Anti-Parkinson's
Generic and Trade Names
| Amantadine Hydrochloride | Symmetrel | ||
| Benztropine Mesylate | Cogentin | ||
| Bromocriptine | Parlodel | ||
| Carbidopa/Levodopa | Sinemet | ||
| Levodopa | Dopar, Larodopa | ||
| Selegiline | Eldepryl | ||
| Pergolide Mesylate | Permax | ||
| Pramipexole | Mirapex | ||
| Procyclidine | Kemadrin | ||
| Ropinirole | Requip | ||
| Tolcapone | Tasmar | ||
| Trihexiphenidyl HCl | Artane, Tremin |
Description
These medications work in a variety of different ways to help Parkinson's symptoms. Many of these drugs work on dopamine receptors or as agonists for dopamine. Carbidopa enhances the effects of Levodopa and should not be given alone,as it will be ineffective.
Trihexyphenidyl and Benztropine are used in parkinsons disease to alleviate the extrapyramidal side effects produced by levodopa and other drugs. (Facts and Comparisons 1999)
Nutritional Considerations:
Iron, protein, and pyridoxine may reduce the effect of levodopa. However, the combination form e.g. Sinemet, may be less vulnerable to larger doses (over 5 mgs) of pyridoxine. (Pronsky 1999)
Avoid alcohol.
Levodopa contains tartrazine which may evoke hives or asthma attacks in sensitive people. (Facts and Comparisons 1999)
Methionine may reduce the effects of levodopa. (Facts and Comparisons 1999)
Take levodopa with food except protein which can impair drug absorption.(Facts and Comparisons 1999) (Bianchine 1976)
Avoid phenylalanine with levodopa, may increase certain side effects. (Nutt 1984)
Use of levodopa with MAOI drugs or food amines (beans or cheese) is contraindicated due to the risk of tyramine reaction i.e. hypertension. (Facts & Comparisons 1999)
Iron has a high affinity for melanin-containing dopaminergic neurons of the nigrostriatal region, qualifying it as a neurotoxin. There may be abnormal iron metabolism in Parkinson's disease. (Playfer 1997)
Studies have consistently shown depressed magnesium in ALS, multiple sclerosis and Parkinson's disease. Prolonged magnesium deficiency can result in neurologic symptoms, including seizure, coma and death. Neurologic disturbances, which include hyperexcitability, convulsions and psychiatric symptoms ranging from apathy to psychosis, can occur with magnesium deficiency and can be corrected with magnesium replacement.
Herbal Considerations:
Kava may reduce the effectiveness of Levodapa if used together.[Brinker 1998]
St. John's Wort theoretically may interact with some of these medications. (Gordon 1998)
Agnus Castus or Vitex (Chaste Tree) has been noted to contain a dopaminergic principle that could interact with dopamine therapy. (Jarry 1994)
References
Ayres J & Maisey MN: Alcohol increases bromocriptine's side effects. N Engl J Med. 1980; 302:806.
Barbieri RL & Ryan KJ: Bromocriptine: endocrine pharmacology and therapeutic applications. Fertil Steril 1983; 39:727-741.
Bianchine, JR et al., Clinical pharmacokinetics of levodopa in Parkinson's disease. Clin. Pharmacokinet. 1976, 1:313-328.
Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.
Brinker, F Herb Contraindications and Drug Interactions, Eclectic Medical Publications, 1998.
Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 1999.
Gordon JB. "SSRIs and St. John's Wort: possible toxicity?" Am Fam Physician, 1998; 57(5):950,953
Gimenez-Roldan, S et al., Predicting beneficial response to a protein-redistribution diet in fluctuating Parkinson's disease. Acta Neurol. Belg. 1991:
Gruenwald, J, Brendler, T & Jaenicke, C (Eds.): PDR for Herbal Medicines. Medical Economics, NJ. 1998.
Jarry, H et al., In vitro prolactin but not LH and FSH release is inhibited by compounds in extracts of Agnus castus: direct evidence for a dopaminergic principle by the dopamine receptor assay. Exp. Clin. Endocrinol. 1994, 102(6):448-454.
Karstaedt, PJ et al., Protein redistribution diet remains effective in patients with fluctuating Parkinsonism. Arch. Neurol. 1992 Feb:
Karstaedt, PJ et al., Aspartame use in parkinson's disease. Neurology, 1993, Mar:
Lieberman, S. & Bruning, N.: The Real Vitamin & Mineral Book. Avery, NY.
Mena, I et al., Protein intake and treatment of Parkinson's disease with levodopa. NEJM, 1975, 292:181.
Nutt, JG et al., The "on-off" phenomenon in Parkinson's disease. Relation to levodopa absorption and transport. NEJM, 1984, 310, Feb 23:483-488.
Playfer, J.R. Parkinson's disease. Postgraduate Medicine Journal, Vol. 73, May 1997, pp. 257-64
Product information: Parlodel(R), bromocriptine mesylate. Sandoz Pharmaceuticals Corp, East Hanover, NJ, 1996.
Pronsky, Z Food Medication Interactions, 11th edition, 1999.
Roos, RA et al., The influence of a standard meal on Sinemet CR absorption in patients with parkinson's disease. Clin. Neurol. Neurosurg. 1993 Sept:
Spark RF & Dickstein G: Bromocriptine and endocrine disorders. Ann Intern Med 1979; 90:949.
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