Parkinson's disease medical therapy: Difference between revisions

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==Overview==
==Overview==
The mainstay of therapy for motor symptoms of Parkinson disease are: Levodopa, dopamine agonists, monoamine oxidase (MAO) B inhibitors, anticholinergic agents, amantadine, catechol-O-methyl transferase (COMT) inhibitors, estrogen and other drugs such as [[Exenatide]], [[uric acid]], [[isradipine]], [[nilotinib]] and [[GDNF]] infusion.
Treatment choices for some of the nonmotor symptoms of PD are:
psychosi<nowiki/>s: [[quetiapine|quet]][[quetiapine|iapine]], [[clozapine|clozap]]<nowiki/>[[clozapine|ine]] and [[pimavanserin]].
Dementia: [[Cholinesterase inhibitors|C]]<nowiki/>[[Cholinesterase inhibitors|holinesterase inhibitors]] such as [[rivastigmine]] and [[donepezil]].
Fatigue: [[Amantadine]], [[methylphenidate]] and [[pemoline]].
<nowiki/>Depression: [[Amitriptyline]], [[desipramine]], [[citalopram]] ,[[paroxetine]], [[venlafaxine]], [[ropinirole]] and [[pramipexole]].
Constipati<nowiki/>on: Increasing [[Probiotic|probiotics]] and fibers, [[lubiprostone]] and [[polyethylene glycol]].
Sialorrhea: chewing gum and hard candy but in severe cases, [[botulinum toxin]] injection into [[Salivary gland|salivary glands]] .
Sexual dysfunction: [[sildenafil]] (for male)
Ortostatic hypotention: [[Fludrocortisone]], [[Sympathomimetic agents]] such as [[ephedrine]], [[pseudoephedrine]], [[methylphenidate|methylp]]<nowiki/>[[methylphenidate|henidate]] and<nowiki/> [[dextroamphetamine]].


