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Medical Treatment of Parkinson’s Disease



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(Last Updated On: August 4, 2015)

4. Amantadine:

Amantadine is an antiviral agent and is also known to counter the symptoms of Parkinson’s Disease.

I. Mechanism of Action:

Its mechanism of action in this disease is not known yet, however it has been postulated that it has dopaminergic effects by increased synthesis and release of dopamine, reduced uptake of dopamine and enhanced activation of dopaminergic receptors.

II. Adverse Effects:

It has a discrete side effect profile, which includes both physical and psychiatric effects. Its adverse effects include difficulty in and lack of sleep, confusion, hallucination, ankle edema, livido reticularis.

III. Dosage:

Its dose is gradually increased to obtain desired effect. It is started at a dose of 100 milligram every other day and then gradually increased up to 100 milligram thrice daily.

5. Anticholinergic Agents:

Anticholinergics are another class of medicines that can be used for the treatment of Parkinson’s disease. This group includes Trihexyphenidyl and Benztropine.

I. Mechanism of Action:

Anticholinergic agents are used to restore balance between cholinergic and dopaminergic transmission. Anticholinergic agents are effective in reducing tremor however these do not work on rigidity and akinesia with a very limited overall clinical efficacy.

II. Adverse Effects:

This group of drugs have typical anticholinergic side effects including both physical and psychological components. Psychological effects include confusion, hallucination and memory loss while physical effects include dry mouth, blurred vision, constipation and urinary retention.

III. Dosage:

Dose of both the anticholinergic agents is as follows. Trihexyphenidyle is started at a dose of 0.5 to 1 milligram twice daily and then gradually increased up to 2 milligram thrice daily. Benztropine is started and continued at 0.5 to 2 mg twice daily. 

6. Catechol-O-methyl-transferase (COMT) Inhibitors:

This group of medications includes Entacapone, Tolcapone and Selegiline.

I. Mechanism of Action:

These agents prevent the conversion of levodopa into 3-O-methyldopa by the enzyme COMT. Hence more levodopa becomes available centrally to control the symptoms of Parkinson’s Disease.

II. Adverse Effects:

These drugs cause movement disorders, diarrhea, liver damage and liver failure. Hypertensive reactions may occur when taken with theophylline, ephedrine, sinemet and tyramine containing foods.

III. Dosage:

Entacapone can be taken up to 1600 milligrams per day in divided doses, depending upon the response, at 200 milligrams per dose. Tolcapone can be taken at a dose of 100 to 200 milligrams thrice daily. Selegiline is taken twicw daily, 5 milligrams at breakfast and 5 milligrams at noon.

All these medicines can be given alone in combination and by alternating courses of different medicines to achieve best control. Best outcome can be achieved when medicines are used in combination with other interventions such as rehabilitation measures, which include use of physical modalities, exercises, assistive devices, counselling, psychotherapy and good nursing care.

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Medical Treatment of Parkinson’s Disease

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