Parkinson's Disease -
Side Effects of Drugs
Side Effects of Drugs
Permax
Parkinson's is progressive, patients need to take drugs to
manage some symptoms, but the disease wasn't about to go
away. Recently, Permax (pergolide) and its generic versions used
by several thousand patients with Parkinson's disease are being
pulled from the market because of reports of heart valve damage.
[1]
At least 14 patients have needed to replace their heart valves.
Indeed, after some reports of heart valve problems in 2002, its
label warnings have been revised. Two recent studies suggested
that up to 20% of the pergolide users developed valve leakage.
Moreover, other dopamine agonists used for Parkinson's disease
are not associated with such high rate of heart valve problems.
[1] This article reviews the side effects of a few popular medicines
for Parkinson's disease.
Levodopa
It has been known that low dopamine levels are associated with
Parkinson's disease. Logically, dopamine supplementation should
be the first line treatment for Parkinson's disease. Unfortunately,
dopamine cannot get through the body's blood-brain barrier.
Because levodopa can pass through the barrier, levodopa
becomes the gold standard of Parkinson's therapy. Approved in
1970, levodopa helps restore muscle control when it is converted
to dopamine in the brain.
However, only a small amount of levodopa actually makes it into
the brain. Most change to dopamine before reaching the brain.
So to relieve symptoms, many patients need to take fairly large
doses, which can cause side effects such as nausea and
dyskinesias (involuntary movements).
Sinemet
To reduce these drawbacks, doctors often prescribe levodopa
mixed with carbidopa, a drug that is marketed as Sinemet or in
generic versions. About 80 percent of Parkinson's patients take
this drug in 1998. Carbidopa delays the conversion of levodopa
to dopamine until it reaches the brain, often lessening or even
preventing levodopa side effects. Carbidopa also decreases the
amount of levodopa needed. Because each Parkinson's patient
reacts differently to treatment, doctors and patients must work
closely to find a tolerable balance between the drug's benefits
and side effects.
Though the levodopa-carbidopa combination can be so effective
that some patients forget for a while that they have Parkinson's,
the drug is far from perfect. Side effects aside, doses typically
must be increased over time, and the disease often manifests an
"on-off" syndrome in advanced patients.
In 1996, FDA approved Exelon (rivastigmine tartrate) for the
treatment of mild to moderate dementia (chronic loss or
impairment of intellectual capacity) associated with Parkinson's
disease. The use of Exelon has been associated with significant
gastrointestinal adverse side effects. In clinical trials, 47 percent
of the patients treated with the drug developed nausea, and 26
percent of women and 18 percent of men on high doses of Exelon
experienced significant weight loss. Other common adverse side
effects reported by patients on Exelon include vomiting, anorexia,
dyspepsia and asthenia (loss of strength). In some patients with
Parkinson's disease, treatment with Exelon was associated with a
worsening of tremor. [3]
Mirapex and Requip
In 1997, FDA approved three drugs to treat Parkinson's disease
and they are Mirapex (pramipexole dihydrochloride), Requip
(ropinirole hydrochloride), and Tasmar (tolcapone). Mirapex and
Requip, which mimic dopamine's role in the brain, allow patients
to regain some of their lost muscle control. Both are approved for
use alone or with levodopa drugs. In clinical trials, patients taking
Mirapex alone saw as much as a 30 percent improvement in
symptoms. Combining Mirapex with levodopa drugs allowed
advanced patients to reduce those doses by up to 25 percent.
Requip trials showed similar benefits, allowing patients to reduce
levodopa doses by an average of 31 percent.
In the three double-blind, placebo-controlled trials of patients with
early Parkinson's disease, the most commonly observed adverse
events (>5%) that were numerically more frequent in the group
treated
with MIRAPEX (pramipexole dihydrochloride) tablets were nausea,
dizziness, somnolence, insomnia, constipation, asthenia, and
hallucinations. [6]
Tasmar
Tasmar is a kind of drug called a COMT inhibitor. It also is
indicated for use with levodopa drugs. It seems that Tasmar
blocks a key enzyme responsible for breaking down levodopa
before it reaches the brain. In trials, patients with a stable
response to levodopa drugs who took Tasmar experienced
significant improvements in daily activities such as talking, writing,
walking, and dressing. However, on November 16, 1998, FDA and
the manufacturer of the drug Tasmar for patients with Parkinson's
Disease, are advising doctors about reports of a new finding of
fatal liver injury associated with use of the drug. The warning calls
for increased liver monitoring (every two weeks) if a prescriber
elects to treat patients with Tasmar. Doctors should also advise
their patients to self-monitor for classical signs of liver disease
such as jaundice and nonspecific ones such as fatigue and loss
of appetite and other signs of side effects. [4]
Some doctors also described levodopa together with Parlodel
(bromocriptine) or Permax (pergolide, withdrawn from market) to
improve response. Parlodel (bromocriptine) and Permax
(pergolide) can mimic dopamine's role in the brain.