==Medical Therapy==
==Medical Therapy==
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* Other agents: Other drugs such as [[Exenatide]]<ref name="pmid18492290">{{cite journal |vauthors=Harkavyi A, Abuirmeileh A, Lever R, Kingsbury AE, Biggs CS, Whitton PS |title=Glucagon-like peptide 1 receptor stimulation reverses key deficits in distinct rodent models of Parkinson's disease |journal=J Neuroinflammation |volume=5 |issue= |pages=19 |date=May 2008 |pmid=18492290 |pmc=2426681 |doi=10.1186/1742-2094-5-19 |url=}}</ref>, [[uric acid]]<ref name="pmid19822770">{{cite journal |vauthors=Ascherio A, LeWitt PA, Xu K, Eberly S, Watts A, Matson WR, Marras C, Kieburtz K, Rudolph A, Bogdanov MB, Schwid SR, Tennis M, Tanner CM, Beal MF, Lang AE, Oakes D, Fahn S, Shoulson I, Schwarzschild MA |title=Urate as a predictor of the rate of clinical decline in Parkinson disease |journal=Arch. Neurol. |volume=66 |issue=12 |pages=1460–8 |date=December 2009 |pmid=19822770 |pmc=2795011 |doi=10.1001/archneurol.2009.247 |url=}}</ref>, [[isradipine]]<ref name="pmid21515375">{{cite journal |vauthors=Ilijic E, Guzman JN, Surmeier DJ |title=The L-type channel antagonist isradipine is neuroprotective in a mouse model of Parkinson's disease |journal=Neurobiol. Dis. |volume=43 |issue=2 |pages=364–71 |date=August 2011 |pmid=21515375 |pmc=3235730 |doi=10.1016/j.nbd.2011.04.007 |url=}}</ref>, [[nilotinib]]<ref name="pmid27434298">{{cite journal |vauthors=Wyse RK, Brundin P, Sherer TB |title=Nilotinib - Differentiating the Hope from the Hype |journal=J Parkinsons Dis |volume=6 |issue=3 |pages=519–22 |date=July 2016 |pmid=27434298 |pmc=5044778 |doi=10.3233/JPD-160904 |url=}}</ref> and [[GDNF]] infusion<ref name="pmid12669033">{{cite journal |vauthors=Gill SS, Patel NK, Hotton GR, O'Sullivan K, McCarter R, Bunnage M, Brooks DJ, Svendsen CN, Heywood P |title=Direct brain infusion of glial cell line-derived neurotrophic factor in Parkinson disease |journal=Nat. Med. |volume=9 |issue=5 |pages=589–95 |date=May 2003 |pmid=12669033 |doi=10.1038/nm850 |url=}}</ref> can be effective in controlling [[Parkinson's disease|PD]] patients [[Symptom|symptoms]].
* Other agents: Other drugs such as [[Exenatide]]<ref name="pmid18492290">{{cite journal |vauthors=Harkavyi A, Abuirmeileh A, Lever R, Kingsbury AE, Biggs CS, Whitton PS |title=Glucagon-like peptide 1 receptor stimulation reverses key deficits in distinct rodent models of Parkinson's disease |journal=J Neuroinflammation |volume=5 |issue= |pages=19 |date=May 2008 |pmid=18492290 |pmc=2426681 |doi=10.1186/1742-2094-5-19 |url=}}</ref>, [[uric acid]]<ref name="pmid19822770">{{cite journal |vauthors=Ascherio A, LeWitt PA, Xu K, Eberly S, Watts A, Matson WR, Marras C, Kieburtz K, Rudolph A, Bogdanov MB, Schwid SR, Tennis M, Tanner CM, Beal MF, Lang AE, Oakes D, Fahn S, Shoulson I, Schwarzschild MA |title=Urate as a predictor of the rate of clinical decline in Parkinson disease |journal=Arch. Neurol. |volume=66 |issue=12 |pages=1460–8 |date=December 2009 |pmid=19822770 |pmc=2795011 |doi=10.1001/archneurol.2009.247 |url=}}</ref>, [[isradipine]]<ref name="pmid21515375">{{cite journal |vauthors=Ilijic E, Guzman JN, Surmeier DJ |title=The L-type channel antagonist isradipine is neuroprotective in a mouse model of Parkinson's disease |journal=Neurobiol. Dis. |volume=43 |issue=2 |pages=364–71 |date=August 2011 |pmid=21515375 |pmc=3235730 |doi=10.1016/j.nbd.2011.04.007 |url=}}</ref>, [[nilotinib]]<ref name="pmid27434298">{{cite journal |vauthors=Wyse RK, Brundin P, Sherer TB |title=Nilotinib - Differentiating the Hope from the Hype |journal=J Parkinsons Dis |volume=6 |issue=3 |pages=519–22 |date=July 2016 |pmid=27434298 |pmc=5044778 |doi=10.3233/JPD-160904 |url=}}</ref> and [[GDNF]] infusion<ref name="pmid12669033">{{cite journal |vauthors=Gill SS, Patel NK, Hotton GR, O'Sullivan K, McCarter R, Bunnage M, Brooks DJ, Svendsen CN, Heywood P |title=Direct brain infusion of glial cell line-derived neurotrophic factor in Parkinson disease |journal=Nat. Med. |volume=9 |issue=5 |pages=589–95 |date=May 2003 |pmid=12669033 |doi=10.1038/nm850 |url=}}</ref> can be effective in controlling [[Parkinson's disease|PD]] patients [[Symptom|symptoms]].
