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Drug therapy for Parkinson's disease

 

“People are on different drugs, so it is important to know what they are, what the side effects are and what the positive results are”

 

  • Parkinson’s disease (PD) cannot be cured by drugs, but they can make a huge difference to symptoms and improve quality of life.

  • The severity of PD symptoms varies greatly from one person to another. Not everyone needs drug treatment at first, but nearly all find that drugs help as symptoms progress. It is impossible to suggest any one drug that is best. All have their place and can be useful.

  • In general, PD drugs are most effective at treating slowness of movement and muscle stiffness. They are less effective against poor balance, speech problems and slowness of thinking and memory difficulties.

  • Drugs which replace dopamine in the brain (levodopa preparations, including Sinemet/Co-careldopa and Madopar/Co-beneldopa) are used most widely and are regarded as the ‘gold-standard’. They come in various strengths and formulations.

  • Drugs which mimic dopamine the dopamine agonists, including ropinirole (Requip), cabergoline (Cabaser), pramipexole (Mirapexin) and bromocriptine (Parlodel) are newer. Some specialists think that using them early delays need for levodopa and reduces long term side effects. They can be used alone, or with levodopa.

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  • Other common PD drugs include selegiline (Eldepryl), amantadine (Symmetrel), and the COMT inhibitor drug, entacapone (Comtess). These are usually used with levodopa or a dopamine agonist. The anticholinergic drugs trihexyphenidyl/ benzhexol (Disipal), orphenadrine and procyclidine (Kemadrin) cause side effects in older people and are seldom useful (except if tremor is very severe).

  • Some people have side effects of nausea, dizziness, sleep disturbance, hallucinations or confusion when they first start PD drugs. These usually can be controlled with adjustment of the dose, or time it is taken, especially in relation to food. Using an additional anti-sickness drug, called domperidone, may sometimes help.

  • The best dose of the drugs can only be found out by trial and error. Usually a very low dose is first given and gradually increased until the best effect is achieved.

  • After months or a few years, the drugs can become less effective, taking longer to act and wearing off abruptly (known as on/off phenomenon). New side effects of involuntary muscle twisting movements (known as dyskinesias) can also develop. Extra care is then needed with timing and dosing of the drug and changing, or adding another drug, may be appropriate.
 
FURTHER INFORMATION

Your doctor, or specialist nursing staff should be able to answer your questions about drug treatment of Parkinson’s disease.

The Parkinson’s Disease Society (telephone 020 7931 8080) can also provide information http://www.parkinsons.org.uk

Useful books include:

‘The New Parkinson’s Disease Handbook’,  by Harvey Sagar, published in 2002 by Vermilion   ISBN 009 188 3873

Useful websites include:

 


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This site has been established for the dissemination of information. While every effort is made to ensure that information on this site is accurate and current we accept no liability for any omissions or inaccuracies that may have crept in. If in any doubt please contact your doctor for further advice.

Last Modified 13 August 2004
Maintained by Matthew Harris