Eldepryl
Doctors may also use Eldepryl (selegiline hydrochloride) or
deprenyl to delay the breakdown of naturally occurring and
levodopa-formed dopamine and allow the chemicals to
accumulate in surviving nerve cells. Thus, the levodopa response
is prolonged.
Comtan
1999, FDA approved Comtan together with carbidopa/ levodopa
to treat people with Parkinson’s disease that experience the signs
and symptoms of end-of-dose "wearing-off". The side effects of
the treatment include Abnormal jerky movements, nausea,
discolored (brownish orange) urine, diarrhea, abdominal pain,
dizziness or fainting especially upon quickly standing or going
from a laying down to an upright position, confusion and
sweating. You should inform your healthcare if you have the
following symptoms: severe diarrhea, hallucinations, muscle pain
or prolonged rigidity and high fever. [5]
FDA approved Azilect (rasagiline) for the treatment of Parkinson's
disease. The drug is a monoamine oxidase type--B (MAO-B)
inhibitor that blocks the breakdown of dopamine.
Azilect
Azilect was approved for use as an initial single drug therapy in
early Parkinson's disease, and as an addition to levodopa in
more advanced patients. Levodopa is a standard treatment for
Parkinson's disease. The safety and effectiveness of Azilect was
demonstrated in three 18- to 26-week controlled clinical trials.
In one study, the condition of patients with early Parkinson's on
Azilect showed significantly less worsening on a rating scale that
measures the ability to perform mental and motor tasks as well as
daily living activities. compared with patients on placebo. In the
other two studies, patients at advanced stage using Azilect
together with levodopa had significantly less time per day with
relatively poor function and mobility as compared with patients on
levodopa and placebo.
However, Azilect may be associated with hypertensive crisis if
patients also consume tyramine-rich foods, beverages (such as
cheese and red wine) or dietary supplements or amines
contained in many cough/cold medications. As with most other
medications for Parkinson's, Azilect has the potential to cause
involuntary movements (dyskinesias), hallucinations and lowered
blood pressure. Check the product label for details of side
effects. In addition, intake of Azilect may also be associated with
an increased risk for melanoma. [2]
More about Parkinson's Disease
Parkinson's Disease - Supplements
Parkinson's Disease - Herbs
Parkinson's Disease - Side Effects of Drugs
Parkinson's Disease - Symptoms
Reference Parkinson's Disease: New Treatments Slow Onslaught
of Symptoms FDA Consumer magazine (July-August 1998) [1]
Parkinson's drug pulled from market, AP, March 29, 2007. FDA
Drug Safety Podcasts Pergolide (marketed as Permax)
Transcript March 29, 2007 [2] FDA Approves New Treatment for
Parkinson's Disease FDA News May 17, 2006. [3] FDA Approves
the First Treatment for Dementia of Parkinson's Disease FDA
News June 27, 2006. [4] NEW WARNINGS FOR PARKINSON'S
DRUG, TASMAR FDA Talk Papers November 16, 1998. [5]
Comtan, Consumer Drug Information Sheet December 29, 2004
[6] Mirapex, Product Insert, NDA 20-667/S-011/S-013
Parkinson's is progressive, patients need to take drugs to
manage some symptoms, but the disease wasn't about to go
away. Recently, Permax (pergolide) and its generic versions used
by several thousand patients with Parkinson's disease are being
pulled from the market because of reports of heart valve damage.
[1]
At least 14 patients have needed to replace their heart valves.
Indeed, after some reports of heart valve problems in 2002, its
label warnings have been revised. Two recent studies suggested
that up to 20% of the pergolide users developed valve leakage.
