treatment of parknsonism
DESCRIPTION
TRANSCRIPT
Treatment of Parkinson’s diseases
• Levadopa
• Dopamine agonists (bromocriptine, pergolide, pramipexole).
• MAOI (Selegiline, rasagiline).
• COMT inhibitors( tolcapone, entacapone)
• Amantadine (antiviral)
• Acetylcholine blocking drugs
(benztropine)
Levadopa
3,4 dihydroxyphenyl-L-alanine metabolic precursor of dopamine does enter the brai( L. amino acid
transpoter, LAT)Where it is decarboxylated to dopamine.D2 receptorGiven in combination of Carbidopa
(peripheral dopa decarboxylase inhibitor).
• Metabolism of levodopa (L-DOPA). ALDH, aldehyde dehydrogenase; COMT, catechol-O-methyltransferase; D H, dopamine -hydroxylase; AADC, aromatic L-amino acid decarboxylase; MAO, monoamine oxidase.
• PK
• Main metabolites
• 3- Methoxy-4-hydroxyphenyl acetic acid
• Homovanillic acid, HVA
• Dihydroxyhenylacetic acid ( DOPAC)
Side effects
• GI effects- vomiting• Cardiovascular effects- Postural hypotension,
tachycardia, ventricular extrasystole, atrial fibrillation (rare).
• Dyskinesia (prolong therapy)• Behavioral effects- Depression, anxiety,
agitation, insomnia, confusion, changes in mood.• Drug holidays- discontinue drug 3-21 days
( improve response)• On-off phenomenon-fluctuation in response
• Contraindications
• Angle-closure glaucoma
• Cardiac diseases
• Acid peptic diseases.
• Melanoma
• Interaction- Pyridoxine Vit B6 enhance peripheral metabolism
Levadopa + Carbidopa
• Sinemet- 25/100 ( carbidopa 25 mg, levadopa 100mg).
• Advantage
• Daily dose req of levadopa dec(75%)
• Less frequent GI effects.
• Less metabolism by pyridoxine.
Dopamine agonists.
• Bromocriptine (D2 agonist)
• Pramipexole ( not ergot, )
• Ropinirole
• Rotigine ( skin patches)
• Side effects(Dopamine agonist)• Anorexia, nausea, vomiting (with meals)• Cardiovascular effects- postural
hypotension.• Dyskinesias- • Mental disturbance • Misc- Headache, nasal congestion.• Contraindication• Psychotic illness, MI, peptic ulcers
MAOB-Inhibitor
• Selegiline
• Rasagiline
• Selegiline • Inhibitor MAOB- inhibitor.• Dec. breakdown of dopamine.• Selegiline + levadopa
COMT inhibitors
• Entacapone ( less hepatotoxic)
• Tolcapone
• Adverse effects:
• Dyskinesia, nausea,confusion.
• Diarrhea, abdominal pain, confusion.
Amantadine (antiviral)
• Antiviral agent
• MOA
• Inhibits dopamine degradation
• Inhibits adenosine that inhibits D2 receptors.
• Less effective than levadopa( iatrogenic dyskinesias)
• S/E- restlessness depression, confusion.
Antimuscarinic drugs
• Benztropine
• Biperiden
• Orphenadrine
Antimuscarinic drugs
• MOA• Antagonists at M receptors in basal ganglia.• Reduce tremor, rigidity.
• Toxicity:• Antimuscarinic effects, sedation, mydriasis, urinary
retention, dry mouth.