Medicines,Used,Parkinson,Disea health Medicines Used in Parkinson's Disease
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This allows considerable economy in the use of levodopa and also reduces the distressing adverse effects like nausea and vomiting. This combination is, therefore, positively superior to the single drug. In fact, it is used in almost all of the patients requiring levodopa. The combination is available in three strengths and this allows selection of appropriate doses required for a patient. An advantage with this combination is that Vitamin B6 or multivitamins can be given together. Levodopa is also available in combination with benserzide and this has the same effect as the combination with carbidopa and is sold under the trade name BENSPAR. Impact of Drugs: Despite good initial response, the benefit with Colevodopa (levodopa+carbidopa) progressively decreases. It is at this time that the addition of other drug& may offer further benefit. However, after a few year (5-7 years), there is a loss of benefit from, dopaminergic drugs probably due to decrease in critical number of nerve cells (degeneration i& ongoing) in the basal nuclei. Physical and social rehabilitation remain the last options for advanced cases. Drugs for Correcting the Effects of Excess Acetylcholine Prior to the introduction of levodopa, various drugs were used in the treatment of Parkinson's disease. Of these the most effective were belladonna alkaloids (anti-cholinergic drugs), obtained from the plant Atropa belladonna, and some synthetic drugs. These drugs rarely produce more than 10-25% improvement, and the disease invariably progresse. One thing is certain though: these caused great improvement in tremor. These are the only drugs effective in drug-induced movement disorder particularly acute dystonia/dyskinesia. They have a role in early and mild form of Parkinsonism disease also. All these drugs had adverse effects like dryness of the mouth, blurring of vision, constipation, urinary retention, and delirium. Orphenadrine has some stimulating effect. Other are sedating. PrecautionsThese drugs should not be administered to patients having difficulty in passing urine due to the prostate or stone in the urinary tract.These agents should be avoided in patients suffering of glaucoma raise pressure in the eyes.The medication should be wIthdrawn gradually. Sudden stopping of the drug may cause an increase in the symptoms of Parkinsonism. Other Drugs Amantadine (AMANTREL) is another drug which is now employed in the treatment of parkinsonism. It brings about beneficial effects by releasing dopamine from the storage site. It is effective in 66% cases but the effect lasts only for 2 to 3 weeks, after which it declines.Bromocriptine (PROCTINAL 1.25 mg, 2.5 mg) is an expensive drug. Though this drug provides the maximum benefit, but it may cause nausea, vomiting, headache, constipation, dizziness, postural hypotension, and drowsiness. In women it increases lactation. Intitially it is given in a dose of 1.25 mg daily with meals and gradually the dose is increased upto 5 to 10 mg per day. Piribedil (TRIVASTAL-LA) is also like levodopa in action and is given in doses of 50-200 mg daily. It should not be given in pregnancy or heart disease. Entacapone and Tolcapone reduce fluctuations in the response due to levodopa+carbidopa and enhance the effect of latter. They are useful in advanced stages only. Selegiline (L-DEPRENYL, SELGIN 5 mg Tab.) is a new drug used as an adjunct to levodopa+carbidopa in a dose of5 mg in the morning and 5 mg at lunch. Additional doses are not beneficial. Because selegiline causes loss of sleep, it should not be taken at night. It is an interesting drug because there is some evidence to show that it may slow the process of neurodegeneration. It allows reduction in the dose of carbidopa+levodopa. It should not be given to epileptics and in chronic tardive dyskinestia. It may cause anxiety, confusion, restlessness, sexual dysfunction, tachycardia, hypertension and syncope. In 1997 two new drugs, pramipexole and ropinirole were introduced. These have fewer side effects than levodopa and are put to use as an adjuncts or alone. A number of surgical methods and even implants to be put in the brain have been developed with considerable success. These are yet to be introduced in India. One such method is implantation of dopamine-producing cells obtained from human foetus. These cells start producing much needed substances (dopamine) in the brain.
Medicines,Used,Parkinson,Disea