Moreover, other dopamine agonists used for Parkinson's disease
are not associated with such high rate of heart valve problems.
[1] This article reviews the side effects of a few popular medicines
for Parkinson's disease.
Levodopa
It has been known that low dopamine levels are associated with
Parkinson's disease. Logically, dopamine supplementation should
be the first line treatment for Parkinson's disease. Unfortunately,
dopamine cannot get through the body's blood-brain barrier.
Because levodopa can pass through the barrier, levodopa
becomes the gold standard of Parkinson's therapy. Approved in
1970, levodopa helps restore muscle control when it is converted
to dopamine in the brain.
However, only a small amount of levodopa actually makes it into
the brain. Most change to dopamine before reaching the brain.
So to relieve symptoms, many patients need to take fairly large
doses, which can cause side effects such as nausea and
dyskinesias (involuntary movements).
Sinemet
To reduce these drawbacks, doctors often prescribe levodopa
mixed with carbidopa, a drug that is marketed as Sinemet or in
generic versions. About 80 percent of Parkinson's patients take
this drug in 1998. Carbidopa delays the conversion of levodopa
to dopamine until it reaches the brain, often lessening or even
preventing levodopa side effects. Carbidopa also decreases the
amount of levodopa needed. Because each Parkinson's patient
reacts differently to treatment, doctors and patients must work
closely to find a tolerable balance between the drug's benefits
and side effects.
Though the levodopa-carbidopa combination can be so effective
that some patients forget for a while that they have Parkinson's,
the drug is far from perfect. Side effects aside, doses typically
must be increased over time, and the disease often manifests an
"on-off" syndrome in advanced patients.
In 1996, FDA approved Exelon (rivastigmine tartrate) for the
treatment of mild to moderate dementia (chronic loss or
impairment of intellectual capacity) associated with Parkinson's
disease. The use of Exelon has been associated with significant
gastrointestinal adverse side effects. In clinical trials, 47 percent
of the patients treated with the drug developed nausea, and 26
percent of women and 18 percent of men on high doses of Exelon
experienced significant weight loss. Other common adverse side
effects reported by patients on Exelon include vomiting, anorexia,
dyspepsia and asthenia (loss of strength). In some patients with
Parkinson's disease, treatment with Exelon was associated with a
worsening of tremor. [3]
Mirapex and Requip
In 1997, FDA approved three drugs to treat Parkinson's disease
and they are Mirapex (pramipexole dihydrochloride), Requip
(ropinirole hydrochloride), and Tasmar (tolcapone). Mirapex and
Requip, which mimic dopamine's role in the brain, allow patients
to regain some of their lost muscle control. Both are approved for
use alone or with levodopa drugs. In clinical trials, patients taking
Mirapex alone saw as much as a 30 percent improvement in
symptoms. Combining Mirapex with levodopa drugs allowed
advanced patients to reduce those doses by up to 25 percent.
Requip trials showed similar benefits, allowing patients to reduce
levodopa doses by an average of 31 percent.
In the three double-blind, placebo-controlled trials of patients with
early Parkinson's disease, the most commonly observed adverse
events (>5%) that were numerically more frequent in the group
treated
with MIRAPEX (pramipexole dihydrochloride) tablets were nausea,
dizziness, somnolence, insomnia, constipation, asthenia, and
hallucinations. [6]
Tasmar
Tasmar is a kind of drug called a COMT inhibitor. It also is
indicated for use with levodopa drugs. It seems that Tasmar
blocks a key enzyme responsible for breaking down levodopa
before it reaches the brain. In trials, patients with a stable
response to levodopa drugs who took Tasmar experienced
significant improvements in daily activities such as talking, writing,
walking, and dressing. However, on November 16, 1998, FDA and
the manufacturer of the drug Tasmar for patients with Parkinson's
Disease, are advising doctors about reports of a new finding of
fatal liver injury associated with use of the drug. The warning calls
for increased liver monitoring (every two weeks) if a prescriber
elects to treat patients with Tasmar. Doctors should also advise
their patients to self-monitor for classical signs of liver disease
such as jaundice and nonspecific ones such as fatigue and loss
of appetite and other signs of side effects. [4]
Some doctors also described levodopa together with Parlodel
(bromocriptine) or Permax (pergolide, withdrawn from market) to
improve response. Parlodel (bromocriptine) and Permax
(pergolide) can mimic dopamine's role in the brain.
