HEALING OF PARKINSON'S DISEASE THRU MEDICATIONS (LEVODOPA)

The most common treatment for Parkinson's disease is the use of medications. The goal of therapy is to provide the brain chemical (neurotransmitter), dopamine, in adequate amounts so as to prevent the symptoms of Parkinson's disease. An antiparkinson drug is usually started when symptoms become disabling or disrupt a person's daily activities.

There are specific instructions in taking the drugs for Parkinson's disease. It is important to follow your doctor's prescriptions about how and when to take your drugs so that they will be effective and safe. You cannot increase, decrease or change the drug without your doctor's knowledge because it may cause more problems in the control of symptoms.

Therapy depends on a person's symptoms and age and how the person responds to a certain drug. Medications often improve symptoms, but they also may cause side effects. It may take awhile to find the best combination of drugs for each particular individual. Several drugs may be used to treat Parkinson's disease at different stages of the disease.

The treatment of early Parkinson's starts with one or more of these medicines, which are commercially available in the Philippines:
 Levodopa and carbidopa
 Dopamine agonists (pramipexole, bromocriptine mesylate, piribedil)
 COMT inhibitors (entacapone)
 MAO-B inhibitors (selegiline)
 Amantadine
 Anticholinergic agents (biperiden Hcl)

 Levodopa is thought to be the most effective drug for controlling symptoms of Parkinson's disease and for many years was the preferred drug for treating newly diagnosed patients. However, long-term use of levodopa at high dosages often leads to motor complications that can be difficult to manage. The decision about whether it is better to use levodopa or other antiparkinson drug like a dopamine agonist as the first treatment has not been fully resolved. The decision on the drug of choice will most likely be different for each person. It is imperative to consult your doctor to find the medicines that work the best for you. 

LEVODOPA/CARBIDOPA 

 (SINEMET) MSD/INVIDA [ZUELLIG] {P 49.00}
 (TIDOMET/TIDOMET CR) TORRENT [METRO DRUG] {P 49.75}

 LEGEND: (BRAND NAME) MANUFACTURER [DISTRIBUTOR] {SRP: levodopa 100mg/carbidopa 25 mg TAB}

 PREPARATION/CONTENTS per tablet:
 Levodopa 100 mg/carbidopa 25 mg
 Levodopa 250 mg/carbidopa 25 mg
 Levodopa 200 mg/carbidopa 50 mg(CR) or Controlled Release

 INDICATIONS: Treatment of symptoms of idiopathic Parkinson's disease(paralysis agitans) Treatment of symptoms of postencephalitic parkinsonism, which follows injury to nervous system by carbon monoxide and manganese intoxication Patients who are taking vitamin preparations containing vit. B6 Reduce "offtime" in patients previously treated with levodopa/ decarboxylase inhibitor preparations

 DOSAGE:

 FOR SINEMET: Sinemet 25/100 1 tab TID. Maximum: 8 tabs Sinemet 25/250 1/2 tab once-BID. Maximum: 8 tabs Transfer from levodopa: Stop levodopa 12 hr before Sinemet is started (24 hr for CR preparation) Patient taking > 1,500 mg levodopa: Initially 1 tab Sinemet TID-QID Patient taking < 1,500 mg levodopa: Initially 1 tab Sinemet 25/100 TID-QID. Sinemet CR 1 CR tab BID-TID, maximum dose 600 mg/day of levodopa or to be given at intervals < 6 hrs.

 FOR TIDOMET: Individualized dosage 

ADMINISTRATION OF ORAL DOSAGE/PRE- & POST-PRANDIAL ADVICE: Take on an empty stomach if possible. If GI distress occurs, take with food. CT tab: Swallow whole, do not chew/crush. 50/200 CR tab may be halved along the score-line only.

 CONTRAINDICATIONS: 
 Narrow-angle glaucoma
 Undiagnosed skin lesions or history of melanoma
 Hypersensitivity to any component of this product

 SPECIAL PRECAUTIONS: Treatment of drug-induced extrapyramidal reactions. Monitor for melanomas frequently and on a regular basis. Perform periodic skin exam. Patients previously treated with levodopa alone. CV disease including history of MI or arrhythmias or pulmonary disease, bronchial asthma, renal, hepatic or endocrine disease, history of psychoses or convulsions, or wide-angle glaucoma. History of active peptic ulcer. Absorption of L-dopa may be impaired in some patients on a high protein diet. Not recommended for children < 18 yrs. Pregnancy, lactation.

 ADVERSE REACTIONS:
 SINEMET: Dyskinesia including choreiform, dystonic and other involuntary movements and nausea. Pathological gambling, hypersexuality and increased libido. Very rarely, excessive daytime somnolence and sudden sleep onset episodes, paresthesia, psychotic episodes. Muscle twitching and blepharospasm. Syncope, chest pain, anorexua, CV, GI, hematologic, hypersensitivity, nervous/psychiatric, resp., dermatological and urogenital effects.
 TIDOMET Choreiform, dystonia, involuntary movements, mental changes, depression w/ or w/o development of suicidal tendencies and dementia. Nausea, orthostatic hypotension, brsadykinetic episodes, anorexia, vomiting and dizziness.

 DRUG INTERACTIONS: Discontinue MAOIs 2 weeks prior to therapy with Sinemet(except low doses of selective MAO-B inhibitors), tricyclic antidepressants, antihypertensives, phenothiazines, butyrophenones, phenytoin, papavarine, INH.

 REFERENCES:
 1. http://www.webmd.com/parkinsons-disease/guide/parkinsons-disease-medications
2. MIMS.com