevoie, France 6Royal Free and University College Medical School, University College London/Reta Lila, Weston Institute of Neurological Studies, London, United Kingdom Abstract: Piribedil is a D2 dopamine agonist, which has been significantly higher for piribedil (42%) than for placebo (14%) shown to improve symptoms of Parkinson’s disease (PD) when (OR ϭ 4.69; 95% CI ϭ 2.82–7.80; P Ͻ 0.001). Piribedil combined with L-dopa. The objective of this study was to significantly improved several UPDRS III subscores. UPDRS compare the efficacy of piribedil monotherapy to placebo in II improved on piribedil by Ϫ1.2 points, while it deteriorated patients with early PD over a 7-month period. Four hundred by 1.5 points on placebo (estimated effect ϭ 2.71; 95% CI ϭ and five early PD patients were randomized (double-blind) to 1.8–3.62; P Ͻ 0.0001).
    [Show full text]
  • Augmentation Suffering and What Can Be Done About It
    AUGMENTATION SUFFERING AND WHAT CAN BE DONE ABOUT IT John W. Winkelman MD PhD Massachusetts General Hospital Harvard Medical School Boston, MA Disclosure Information Type of Affiliation Commercial Entity Consultant/Honoraria UCB Research Grant Purdue Pharma UCB WHITE PAPER SUMMARY OF RECOMMENDATIONS FOR THE PREVENTION AND TREATMENT OF RLS/WED AUGMENTATION A COMBINED TASK FORCE OF THE IRLSSG, EURLSSG AND THE RLS-FOUNDATION AUGMENTATION Augmentation is a long-term (6 months-years) complication of RLS treatment with dopaminergic medications Dopaminergic (DA) medications: ­ Levodopa (Sinemet) ­ Pramipexole (Mirapex) ­ Ropinirole (Requip) ­ Rotigotine (Neupro) AUGMENTATION DEFINITION Compared to before medication was initiated there is: ­ Advance in the time of symptom onset ­ More intense symptoms ­ Symptoms start faster after lying down/sitting ­ Extension of symptoms to arms In short, RLS gets worse with medication treatment! AUGMENTATION SEVERITY EXISTS ALONG A CONTINUUM Pre-augmentation/tolerance: DA medication dose needs to be increased to maintain effectiveness but there is no change in timing of symptoms Mild: 2-4 hour advance in time of RLS symptom onset, most days Severe: 4-8 hour advance in the time of RLS symptom onset, most days Very severe: RLS symptoms present much of the day and night WHAT WORSENS RLS BUT ISN’T AUGMENTATION Iron deficiency Medication effects ­ Antidepressants ­ Antihistamines ­ Dopamine blockers (anti-nausea or antipsychotics) Sleep disruption/deprivation (eg sleep apnea, insomnia) More time spent immobile (in
    [Show full text]
  • Ropinirole 0.25 Mg Film-Coated Tablets
    Package leaflet: Information for the patient Ropinirole 0.25mg Film-coated Tablets Ropinirole 0.5 mg Film-coated Tablets Ropinirole 1 mg Film-coated Tablets Ropinirole 2 mg Film-coated Tablets ropinirole Read all of this leaflet carefully before you start taking this medicine because it contains important information for you. - Keep this leaflet. You may need to read it again. - If you have any further questions, ask your doctor or pharmacist. - This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours. - If you get any side effects talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4. What is in this leaflet 1. What Ropinirole is and what it is used for 2. What you need to know before you take Ropinirole 3. How to take Ropinirole 4. Possible side effects 5. How to store Ropinirole 6. Contents of the pack and other information 1. What Ropinirole is and what it is used for The active substance in Ropinirole is ropinirole, which belongs to a group of medicines called dopamine agonists. Dopamine agonists affect the brain in a similar way to a natural substance called dopamine. Ropinirole is used to treat Parkinson’s disease. People with Parkinson’s disease have low levels of dopamine in some parts of their brains. Ropinirole has effects similar to those of natural dopamine, so it helps to reduce the symptoms of Parkinson’s disease.
