It is a known fact that Parkinson’s disease has no cure. In the early stages of uncomplicated Parkinson’s disease, use of pharmacological agents is still the primary mode of treatment. One of the drugs being used in the treatment of PD is the catechol- O - methyltransferase (COMT) inhibitors like entacapone and tolcapone.
MECHANISM OF ACTION:
COMT INHIBITORS reduce the metabolism of levodopa, extending its plasma half - life and prolonging the action of each levodopa dose. Therapeutic dose of entacapone only acts peripherally and does not alter cerebral COMT activity. It is administered together with each dose of levodopa and is not approved for use in early (uncomplicated) and non- fluctuating PD patients.
SYMPTOMATIC TREATMENT:
SYMPTOMATIC TREATMENT:
Symptomatic treatment of parkinsonism using COMT inhibitors as monotherapy is not applicable hence COMT inhibitors should always be given with levodopa. In some studies done on COMT inhibitors, all trials showed a small benefit in the control of the symptoms of parkinsonism, mostly reflected in the activities of daily living but the results were not consistent.
When the initiation of treatment with levodopa/carbidopa/entacapone was compared to that with levodopa/carbidopa, no difference was found between the two treatment arms as to the prevention of motor fluctuations and dyskinesia. There are no studies available on the symptomatic treatment of non-motor problems.
SAFETY:
COMT inhibitors increase levodopa bioavailability, so they can increase the incidence of dopaminergic adverse reactions, including nausea, and cardiovascular and neuropsychiatric complications. Diarrhea and urine discoloration are the most frequently reported non-dopaminergic adverse reactions. The combination with selective MAO-B inhibitors (selegiline) is allowed if the dose of MAO-B inhibitor does not exceed the recommended dose.
ENTACAPONE (COMTAN)
The commercially available preparation of a COMT inhibitor in the Philippines is ENTACAPONE (COMTAN) manufactured by NOVARTIS HEALTHCARE. The indications, dosage, manner of administration, contraindication and special precautions are the following:
INDICATIONS: Adjunct to levodopa/benserazide or levodopa/carbidopa treatment in patients with Parkinson's disease and end-of-dose motor fluctuations, who cannot be stabilized on those combinations.
DOSAGE:
One 200-mg tab with each levodopa or dopa decarboxylase inhibitor dose. Maximum: 2 g/day
ADMINISTRATION:
May be taken with or without meals.
CONTRAINDICATIONS: Pregnancy and lactation
Pheochromocytoma
Concommitant use with nonselective MAO inhibitors (MAO-A and MAO-B) or with a selective MAO-A plus a selective MAO-B inhibitor.
Liver impairment
History of neuroleptic malignant syndrome &/or nontraumatic rhabdomyolysis
Pheochromocytoma
Concommitant use with nonselective MAO inhibitors (MAO-A and MAO-B) or with a selective MAO-A plus a selective MAO-B inhibitor.
Liver impairment
History of neuroleptic malignant syndrome &/or nontraumatic rhabdomyolysis
SPECIAL PRECAUTIONS:
Dosage of L-dopa and other antiparkinsonism drugs(e.g. dopamine agonists) may need to be adjusted.
L-dopa induced orthostatic hypotension may be aggravated.
Effects of medicinal products metabolized by catechol-O-methyl transferase may be potentiated.
Caution when discontinuing treatment, when driving or operating machines due to potential sudden sleep onset episodes.
Dosage of L-dopa and other antiparkinsonism drugs(e.g. dopamine agonists) may need to be adjusted.
L-dopa induced orthostatic hypotension may be aggravated.
Effects of medicinal products metabolized by catechol-O-methyl transferase may be potentiated.
Caution when discontinuing treatment, when driving or operating machines due to potential sudden sleep onset episodes.
To get an update in the diagnosis and management of Parkinson's disease, Pinoy Parkinson's Disease or Pinoy PD is holding its First Annual Convention on October 22, 2011 in Makati City.
P.S. FINAL EXTENSION OF FREE REGISTRATION! Register for FREE on or before OCTOBER 15, 2011.
P.P.S. Register for a GUARANTEED SEAT and SLOT in the workshop to a LIMITED NUMBER of participants on or before OCTOBER 15, 2011 including LUNCH, 2 SNACKS and SEMINAR KIT.
P.P.P.S. Submit REGISTRATION DETAILS (Name, Age, Contact number and E-mail address) on or before OCTOBER 15, 2011 to avail of FREE REGISTRATION and send via email to drajoy31@yahoo.com / drajoy31@gmail.com
I was diagnosed with Parkinson's disease a year ago at the age of 68. For several months I had noticed tremors in my right hand and the shaking of my right foot when I was sitting. My normally beautiful cursive writing was now small cramped printing. And I tended to lose my balance. Neurologist had me walk down the hall and said I didn't swing my right arm. I had never noticed! I was in denial for a while as there is no history in my family of parents and five older siblings, but now accept I had classic symptoms. I was taking pramipexole (Sifrol), carbidopa/levodopa and Biperiden, 2 mg. and started physical therapy to strengthen muscles. nothing was really working to help my condition.I went off the Siferol (with the doctor’s knowledge) and started on parkinson’s herbal formula i ordered from Health Herbal Clinic, my symptoms totally declined over a 5 weeks use of the Parkinsons disease natural herbal formula. i am now almost 70 and doing very well, the disease is totally reversed!! Visit there website www . healthherbalclinic . net
ReplyDeleteMy dad was also diagnosed with Parkinson's disease.his symptoms were shuffling of feet,slurred speech,degradation of hand writing, horrible driving skills, right arm held at 46 degree angle, things were tough for me, but now he finally free from the disease with the help of total cure from ULTIMATE LIFE CLINIC, he now walks properly and all symptoms has reversed, he was having trouble with balance especially at night, getting into the shower and exiting it is difficult,getting into bed is also another thing he finds impossible.we had to find a better solution for his condition which really helped him a lot,the biggest helped we had was ultimate life clinic they walked us through the proper steps,i recommended this www.ultimatelifeclinic.com to anyone who also needs help.
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