Treatment choices for some of the nonmotor symptoms of PD are:
Treatment choices for some of the nonmotor symptoms of PD are:
* Psychosis: Drugs such as [[quetiapine]], [[clozapine]] and [[pimavanserin]] are used in managing [[psychosis]] in [[Parkinson's disease|PD]].(10_15) one of the [[side effects]] of [[clozapine]] is [[leukopenia]] and [[agranulocytosis]].(14)
* Psychosis: Drugs such as [[quetiapine]], [[clozapine]] and [[pimavanserin]] are used in managing [[psychosis]] in [[Parkinson's disease|PD]].<ref name="pmid21179595">{{cite journal |vauthors=Shotbolt P, Samuel M, David A |title=Quetiapine in the treatment of psychosis in Parkinson's disease |journal=Ther Adv Neurol Disord |volume=3 |issue=6 |pages=339–50 |date=November 2010 |pmid=21179595 |pmc=3002640 |doi=10.1177/1756285610389656 |url=}}</ref><ref name="pmid24183563">{{cite journal |vauthors=Cummings J, Isaacson S, Mills R, Williams H, Chi-Burris K, Corbett A, Dhall R, Ballard C |title=Pimavanserin for patients with Parkinson's disease psychosis: a randomised, placebo-controlled phase 3 trial |journal=Lancet |volume=383 |issue=9916 |pages=533–40 |date=February 2014 |pmid=24183563 |doi=10.1016/S0140-6736(13)62106-6 |url=}}</ref> one of the [[side effects]] of [[clozapine]] is [[leukopenia]] and [[agranulocytosis]].<ref name="pmid16595571">{{cite journal |vauthors=Schulte P |title=Risk of clozapine-associated agranulocytosis and mandatory white blood cell monitoring |journal=Ann Pharmacother |volume=40 |issue=4 |pages=683–8 |date=April 2006 |pmid=16595571 |doi=10.1345/aph.1G396 |url=}}</ref>
* Dementia: [[Cholinesterase inhibitors]] such as [[rivastigmine]] and [[donepezil]] are the main treatment of [[dementia]] in [[Parkinson's disease|PD]].(130_131_138)
* Dementia: [[Cholinesterase inhibitors]] such as [[rivastigmine]] and [[donepezil]] are the main treatment of [[dementia]] in [[Parkinson's disease|PD]].<ref name="pmid22419314">{{cite journal |vauthors=Rolinski M, Fox C, Maidment I, McShane R |title=Cholinesterase inhibitors for dementia with Lewy bodies, Parkinson's disease dementia and cognitive impairment in Parkinson's disease |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD006504 |date=March 2012 |pmid=22419314 |doi=10.1002/14651858.CD006504.pub2 |url=}}</ref><ref name="pmid15590953">{{cite journal |vauthors=Emre M, Aarsland D, Albanese A, Byrne EJ, Deuschl G, De Deyn PP, Durif F, Kulisevsky J, van Laar T, Lees A, Poewe W, Robillard A, Rosa MM, Wolters E, Quarg P, Tekin S, Lane R |title=Rivastigmine for dementia associated with Parkinson's disease |journal=N. Engl. J. Med. |volume=351 |issue=24 |pages=2509–18 |date=December 2004 |pmid=15590953 |doi=10.1056/NEJMoa041470 |url=}}</ref><ref name="pmid22915447">{{cite journal |vauthors=Dubois B, Tolosa E, Katzenschlager R, Emre M, Lees AJ, Schumann G, Pourcher E, Gray J, Thomas G, Swartz J, Hsu T, Moline ML |title=Donepezil in Parkinson's disease dementia: a randomized, double-blind efficacy and safety study |journal=Mov. Disord. |volume=27 |issue=10 |pages=1230–8 |date=September 2012 |pmid=22915447 |doi=10.1002/mds.25098 |url=}}</ref>
