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Levadopa, Carbidopa, Sinamet
Dopimergics
- -Levadopa is a precursor to dopamine, standard tx since 1967
- -no "right" dose of Lepadova, titrated to pt's response and s/e
- -"end of dose symptoms:" pt. may freeze up or "turn off"
- -s/e: N/V, orthostatic hypotension,
arrythmias, dyskinesias, vivid dreams, hallucinations - -Carbidopa delays the conversion of levodopa to dopamine until it reaches the brain, reducing the amount of Levadopa needed.
- -Sinamet is the only combo drug avil. in the US
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Bromocriptine (Parlodel)
Pergolide (Permax)
Pramipexole (Mirapex)
Ropinirole (Requip)
Dopamine Agonists
- -mimic the role of dopamine in the brain, synergize levodopa (help receptor cells take up dopamine in the brain)
- -s/e: nausea, constipation, dizziness, somnolence, dyskinesia, "wearing off" phenomenon
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Amanadine (Symmetrel)
Antiviral
- -enhances release of incr. amounts of dopamine in the brain
- -first-line med early in dx
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Benztropin (Cogentin)
Trihexphenidyl (Artane)
Anticholinergic
- -block some of the excitatory effects of ACH which contribute to tremors, also incr. HR and decr. gastric and oral secretions
- -can also be used to prevent oculogyric crisis (when eyes are fixed in a lateral upward gaze)
- -s/e: dry mouth, blurred vision, mydriasis, urinary retention
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Selegiline (Eldepryl)
MAO-A inhibitor (monoamine oxidase-A)
- -inhibits enzyme that breaks down lepadova in the brain, and so synergizes lepodova
- -s/e: insomnia, orthostatic hypotension, arrhythmias, nausea
- -MAO's have many drug interactions! and when taken w/ foods high in thiamine such as chianti and aged cheeses can cause HTN
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Tolcapone (Tasmar)
Entcapone (Comtin)
COMT inhibitors (catechol-O-methyl transferase)
- -incr. bioavailability of levodopa by inhibiting enzyme that reduces it to a less active form (so it must be given w/ levodopa)
- -s/e: liver toxicity (monitor LFTs q2-4 wks at start of tx and stop drug if not therapeutic effect in 3 wks), dyskinesia, hyperkinesia, nausea, diarrhea, brownish-orange discoloration of urine
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