-
levodopa
- MOA: dopamine precursor, must cross the BBB, iron interferes with the effectiveness of the drug
- USES: PD
- AE: sedation, insomnia, hallucinations, dyskinesia
- always given with carbidopa (enzyme to inhibit its breakdown)
-
entacapone
- MOA: COMT inhibitor, prevents L-dopa from breaking down, increases cerebral levels of L-dopa
- USES: helps prevent DA peripheral AE by enhancing L-dopa in the periphery
- poor BBB penetration, works in the periphery only
-
selegiline
- MOA: MAO-B mainly in the brain, prevents the breakdown of DA
- USES: used in early and late stages, can be used alone or together with L-dopa
- AE: agitation, insomnia, vivid dreams, may worsen dyskinesia
- Neuroprotective - slows the progression of the disease
-
rasagiline
- MOA: MAO-B, prevents the breakdown of DA and increase the amount of DA in the brain
- USES: early and late stages of disease
- AE: aggitation, insomnia, vivid dreams, may worsen dyskinesia
- Neuroprotective - slow the progression of the disease
-
bromocriptine
- dopamine agonst - ergotamines
- MOA: - D2>D1 agonist
- USES: used to tx early PD and delay L-dopa, may prevent dyskinesia, acromegaly, fertility control
- AE: fibrosis and thickening of cardiac valves
- CI: pts with psychoses/schizophrenia
- neuroprotective
-
pergolide
- dopamine agonist - ergotamines
- MOA: D2>D1 agonist
- USES: used to tx early PD and delay L-dopa, may prevent dyskinesia, acromegaly, fertility control
- AE: fibrosis and thickening of cardiac valves
- CI: pts with psychoses/schizophrenia
- neuroprotective
-
pramipexole
- dopamine agonist - non-ergotamines
- MOA: D2>D1 agonist
- USES: used to tx early PD and delay L-dopa, may prevent dyskinesia, acromegaly, fertility control
- AE: low BP, nausea, leg swelling, compulsive behavior, sleep attacks
- CI: pts with psychoses/schizophrenia
- NEUROPROTECTIVE
-
ropinirole
- dopamine agonist - non-ergotamines
- MOA: D2>D1 agonist
- USES: used to tx early PD and delay L-dopa, may prevent dyskinesia, acromegaly, fertility control
- AE: low BP, nausea, leg swelling, compulsive behavior, sleep attacks
- CI: pts with psychoses/schizophrenia
- NEUROPROTECTIVE
-
rotigotine
- dopamine agonist - non-ergotamines
- MOA: stable plasma levels, D3>D2>D1
- USES: effective in both early and late PD, helpful in non-motor deficits, cognition and pain as well
- transdermal path
-
apomorphine
- dopamine agoinst, non - ergotamines
- rescue for those freezing movements
- USES: used in advanced disease, to help with motor fluctuations
- AE: emesis
- SC but working on nasal spray
-
amantadine
- antiviral/glutamate inhibitor
- MOA: NMDA receptor antagonist, alters DA release and may alter re-uptake of dopamine
- USES: reduces PD or L-dopa motor fluctuations and drug induced dyskinesia, accelerates the recovery from severe traumatic brain injury
- AE: purple rash (levido reticularis)
- don't use in ppl predisposed to epilepsy or show psychiatric problems
-
benztropine
- muscarinic antagonist
- MOA: anti-cholinergic, capable of hitting DA receptor
- USES: prescribed to young pts with severe tremor - more effective than L-dopa for this symptom
- AE: constipation, dry mouth, dry skin
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