Parkinson Drug Therapy
Parkinson Drug Therapy
Parkinson Drug Therapy
13 April 2012
Classification
Drugs affecting brain dopaminergic system Dopamine precursor
Levodopa (l- dopa)
Dopaminergic agonists
Bromocriptine, Lisuride, Pergolide, Piribedil
Antihistaminics
Orphenadrine, Promethazine
Dept of Pharmacology, Manipal College of Pharmaceutical Sciences Manipal
LEVODOPA
95% of an oral dose is decarboxylated in the peripheral tissues (mainly gut and liver) and converted into DA
arrythmia
Dose of levodopa
Start with 0.25 g BD after meals, gradually increase till adequate response is obtained
Usual dose is 2-3 g/day
Degree of improvement may be higher; some patients, not responding adequately to levodopa alone, also improve
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1. Involuntary movements
2. Behavioral abnormalitIes
3. Postural hypotension
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Currently levodopa always used with a decarboxylase inhibitor, except in patients who develop marked involuntary movements with the combination Combination of levodopa with carbidopa has been given the name 'Co-careldopa'
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Bromocriptine
Improvement in parkinsonian symptoms occurs within -1 hr of an oral dose of bromocriptine; and lasts 6-10 hours
High dose required, expensive and produce intolerable side effects
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Generally not serious: insomnia, dizziness, confusion, nightmares and rarely hallucinations AMANTREL 100 mg tab
Dept of Pharmacology, Manipal College of Pharmaceutical Sciences Manipal
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CATECHOL-O-METHYL TRANSFERASE
E.g Tolcapone and entacapone. Are reversible COMT inhibitors. Used as adjunct toL-Dopa-carbidopa forfor advanced cases of parkinsons disease (PD). Combined preparation of LDopa+carbidopa+entacapone is available . Adverse effects: dyskinesia,diarrhoea, confusion, hypotension and hallucinations. Tolcapone is hepatotoxic therefore should be avoided in patients with liver disease. Entacapone does not cause hepatotoxicity
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ANTICHOLINERGIC DRUGS:
E.g benzhexol, benztropine Are treatment of choice in drug induced parkinsonism. Act by reducing increased cholinergic activity in striatum and have mainly peripheral action. Adverse effects:dry mouth confusion, blurring of vision,constipation.
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THANK YOU
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