* Fatigue: [[Amantadine]], [[methylphenidate]] and [[pemoline]] can improve [[fatigue]] in [[Parkinson's disease|PD]] patients.(21_22_23)
* Fatigue: [[Amantadine]], [[methylphenidate]] and [[pemoline]] can improve [[fatigue]] in [[Parkinson's disease|PD]] patients.<ref name="pmid26447539">{{cite journal |vauthors=Elbers RG, Verhoef J, van Wegen EE, Berendse HW, Kwakkel G |title=Interventions for fatigue in Parkinson's disease |journal=Cochrane Database Syst Rev |volume= |issue=10 |pages=CD010925 |date=October 2015 |pmid=26447539 |doi=10.1002/14651858.CD010925.pub2 |url=}}</ref><ref name="pmid17674415">{{cite journal |vauthors=Mendonça DA, Menezes K, Jog MS |title=Methylphenidate improves fatigue scores in Parkinson disease: a randomized controlled trial |journal=Mov. Disord. |volume=22 |issue=14 |pages=2070–6 |date=October 2007 |pmid=17674415 |doi=10.1002/mds.21656 |url=}}</ref><ref name="pmid20231670">{{cite journal |vauthors=Zesiewicz TA, Sullivan KL, Arnulf I, Chaudhuri KR, Morgan JC, Gronseth GS, Miyasaki J, Iverson DJ, Weiner WJ |title=Practice Parameter: treatment of nonmotor symptoms of Parkinson disease: report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=74 |issue=11 |pages=924–31 |date=March 2010 |pmid=20231670 |doi=10.1212/WNL.0b013e3181d55f24 |url=}}</ref>
* Depression: [[Amitriptyline]](24), [[desipramine]], [[citalopram]](25),[[paroxetine]], [[venlafaxine]](28), [[ropinirole]] and [[pramipexole]](11_29_30) are useful in managing [[depression]] in [[Parkinson's disease|PD]] patients. If we intent to use tricyclics we should be aware that their [[anticholinergic]] effect can increase [[orthostatic hypotension]] and [[cognitive impairment]](13) and for [[SSRI]] we should know that they can cause [[dystonia]], [[tremor]] and [[parkinsonism]].(34) the combination of [[MAO inhibitors|MAO B inhibitors]] with [[SSRIs]] or tricyclics can cause [[serotonin syndrome]]<nowiki/>s(48)
* Depression: [[Amitriptyline]]<ref name="pmid12497304">{{cite journal |vauthors=Serrano-Dueñas M |title=[A comparison between low doses of amitriptyline and low doses of fluoxetin used in the control of depression in patients suffering from Parkinson's disease] |language=Spanish; Castilian |journal=Rev Neurol |volume=35 |issue=11 |pages=1010–4 |date=2002 |pmid=12497304 |doi= |url=}}</ref>, [[desipramine]], [[citalopram]]<ref name="pmid18311826">{{cite journal |vauthors=Devos D, Dujardin K, Poirot I, Moreau C, Cottencin O, Thomas P, Destée A, Bordet R, Defebvre L |title=Comparison of desipramine and citalopram treatments for depression in Parkinson's disease: a double-blind, randomized, placebo-controlled study |journal=Mov. Disord. |volume=23 |issue=6 |pages=850–7 |date=April 2008 |pmid=18311826 |doi=10.1002/mds.21966 |url=}}</ref>,[[paroxetine]], [[venlafaxine]]<ref name="pmid22496199">{{cite journal |vauthors=Richard IH, McDermott MP, Kurlan R, Lyness JM, Como PG, Pearson N, Factor SA, Juncos J, Serrano Ramos C, Brodsky M, Manning C, Marsh L, Shulman L, Fernandez HH, Black KJ, Panisset M, Christine CW, Jiang W, Singer C, Horn S, Pfeiffer R, Rottenberg D, Slevin J, Elmer L, Press D, Hyson HC, McDonald W |title=A randomized, double-blind, placebo-controlled trial of antidepressants in Parkinson disease |journal=Neurology |volume=78 |issue=16 |pages=1229–36 |date=April 2012 |pmid=22496199 |pmc=3324323 |doi=10.1212/WNL.0b013e3182516244 |url=}}</ref>, [[ropinirole]] and [[pramipexole]]<ref name="pmid22021174">{{cite journal |vauthors=Seppi K, Weintraub D, Coelho M, Perez-Lloret S, Fox SH, Katzenschlager R, Hametner EM, Poewe W, Rascol O, Goetz CG, Sampaio C |title=The Movement Disorder Society Evidence-Based Medicine Review Update: Treatments for the non-motor symptoms of Parkinson's