    [Show full text]
  • Dopamine Agonists 1
    VA/DoD Drug Class Review: Dopamine Agonists 1 VA/DoD Drug Class Review: Dopamine Agonists Department of Defense Pharmacoeconomic Center (DoD PEC) Department of Veterans Affairs Pharmacy Benefits Management Strategic Healthcare Group (VA PBM) and the VA Medical Advisory Panel (VA MAP) Introduction The purpose of this review is to evaluate whether the dopamine agonists (DA) are therapeutically interchangeable. The dopamine agonists are subcategorized as ergoline and non-ergoline. The ergoline compounds (bromocriptine and pergolide) are derived from the ergot alkaloids. The non-ergoline compounds include pramipexole and ropinirole. Though the exact mechanism of action in Parkinsonism is unknown, all of the dopamine agonists are thought to work by directly stimulating postsynaptic dopaminergic receptors in the nigrostriatal system. The two ergoline agents were introduced into the market in the 1980’s. Only bromocriptine, which was FDA- approved prior to January 1, 1982, is available in generic form. Table 1: Dopamine agonists available in the U.S for the treatment of Parkinson’s disease Strengths & FDA approval Generic Brand (Manufacturer) formulations date Bromocriptine Parlodel (Novartis); Generics Tablets 2.5, and 5 mg N/A* available Pergolide Permax (Amarin) Generics Tablets 0.05, 0.25, and 1 mg 12/30/88 availab le** Pramipexole Mirapex (Pharmacia) Tablets 0.125, 0.25, 0.5, 1, 7/1/97 and 1.5 mg Ropinirole Requip (SKB) Tablets 0.25, 0.5, 1, 2, 3, 4 9/19/97 and 5 mg *Parlodel was approved prior to Jan 1, 1982. ** pergolide was voluntarily withdrawn from the market on March 29, 2007 Parkinson’s Disease is a degenerative brain disorder that affects approximately 500,000 to 1 million people in the United States.
    [Show full text]
  • DRUG TREATMENTS for Parkinson's
    DRUG TREATMENTS FOR Parkinson’s 1 There is no cure yet for Parkinson’s but there are The content in this booklet is designed to be dipped in and out many different drugs that can of – don’t feel like you need to help manage the symptoms. read everything in one go. This is particularly true because what This booklet is for people works for you when starting with Parkinson’s and their treatment for Parkinson’s may family, friends and carers. change later on. It provides information Reading the bits of this about the drugs most information that you need will commonly used to help also make this booklet more manage the condition. manageable and relevant for you. This booklet starts with some key practical points about the drugs used for treating Parkinson’s, then gives further details about categories of drugs and individual drugs. There is also a summary that gives an overview list of Parkinson’s drugs. Choosing the right medication is always a decision you should make with your specialist or Parkinson’s nurse. You can show this booklet to your specialist or Parkinson’s nurse and ask them questions about the information here. You may also find it a useful starting point when you are talking about the next steps in your treatment. Contents Section 1 This gives an overview of Parkinson’s medication and is recommended for anyone with the condition. Parkinson’s drugs: an introduction .........................................................6 This includes how drugs work, their names and what treatment to take. Other ways to manage your Parkinson’s .............................................9 This includes exercise and therapies.
    [Show full text]
  • Product Monograph
    PRODUCT MONOGRAPH Pr Ebixa® Memantine Hydrochloride Tablets 10 mg N-methyl-D-aspartate (NMDA) receptor antagonist Lundbeck Canada Inc. Date of revision: 2600 Alfred-Nobel July 8th, 2016 Suite 400 St-Laurent, QC H4S 0A9 Control No. 181785 2 NAME OF DRUG Pr Ebixa® Memantine Hydrochloride Tablets 10 mg THERAPEUTIC CLASSIFICATION N-methyl-D-aspartate (NMDA) receptor antagonist ACTION AND CLINICAL PHARMACOLOGY Persistent activation of the central nervous system N-methyl-D-aspartate (NMDA) receptors by the excitatory amino acid glutamate has been hypothesized to contribute to the symptomatology of Alzheimer’s disease. Memantine is postulated to exert its therapeutic effect through its action as a low to moderate affinity uncompetitive (open channel) NMDA receptor antagonist, which binds preferentially to the NMDA receptor-operated cation channels. It blocks the effects of pathologically elevated sustained levels of glutamate that may lead to neuronal dysfunction. There is no clinical evidence that memantine prevents or slows neurodegeneration or alters the course of the underlying dementing process in patients with Alzheimer’s disease. Memantine exhibits low to negligible affinity for other receptors (GABA, benzodiazepine, dopamine, adrenergic, noradrenergic, histamine and glycine) or voltage-dependent Ca2+, Na+ or K+ channels. In addition, it does not directly affect the acetylcholine receptor or cholinergic transmission, which have been implicated in the cholinomimetic side effects (e.g., increased gastric acid secretion, nausea and vomiting) seen with acetylcholinesterase inhibitors. Memantine showed antagonist effects at the 5HT3 receptor with a potency similar to that for the NMDA receptor. 3 In vitro studies have shown that memantine does not affect the reversible inhibition of acetylcholinesterase by donepezil or galantamine.
