Medication management is the cornerstone of treatment for Parkinson's disease. One thing to keep in mind is that medications work best with all other aspects of treatment. It is a supportive therapy, not a cure. You need a treatment plan that takes into consideration a number of factors that work to overcome Parkinson's symptoms. Medications work best when used in combination with rehabilitation therapies and general health measures, such as proper diet, stress management, exercise, and so on..

There are several forms of medication management: The medications used today work in several different ways.

  • Slow progression of the disease. Currently the dopamine agonists have been shown to have some effect in this area.

  • Restore the lost nerve cells. This is a research focus at present, but no agent has been found to be effective to accomplish this task.

  • Treat active Parkinson's symptoms:

    • agents that are dopamine replenishing (Sinemet®)

    • Dopamine releasing (Amantdine®)

    • Dopamine enhancing (dopamine agonists)

    • Increase dopamine absorption

Advancing Parkinson's

When does treatment with medications begin? What agents should be used first?

When one should start taking medications depends upon the individual: how much the symptoms interfere with lifestyle.

What medications should be used first?

It is currently agreed that Sinemet® should be avoided initially. Other medications, such as the agonists, are preferred first. This depends, however, on what your initial symptoms and disabilities are, and how old you are. For example, younger people with Parkinson's may be treated initially with the anticholinergics, such as Artane or Cogentin for tremor. Older people may be started initially on the agonists.

Similar to the treatment of most disease states, the optimal drug therapy for Parkinson's disease is both individualized and based on numerous factors. The choice of medication takes into consideration patient response, short and long-term side effects, possible drug interactions, presence of other medical and psychiatric conditions, as well as prescription insurance coverage.

Tips in taking your medications.

  • Get all the information you can about medications that are prescribed from your doctor, pharmacist or health care professional.

  • Make sure that you doctor is aware of ALL the medications you take, including over the counter medication, herbals, vitamins, etc.

  • Ask questions, as given below, about your medications and how to take them - and keep notes.

    • What is the name of the medication, the dose, and when do you take it.

    • How do you take your medication, such as the time of day, with or without meals.

    • What can you expect from your medication? What kind of symptom relief is to be expected and when? In one day; in two days? How long do you wait before you call you doctor to know if your medication is working as expected? When you start some medications, it may take a while to build up to a "therapeutic dose." You may be started on a low dose and gradually build up to the level you need in order to manage your symptoms adequately.

    • What happens if you miss a dose, or forget to take it at the allotted time? This greatly depends on the medication - so don't assume from one medication to the next.

    • Anticipate situations that may happen to you and ask the doctor how to handle that situation.

    • What side effects are usual for each medication? If you have the side effect, what do you do? When do you call the doctor?

    • You need to recognize side effects. What will the side effect look like?

    • Learn the terms used to describe the side effect, such as dystonia (involuntary movement resulting in a sustained posture of the affected limb, often associated with painful muscle spasms), dyskinesia (abnormal involuntary writhing movement) nausea, vomiting, headaches, ataxia (loss of balance), on-off, discolored urine.

    • What do you do if you experience a side effect?

    • Is there anything you can do to avoid having a side effect?

Are there other medications I need to avoid when taking Parkinson's medications?

Several medications should not be taken when you are on Parkinson's medications. You need to inform health professionals about this, particularly when hospitalized, in a nursing home, or in an emergency room. Some medications frequently used in these settings could create problems for you. Here is a listing that you can print off - put a copy in your wallet.  need to post list of medications

If I am experiencing problems, such as if I have symptoms that are not relieved by the medication or I have fluctuating symptoms, how can I effectively communicate with my physician?

It is not unusual that you may be having symptoms at home and when you have your office appointment, the symptoms are not readily apparent. Your health care provider may not actually see the difficulties you experience. It is a good idea for you to keep a diary for 3 days prior to your office visit, or at times you are experiencing difficulty.

Your health care provider will want to know:

  • What are your symptoms?

  • When your symptoms start?

  • How long your symptoms last?

  • When do you take your medications (with or without meals)?

  • Are you experiencing any stress or anxiety, or are you sick (any special situations you notice)

  • Write down the symptoms you have to keep track of them, including tremor, falls, dyskinesia, and ESPECIALLY when you take which medication, when you sleep (how long), when you eat, and what foods are you eating?

icon Click here for a form you can use to monitor your response to medication and symptoms.

How can I remember to take my medications?

There are several tips that people use to remember to take their medications at the correct time. Here are a few:

  • use medication boxes (you can purchase them at your pharmacy or ask your doctor)

  • use a timer or alarm

  • leave cues in the house, such as notes, or leave the medicine bottle near your phone

  • keep a calendar

  • associate taking your medication dose with your normal daily activities

How important is scheduling?

  • You want to develop a regular schedule and stick as close to it as you can.

  • If you're feeling good, don't take less.

  • Look at what your medication is designed to do - you're not always trying to treat the acute problem. Keep a routine of when you are taking your dose, realizing that you will have ups and downs. Taking more is not always better. Symptoms may fluctuate and your response to medications may fluctuate over the course of the day and from day to day.

  • One of the biggest problems is not being able to count on your medication working to control symptoms all of the time.

You need to "get tough" - try not to let changes affect you. Continue to function in a manner you're accustomed to. DON'T GIVE UP.

There may be challenges when you are initially started on a medication, when your medications are adjusted or when a medication is to be discontinued.

Other Tips:

  1. Make sure you take the entire dose of your medication. Drink a full glass of water with each dose.

  2. When you go out, take a dose of medication with you so you will not be caught without it if you are away from home longer than expected.

  3. Store your medication in a clean, dry place that is not too warm or too cold. Don't leave your medication in a glove box during the summer.

Other information on medications:

Medication Assistance Programs

Contributed by:

Richard Berchou, PharmD, Wayne State University School of Medicine
Member MPF Professional Advisory Board
and
Debby Orloff, MPH, BSN, RN
Chief Executive Officer, Michigan Parkinson Foundation

 

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