disease |journal=Mov. Disord. |volume=26 Suppl 3 |issue= |pages=S42–80 |date=October 2011 |pmid=22021174 |pmc=4020145 |doi=10.1002/mds.23884 |url=}}</ref><ref name="pmid17404192">{{cite journal |vauthors=Pahwa R, Stacy MA, Factor SA, Lyons KE, Stocchi F, Hersh BP, Elmer LW, Truong DD, Earl NL |title=Ropinirole 24-hour prolonged release: randomized, controlled study in advanced Parkinson disease |journal=Neurology |volume=68 |issue=14 |pages=1108–15 |date=April 2007 |pmid=17404192 |doi=10.1212/01.wnl.0000258660.74391.c1 |url=}}</ref><ref name="pmid20452823">{{cite journal |vauthors=Barone P, Poewe W, Albrecht S, Debieuvre C, Massey D, Rascol O, Tolosa E, Weintraub D |title=Pramipexole for the treatment of depressive symptoms in patients with Parkinson's disease: a randomised, double-blind, placebo-controlled trial |journal=Lancet Neurol |volume=9 |issue=6 |pages=573–80 |date=June 2010 |pmid=20452823 |doi=10.1016/S1474-4422(10)70106-X |url=}}</ref> are useful in managing [[depression]] in [[Parkinson's disease|PD]] patients. If we intent to use tricyclics we should be aware that their [[anticholinergic]] effect can increase [[orthostatic hypotension]] and [[cognitive impairment]]<ref name="pmid16606910">{{cite journal |vauthors=Miyasaki JM, Shannon K, Voon V, Ravina B, Kleiner-Fisman G, Anderson K, Shulman LM, Gronseth G, Weiner WJ |title=Practice Parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=66 |issue=7 |pages=996–1002 |date=April 2006 |pmid=16606910 |doi=10.1212/01.wnl.0000215428.46057.3d |url=}}</ref> and for [[SSRI]] we should know that they can cause [[dystonia]], [[tremor]] and [[parkinsonism]].<ref name="pmid8723152">{{cite journal |vauthors=Bharucha KJ, Sethi KD |title=Complex movement disorders induced by fluoxetine |journal=Mov. Disord. |volume=11 |issue=3 |pages=324–6 |date=May 1996 |pmid=8723152 |doi=10.1002/mds.870110318 |url=}}</ref> the combination of [[MAO inhibitors|MAO B inhibitors]] with [[SSRIs]] or tricyclics can cause [[serotonin syndrome]]<nowiki/>s<ref name="pmid9109902">{{cite journal |vauthors=Richard IH, Kurlan R, Tanner C, Factor S, Hubble J, Suchowersky O, Waters C |title=Serotonin syndrome and the combined use of deprenyl and an antidepressant in Parkinson's disease. Parkinson Study Group |journal=Neurology |volume=48 |issue=4 |pages=1070–7 |date=April 1997 |pmid=9109902 |doi= |url=}}</ref>
* Constipation: Increasing [[Probiotic|probiotics]] and fibers, [[lubiprostone]] and [[polyethylene glycol]] are effective in treatment of [[constipation]].(51_52_53)
* Constipation: Increasing [[Probiotic|probiotics]] and fibers, [[lubiprostone]] and [[polyethylene glycol]] are effective in treatment of [[constipation]].<ref name="pmid22573627">{{cite journal |vauthors=Ondo WG, Kenney C, Sullivan K, Davidson A, Hunter C, Jahan I, McCombs A, Miller A, Zesiewicz TA |title=Placebo-controlled trial of lubiprostone for constipation associated with Parkinson disease |journal=Neurology |volume=78 |issue=21 |pages=1650–4 |date=May 2012 |pmid=22573627 |doi=10.1212/WNL.0b013e3182574f28 |url=}}</ref><ref name="pmid17566120">{{cite journal |vauthors=Zangaglia R, Martignoni E, Glorioso M, Ossola M, Riboldazzi G, Calandrella D, Brunetti G, Pacchetti C |title=Macrogol for the treatment of constipation in Parkinson's disease. A randomized placebo-controlled study |journal=Mov. Disord. |volume=22 |issue=9 |pages=1239–44 |date=July 2007 |pmid=17566120 |doi=10.1002/mds.21243 |url=}}</ref><ref name="pmid27543643">{{cite journal |vauthors=Barichella M, Pacchetti C, Bolliri C, Cassani E, Iorio L, Pusani C, Pinelli G, Privitera G, Cesari I, Faierman SA, Caccialanza R, Pezzoli G, Cereda E |title=Probiotics and prebiotic fiber for constipation associated with Parkinson disease: An RCT |journal=Neurology |volume=87 |issue=12 |pages=1274–80 |date=September 2016 |pmid=27543643 |doi=10.1212/WNL.0000000000003127 |url=}}</ref>
