Parkinson’s is a progressive disease of the nervous system that affects movement. People with this condition have symptoms such as shakiness, stiffness, slow movements, and problems with balance and coordination. The symptoms gradually get worse over time. As Parkinson’s disease progresses, an affected individual may have difficulty with walking and talking and can develop behavioral changes, memory difficulties, depression, sleep problems, and fatigue.

Parkinson’s disease occurs because neurons (nerve cells) in the part of the brain that controls movement become damaged or die. These neurons are responsible for producing a neurotransmitter (chemical) called dopamine. The death of these neurons leads to low levels of dopamine and consequently movement problems. It is unclear what causes the neurons to die in Parkinson’s patients. Some of the non-movement symptoms of Parkinson’s disease, such as fatigue, drop in blood pressure when standing up from sitting or lying down, and slowed digestion can be explained by the loss of nerve endings that produce another chemical called norepinephrine.

Approximately 60,000 people are diagnosed with Parkinson’s disease every year in the United States. In 2020, an estimated 1 million Americans are living with this condition. Both men and women can develop Parkinson’s disease but it is 1.5 times more common in men than women. Age is a risk factor and most people are diagnosed at around age 60, but the disease can occasionally occur before age 50.

Medications to Treat Parkinson’s

Some of the medications used to treat Parkinson’s disease are described below:

Levodopa is a precursor of dopamine. It is taken up by the remaining neurons in the brain and converted to dopamine, thereby overcoming the deficit in Parkinson’s patients. Levodopa is the most widely used Parkinson’s treatment. It is almost always given with another medication called carbidopa (Lodosyn) or benserazide (Benspar) which allows the dose of levodopa to be reduced and the severity of side effects to be less while maintaining the anti-Parkinson effect. An example is Sinemet (carbidopa-levodopa combination medication). It is available as tablets, controlled-release or prolonged-release capsules and tablets, and dispersible tablets. While levodopa is very effective in improving stiffness and slowness as well as speech, swallowing, and sleep symptoms, it can become less effective over time.

COMT inhibitors (catechol-O-methyl-transferase inhibitors) prevent the breakdown of dopamine in the brain. Examples include entacapone (Comtan), opicapone (Ongentys), and tolcapone (Tasmar). They are often used with levodopa-carbidopa to help the latter work more smoothly, i.e., reduce the fluctuation of symptoms (on and off episodes where the medication works and then wears off and stops working). Combination drugs like Stalevo contain levodopa, carbidopa, and entacapone.

Dopamine agonists are medications that mimic the action of dopamine in the brain. They are used with levodopa and other Parkinson’s drugs to make the treatment more effective with fewer side effects. Examples include apomorphine (Apokyn), pramipexole (Mirapex), ropinirole (Requip), and rotigotine (Neupro). Some of the older dopamine agonists like bromocriptine, cabergoline, and pergolide have a higher risk of causing heart problems and they are therefore only used when the newer dopamine agonists do not work.

MAO-B inhibitors (monoamine oxidase B inhibitors) work by blocking an enzyme that breaks down dopamine, thereby increasing the amount of dopamine available in the brain. Examples include rasagiline (Azilect), selegiline (Eldepryl), Zelapar), and safinamide (Xadago).

Anticholinergics like benztropine (Cogentin) are used along with other Parkinson’s medications. They work by blocking a chemical called acetylcholine to decrease symptoms of Parkinson’s disease.

Adamantanes like amantadine (Osmolex ER) treat Parkinson’s symptoms by increasing the amount of dopamine.

Adenosine A2A antagonists like istradefylline (Nourianz) are used as add-on therapy in patients on levodopa-carbidopa for “off periods” when the effects of the medications wear off.

Over-the-Counter Medications for Parkinson’s

Scientists are researching several supplements to see if they play a role in Parkinson’s disease. Some people take over-the-counter dietary supplements, such as coenzyme Q10, vitamin C, vitamin E, creatine, glutathione, curcumin, and herbal remedies to try and improve their Parkinson’s symptoms. However, there is currently not enough scientific data to support their use for Parkinson’s disease. It is worth remembering that OTC medications can have side effects and may interfere with prescription medications. If you have been diagnosed with Parkinson’s, it is highly recommended that you talk to your doctor before taking any OTC supplement.

Common Side Effects of Parkinson’s Medications

Levodopa can cause side effects like nausea, vomiting, low blood pressure, sleep problems, loss of appetite, and hallucinations. Side effects also include “off periods” which can build up over time. During off periods, the effect of the medication wears off and the body becomes very stiff and slow. Another side effect of long-term levodopa use is dyskinesia (involuntary movements). Controlled-release formulations of levodopa can help reduce the incidence and severity of dyskinesia. A small number of people experience problems with impulse control or compulsive behaviors while taking levodopa.

COMT inhibitors can make the side effects of levodopa such as nausea and unwanted movements worse. Other side effects of COMT inhibitors include sleep problems, loss of appetite, dizziness, fainting, falls, diarrhea, headache, dry mouth, chest pain, hallucinations, confusion.

Potential side effects of dopamine agonists include dizziness, drowsiness, confusion, memory problems, headache, dry mouth, stuffy nose, nausea, constipation, hallucinations, and swelling in the arms and legs.

Common side effects of MAO-B inhibitors include nausea, lightheadedness, dry mouth, constipation, insomnia, confusion, hallucinations, and worsening dyskinesia.

Anticholinergics can cause dry mouth, constipation, pain while urinating, nausea, and loss of appetite. More serious side effects include fever, irregular heartbeat, rash, confusion, depression, vision changes, and hallucinations.

Amantadine can cause side effects like drowsiness, confusion, headache, nausea, vomiting, constipation, dry mouth, loss of appetite, sleep problems, and fatigue.

Common Questions

Is Parkinson’s disease hereditary?

Some cases of Parkinson’s appear to be inherited and can be traced to mutations in specific genes. However, in most Parkinson’s patients, the disease is random and does not appear to run in families. Scientists believe the cause of Parkinson’s is a mix of genetic and environmental factors like exposure to toxins.

Can surgery cure Parkinson’s?

No surgery that can cure Parkinson’s. However, surgery may be an option for some people with the disease. Surgical procedures like deep brain stimulation, pallidotomy, and thalamotomy are considered when non-invasive treatment options like medications have been exhausted.

Can I get a discount on medications to treat Parkinson’s with BuzzRx?

Yes, you can get discounts on some medicines—including medications to treat Parkinson’s disease—as long as you have a signed prescription from your doctor.

References:

1.      https://www.nia.nih.gov/health/parkinsons-disease

2.      https://www.parkinson.org/Understanding-Parkinsons/Statistics

3.      https://www.epda.eu.com/about-parkinsons/treatments/classes-of-medication/

4.      https://www.parkinson.org/Understanding-Parkinsons/Treatment/Prescription-Medications/MAO-B-Inhibitors

5.      https://www.parkinson.org/Understanding-Parkinsons/Treatment/Over-the-Counter-and-Complementary-Therapies

6.      https://medlineplus.gov/druginfo/meds/a682155.html

7.      https://medlineplus.gov/druginfo/meds/a682064.html

8.      https://parkinsonsdisease.net/treatment/surgical-options/