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Digital PharmD

Informatics in Pharmacy

Parkinson’s Disease

August 13, 2018 By Dr. G, PharmD

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In patients who need to be initiation on dopaminergic agents, either levodopa or dopamine agonists can be used. Levodopa is better at improving motor functions, dopamine agonists are better at lessening motor complications.  May also use a MAOI (rasagiline or selegiline only, they increase extracellular dopamine).

Carbidopa/Levodopa is the mainstay of therapy, but often clinicians will use a dopamine agonist as the first line in a younger patient to save carbidopa/levodopa, which has a limited effective life of 3-4 years.

  • Wearing Off Phenomenon: the return of symptoms before the next dose. Add dopamine agonist, MAO-B, COMT inhibitor increase levodopa.
  • On-Off Phenomenon: profound, predictable return of symptoms without respect to dosing interval. Add COMT inhibitor (entacapone) or  rasagiline
  • Dyskinesias are drug induced.  Decrease levodopa or add amantadine.

Dopamine Agonists:

  • Bromocriptine 5-40 mg
  • Pramipexole 1.5-4.5
  • Ropinirole: 0.75-24
  • Rotigotine: 6-8
  • Peroglide
  • May cause nausea and vomiting, hypotension, hallucinating. hypersexuality and/or compulsive behavior.  Monitor BP while titrating.

Anticholinergics: Trihexyphenidyl and benztropine are both 0.5-1 mg BID and cause dry mouth, urinary retention, dry eyes, constipation (think dry)

Amantadine: may reduce dyskinesia caused by levodopa, 100 mg BID to TID

COMT Inhibitors: Tolcapone is restricted due to hepatotoxicity.  Entacapone must be used with levodopa/carbidopa, increases levodopa to the brain.

Filed Under: Neurology

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020