* Sialorrhea: If the [[sialorrhea]] is mild we can treat it with chewing gum and hard candy(54_55) but in severe cases, [[botulinum toxin]] injection into [[Salivary gland|salivary glands]] is helpful.(11_56 ta 59)
* Sialorrhea: If the [[sialorrhea]] is mild we can treat it with chewing gum and hard candy<ref name="pmid20829091">{{cite journal |vauthors=Pfeiffer RF |title=Gastrointestinal dysfunction in Parkinson's disease |journal=Parkinsonism Relat. Disord. |volume=17 |issue=1 |pages=10–5 |date=January 2011 |pmid=20829091 |doi=10.1016/j.parkreldis.2010.08.003 |url=}}</ref><ref name="pmid21499704">{{cite journal |vauthors=Cloud LJ, Greene JG |title=Gastrointestinal features of Parkinson's disease |journal=Curr Neurol Neurosci Rep |volume=11 |issue=4 |pages=379–84 |date=August 2011 |pmid=21499704 |doi=10.1007/s11910-011-0204-0 |url=}}</ref> but in severe cases, [[botulinum toxin]] injection into [[Salivary gland|salivary glands]] is helpful.<ref name="pmid22021174">{{cite journal |vauthors=Seppi K, Weintraub D, Coelho M, Perez-Lloret S, Fox SH, Katzenschlager R, Hametner EM, Poewe W, Rascol O, Goetz CG, Sampaio C |title=The Movement Disorder Society Evidence-Based Medicine Review Update: Treatments for the non-motor symptoms of Parkinson's disease |journal=Mov. Disord. |volume=26 Suppl 3 |issue= |pages=S42–80 |date=October 2011 |pmid=22021174 |pmc=4020145 |doi=10.1002/mds.23884 |url=}}</ref><ref name="pmid21887710">{{cite journal |vauthors=Chinnapongse R, Gullo K, Nemeth P, Zhang Y, Griggs L |title=Safety and efficacy of botulinum toxin type B for treatment of sialorrhea in Parkinson's disease: a prospective double-blind trial |journal=Mov. Disord. |volume=27 |issue=2 |pages=219–26 |date=February 2012 |pmid=21887710 |doi=10.1002/mds.23929 |url=}}</ref>
* Sexual dysfunction: Male [[sexual dysfunction]] can be treated with [[sildenafil]].(66)
* Sexual dysfunction: Male [[sexual dysfunction]] can be treated with [[sildenafil]].<ref name="pmid12074807">{{cite journal |vauthors=Raffaele R, Vecchio I, Giammusso B, Morgia G, Brunetto MB, Rampello L |title=Efficacy and safety of fixed-dose oral sildenafil in the treatment of sexual dysfunction in depressed patients with idiopathic Parkinson's disease |journal=Eur. Urol. |volume=41 |issue=4 |pages=382–6 |date=April 2002 |pmid=12074807 |doi= |url=}}</ref>
* Ortostatic hypotention:
* Ortostatic hypotention: [[Fludrocortisone]]<ref name="pmid1094320">{{cite journal |vauthors=Campbell IW, Ewing DJ, Clarke BF |title=9-Alpha-fluorohydrocortisone in the treatment of postural hypotension in diabetic autonomic neuropathy |journal=Diabetes |volume=24 |issue=4 |pages=381–4 |date=April 1975 |pmid=1094320 |doi= |url=}}</ref>, [[Sympathomimetic agents]] such as [[ephedrine]], [[pseudoephedrine]], [[methylphenidate]] and [[dextroamphetamine]] are used to treat [[orthostatic hypotension]].<ref name="pmid74603">{{cite journal |vauthors=Davies B, Bannister R, Sever P |title=Pressor amines and monoamine-oxidase inhibitors for treatment of postural hypotension in autonomic failure. Limitations and hazards |journal=Lancet |volume=1 |issue=8057 |pages=172–5 |date=January 1978 |pmid=74603 |doi= |url=}}</ref><ref name="pmid3599310">{{cite journal |vauthors=Biaggioni I, Onrot J, Stewart CK, Robertson D |title=The potent pressor effect of phenylpropanolamine in patients with autonomic impairment |journal=JAMA |volume=258 |issue=2 |pages=236–9 |date=July 1987 |pmid=3599310 |doi= |url=}}</ref>