    [Show full text]
  • Serotonin Syndrome in Stroke Patients
    J Rehabil Med 2015; 47: 282–285 CASE REPORT Serotonin SYNDROME IN STROKE patients Sung Ho Jang, MD1*, Yong Min Kwon, MD1* and Min Cheol Chang, MD2 From the 1Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University and 2Department of Physical Medicine and Rehabilitation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. *These authors contributed equally to this study. Objective: Serotonin syndrome is a potentially life-threaten- Dopaminergic agents are known to be effective in improve- ing condition that can be caused by administration of agents ment of cognitive, language, motor, and executive function that increase serotonergic activity in the brain. We report in stroke patients (3). Therefore, dopaminergic drugs are here on 2 stroke patients who presented with serotonin syn- often prescribed for stroke patients during rehabilitation; drome following administration of dopaminergic agents. however, administration of dopaminergic drugs is associated Case report: Two stroke patients were administered ropin- with the risk of inducing SS (1, 4, 5). Although SS has been irole (patient 1) and carbidopa/levodopa (patient 2) during reported in other brain pathologies, including depressive rehabilitation. Both patients exhibited the clinical features of disorder and Parkinson’s disease, little is known about SS in serotonin syndrome, coinciding with an increase in dosage of stroke patients (5). each drug. Based on the clinical features included in revised We report here on 2 stroke patients who presented with SS Radomski’s criteria, they presented with 3 major symptoms after administration of dopaminergic agents. with 3 and 2 minor symptoms, respectively. The drugs that were thought to trigger serotonin syndrome were discontin- ued and the patients underwent conservative treatment.
    [Show full text]
  • Neuromodulatory Neurotransmitters Influence LTP-Like Plasticity in Human Cortex: a Pharmaco-TMS Study
    Neuropsychopharmacology (2011) 36, 1894–1902 & 2011 American College of Neuropsychopharmacology. All rights reserved 0893-133X/11 www.neuropsychopharmacology.org Neuromodulatory Neurotransmitters Influence LTP-Like Plasticity in Human Cortex: A Pharmaco-TMS Study Alexei Korchounov1,2 and Ulf Ziemann*,1 1 Department of Neurology, Goethe-University Frankfurt, Frankfurt, Germany Long-term potentiation (LTP) of synaptic efficacy is considered a fundamental mechanism of learning and memory. At the cellular level a large body of evidence demonstrated that the major neuromodulatory neurotransmitters dopamine (DA), norepinephrine (NE), and acetylcholine (ACh) influence LTP magnitude. Noninvasive brain stimulation protocols provide the opportunity to study LTP-like plasticity at the systems level of human cortex. Here we applied paired associative stimulation (PAS) to induce LTP-like plasticity in the primary motor cortex of eight healthy subjects. In a double-blind, randomized, placebo-controlled, crossover design, the acute effects of a single oral dose of the neuromodulatory drugs cabergoline (DA agonist), haloperidol (DA antagonist), methylphenidate (indirect NE agonist), prazosine (NE antagonist), tacrine (ACh agonist), and biperiden (ACh antagonist) on PAS-induced LTP-like plasticity were examined. The antagonists haloperidol, prazosine, and biperiden depressed significantly the PAS-induced LTP-like plasticity observed under placebo, whereas the agonists cabergoline, methylphenidate, and tacrine had no effect. Findings demonstrate that antagonists in major neuromodulatory neurotransmitter systems suppress LTP-like plasticity at the systems level of human cortex, in accord with evidence of their modulating action of LTP at the cellular level. This provides further supportive evidence for the known detrimental effects of these drugs on LTP-dependent mechanisms such as learning and memory.
    [Show full text]
  • Medications for Ataxia Symptoms
    NATIONALFA ATAXIAQ FOUNDATION FREQUENTLY ASKED QUESTIONS ABOUT... Medications for Ataxia Symptoms DISCLAIMER: This fact sheet is designed for educational purposes Depression: SSRI’s (Selective serotonin reuptake only and is not intended to serve as medical advice. The information inhibitors), SNRI’s (Selective norepinephrine-serotonin provided here should not be used for diagnosing or treating a health reuptake inhibitors)--classes of drugs for anxiety or problem or disease. It is not a substitute for professional care. All of these depression medications may have serious side effects and should only be used under a doctor’s supervision. NAF makes no representation or promise regarding the Dizziness/Vertigo: Acetazolamide (Diamox), effectiveness of any drug listed below. 4-aminopyridine, Baclofen, Clonazepam, Flunarizine, Gabapentin (Neurontin), Meclizine, Memantine, At this time, the goals of treatment of ataxia are to Ondansetron (Zofran), Scopolamine (eg. Transderm improve the quality of life for the person with ataxia. Scop Patch for motion sickness) For certain types of ataxia, such as ataxia due to Vitamin E deficiency, specific treatment of the underlying Excessive daytime sleepiness: Modafinil (Provigil) or problem may improve the ataxia itself. But for most Armodafinil (Nuvigil) kinds of ataxia, a treatment or cure for the disease is not yet available, so the focus is on identifying symp- Erectile Dysfunction: Cialis, Levitra, Viagra toms related to or caused by the ataxia, and treating those symptoms. Fatigue: Amantadine, Atomoxetine
    [Show full text]