The bad, ugly and good of PD medications – part deux: By Maria De Leon

Last time, I discussed the effects of dopamine agonists. Today, I will continue to the discussion on medications.- Levodopa still remains the gold standard in the treatment of PD. But, because dopamine is unable cross the blood brain barrier it must be given in a precursor form that does cross barrier when ingested. However, because Levodopa causes nausea when taken orally it is combined with lodosyn – hence the two numbers in the medication compound of Sinemet for which its name arises from –Sin emet (without emesis).
Yet despite this, one of the biggest problems with intake of dopamine compounds whether is medopar or levodopa is frequent nausea. In my experience, women are more susceptible to this side effect compared to men. Fortunately, for the majority of people with PD who experience nausea find it to be transitory lasting 1-2 weeks and then gradually subsiding.

For those of us, who find the nausea to be more persistent there are a number of ways to deal with this problem.
1. increase the lodosyn portion of medication- it comes in 25mg tablets. Most doctors, including myself, typically prescribe an extra 25 mg to be taken with each dose. Other physicians, however, may choose to give a larger dose once daily (100- 300mg).
2. others may select different compounds with varying delivering systems which have more favorable gi symptoms such as Parcopa
which happens to be orally disintegrating thus bypassing the Gut.
3. a third option is use of anti emetics such as zofran or domperidone to minimize side effects.
4. finally, one of the easiest way to combat this problem is to take levodopa with food especially protein based which diminishes absorption to a degree; thus having a lower gastric side effect profile or combining levodopa with comtan, tasmar, or opicapone (COMT inhibitor). This last tactic by the way is extremely effective in reducing and preventing dyskenesias as well as wearing on/off phenomena. one of my favorite drugs is Stalevo which is a combination drug of both levodopa and comtan making things easier and cheaper. The down side of stalevo is that it may cause increased migraines, and headaches most of which are due to increased blood pressure.

All dopamine compounds have risk of causing sedation but not as high as with dopamine agonists- but I suspect that the sedation is directly related to increased blood pressure, which in my experience is more common in women than

Rytary is the intermediate relatively new compound of levodopa which has a bead delivery system which because of its slow delivery there is much less gi problems as well as less other side effects. although, it is typically given two tablets at a time – personally I have found that taking one tablet at a time has decreased the risk of dyskenesias. I absolutely love Rytary because it gave me my life back completely..before Rytary I had stopped enjoying music, and reading ..
Of note: I have personally found that this causes much more constipation and also higher likelihood of high blood pressure.

****Autonomic dysfunction in Parkinson’s as well the medications both dopamine agonists and dopa itself can cause hypertensive urgency this can manifest as chest pain, sob (shortness of breath), headache, and vision problems.I myself experienced this with Rytary. However, this does not mean you must stop medication. I simply had my blood pressure medicine increased. Talk with your physician regarding options.

Parcopa as I mentioned before is another option for treatment and in my opinion underutilized. I love using parcopa because it is orally disintegrating can be used even in patients that are not able to swallow, especally in hospital post surgeries or when asked to be NPO (i.e. no drinking, eating before procedures. Also great when someone has lots of nausea. it is also faster acting than oral but lasts as long as regular sinemet.

Inbrijia Inhaler– the newest medication that is levodopa which it bypasses gi symptoms and also is fast acting – faster than Parcopa, however it is shorter acting. It’s great for on/off – used and targeted as a rescue medicine. Although, it works great it is not very easy to use especially when you are off or on the go because it requires several steps to use. Thus,limiting its use plus it is very expensive. If have cough or sob or asthma may not be able to use.

Apomorphine injection is another terrific medication which is severely under utilized. It works amazingly well – fast acting and safe. Available and covered for many years plus no longer has to be initiated only at doctors office. There are services available 24 hour 7 days a week to help with any questions. Plus the syringes and shots are extremely easy to use. Soon this medicine will be available in a thin film strip (from Sunovion) which will make treatment for “on-off” easier and on the go.

All dopa compounds can have side effects of dyskenesia, hallucinations, sleepiness, etc.

@copyright 2020
all rights reserved by Maria De Leon (aka. Parkinson’s Diva)


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