==References==
==References==

Latest revision as of 19:15, 28 November 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The mainstay of therapy for motor symptoms of Parkinson disease are: Levodopa, dopamine agonists, monoamine oxidase (MAO) B inhibitors, anticholinergic agents, amantadine, catechol-O-methyl transferase (COMT) inhibitors, estrogen and other drugs such as Exenatide, uric acid, isradipine, nilotinib and GDNF infusion.

Treatment choices for some of the nonmotor symptoms of PD are:

psychosis: quetiapine, clozapine and pimavanserin.

Dementia: Cholinesterase inhibitors such as rivastigmine and donepezil.

Fatigue: Amantadine, methylphenidate and pemoline.

Depression: Amitriptyline, desipramine, citalopram ,paroxetine, venlafaxine, ropinirole and pramipexole.

Constipation: Increasing probiotics and fibers, lubiprostone and polyethylene glycol.

Sialorrhea: chewing gum and hard candy but in severe cases, botulinum toxin injection into salivary glands .

Sexual dysfunction: sildenafil (for male)

Ortostatic hypotention: Fludrocortisone, Sympathomimetic agents such as ephedrine, pseudoephedrine, methylphenidate and dextroamphetamine.

Medical Therapy

The mainstay of therapy for motor symptoms of Parkinson disease are:

Treatment choices for some of the nonmotor symptoms of PD are:

References

  1. ↑ Connolly BS, Lang AE (2014). "Pharmacological treatment of Parkinson disease: a review". JAMA. 311 (16): 1670–83. doi:10.1001/jama.2014.3654. PMID 24756517.
  2. ↑ Ferreira JJ, Katzenschlager R, Bloem BR, Bonuccelli U, Burn D, Deuschl G, Dietrichs E, Fabbrini G, Friedman A, Kanovsky P, Kostic V, Nieuwboer A, Odin P, Poewe W, Rascol O, Sampaio C, Schüpbach M, Tolosa E, Trenkwalder C, Schapira A, Berardelli A, Oertel WH (January 2013). "Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson's disease". Eur. J. Neurol. 20 (1): 5–15. doi:10.1111/j.1468-1331.2012.03866.x. PMID 23279439.
  3. ↑ "Parcopa: a rapidly dissolving formulation of carbidopa/levodopa". Med Lett Drugs Ther. 47 (1201): 12. January 2005. PMID 15706700.
  4. ↑ Ondo WG, Shinawi L, Moore S (December 2010). "Comparison of orally dissolving carbidopa/levodopa (Parcopa) to conventional oral carbidopa/levodopa: A single-dose, double-blind, double-dummy, placebo-controlled, crossover trial". Mov. Disord. 25 (16): 2724–7. doi:10.1002/mds.23158. PMID 20925074.
  5. ↑ Toth C, Brown MS, Furtado S, Suchowersky O, Zochodne D (October 2008). "Neuropathy as a potential complication of levodopa use in Parkinson's disease". Mov. Disord. 23 (13): 1850–9. doi:10.1002/mds.22137. PMID 18785232.
  6. ↑ Toth C, Breithaupt K, Ge S, Duan Y, Terris JM, Thiessen A, Wiebe S, Zochodne DW, Suchowersky O (July 2010). "Levodopa, methylmalonic acid, and neuropathy in idiopathic Parkinson disease". Ann. Neurol. 68 (1): 28–36. doi:10.1002/ana.22021. PMID 20582991.
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