Eldepryl
Doctors may also use Eldepryl (selegiline hydrochloride) or
deprenyl to delay the breakdown of naturally occurring and
levodopa-formed dopamine and allow the chemicals to
accumulate in surviving nerve cells. Thus, the levodopa response
is prolonged.
Comtan
1999, FDA approved Comtan together with carbidopa/ levodopa
to treat people with Parkinson’s disease that experience the signs
and symptoms of end-of-dose "wearing-off". The side effects of
the treatment include Abnormal jerky movements, nausea,
discolored (brownish orange) urine, diarrhea, abdominal pain,
dizziness or fainting especially upon quickly standing or going
from a laying down to an upright position, confusion and
sweating. You should inform your healthcare if you have the
following symptoms: severe diarrhea, hallucinations, muscle pain
or prolonged rigidity and high fever. [5]
FDA approved Azilect (rasagiline) for the treatment of Parkinson's
disease. The drug is a monoamine oxidase type--B (MAO-B)
inhibitor that blocks the breakdown of dopamine.
Azilect
Azilect was approved for use as an initial single drug therapy in
early Parkinson's disease, and as an addition to levodopa in
more advanced patients. Levodopa is a standard treatment for
Parkinson's disease. The safety and effectiveness of Azilect was
demonstrated in three 18- to 26-week controlled clinical trials.
In one study, the condition of patients with early Parkinson's on
Azilect showed significantly less worsening on a rating scale that
measures the ability to perform mental and motor tasks as well as
daily living activities. compared with patients on placebo. In the
other two studies, patients at advanced stage using Azilect
together with levodopa had significantly less time per day with
relatively poor function and mobility as compared with patients on
levodopa and placebo.
However, Azilect may be associated with hypertensive crisis if
patients also consume tyramine-rich foods, beverages (such as
cheese and red wine) or dietary supplements or amines
contained in many cough/cold medications. As with most other
medications for Parkinson's, Azilect has the potential to cause
involuntary movements (dyskinesias), hallucinations and lowered
blood pressure. Check the product label for details of side
effects. In addition, intake of Azilect may also be associated with
an increased risk for melanoma. [2]
More about Parkinson's Disease
Parkinson's Disease - Supplements
Parkinson's Disease - Herbs
Parkinson's Disease - Side Effects of Drugs
Parkinson's Disease - Symptoms
Reference Parkinson's Disease: New Treatments Slow Onslaught
of Symptoms FDA Consumer magazine (July-August 1998) [1]
Parkinson's drug pulled from market, AP, March 29, 2007. FDA
Drug Safety Podcasts Pergolide (marketed as Permax)
Transcript March 29, 2007 [2] FDA Approves New Treatment for
Parkinson's Disease FDA News May 17, 2006. [3] FDA Approves
the First Treatment for Dementia of Parkinson's Disease FDA
News June 27, 2006. [4] NEW WARNINGS FOR PARKINSON'S
DRUG, TASMAR FDA Talk Papers November 16, 1998. [5]
Comtan, Consumer Drug Information Sheet December 29, 2004
[6] Mirapex, Product Insert, NDA 20-667/S-011/S-013
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Supplements
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Polycosanol
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Reishi / Lingzhi
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Rhodiola
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Stevia
Whey
Xylitol
Supplements
Acetyl-L Carnitine
Acidophilus
Bladderwrack
Bilberry
Chromium
CLA
Cod Liver Oil
Coenzyme Q
Colostrum
Dandelion
EGCG
Echinacea
Eleuthero
Ellagic Acid
Eve. Primrose Oil
Fish Oil
Flaxseed
Garlic
Ginger
Ginseng
Ginkgo Biloba
Glucosamine
Gotu Kola
Guar Gum
Hyaluronic acid
Lecithin
Lycopene
Milk Thistle
Nattokinase
Passion Flower
Probiotics
Policosanol /
Polycosanol
Pycnogenol
Reishi / Lingzhi
Resveratrol
Rhodiola
Royal Jelly
Stevia
Whey
Xylitol
Discuss with your doctor before taking any alternative medicine. This article is for reference only, it is not a medical advice. All rights
reserved. Do not copy this article to other website or blog.
reserved. Do not copy this article to other website or blog.
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