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Tags >> Medications

Deborah M. Orloff, MPH, BSN, RN, Chief Executive Officer, MPFwith Richard Berchou, Pharm.D., R. Ph., Wayne State University School of Medicine, and Bradley K. Evans, M.D., Northern Michigan Neurology

When we began organizing the Michigan Parkinson Foundation in 1982, a group of volunteers came to our offices at Harper Hospital to help with a mailing. Conversation was lively about medications each person was taking. Even today, after presentations about PD, the most frequent questions center on medication issues. We all know that careful balancing of medications and timing of when to take them can make a great difference in how people with PD feel and function.

The following article contains tips to help you to get the most out of your medication regimen to control Parkinson's disease symptoms, increase your ability to function and achieve the best quality of life possible.

Parkinson's disease is a chronic, progressive neurological disorder that currently cannot be cured. Many medical diseases cannot be cured (diabetes, hypertension, arthritis), but optimum medication management, psychosocial support and healthy living contribute to better outcomes. The objective of treatment is controlling the symptoms with medication. Other actions can be taken to improve functioning, such as exercise, stress management, occupational, physical and speech therapies. Key to quality of life is making sure a medication regimen is organized so that symptoms are controlled.

When does treatment with medications begin for early Parkinson's? What agents should be used first?

When you should start taking medications depends upon you as an individual and how much the symptoms interfere with your lifestyle.

Similar to the treatment of most diseases, the optimal drug therapy for Parkinson's disease is based on many factors and must be individualized. Medications are selected depending upon careful consideration of each person's responses, short and long-term side effects, possible drug interactions, presence of other medical and psychiatric conditions, as well as prescription insurance coverage and cost. If you have a Medicare D plan, whether or not it has a donut hole may make a big difference in the medicine you take. There has always been controversy in terms of when to start medications and which ones should be used initially. Discuss these options with your neurologist.

Does the amount or type of Parkinson medication you take mean your condition is more or less serious than someone else's?

No. Each person has different challenges with Parkinson's disease. Symptoms vary and so do treatments, the amount and types of medications and the individual's response to specific medications.

Tips in taking your medications:

Make sure that your doctor is aware of ALL the medications you take, including over the counter medication, herbals, vitamins, nutritional supplements, or any special dietary requirements. Carry a list of your medicines or the pill bottles themselves to your appointment and a list of questions to ask your doctor.

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

  • What is the name of the medication, the dose and when do you take it (not just how many times a day)?
  • How do you take your medication - with or without food?
  • What can you expect from your medication? What kinds of symptom relief is to be expected and when - in one day, in a week? How long do you wait before you call your doctor to learn 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 begin on a low dose and gradually build up to the level that adequately manages your symptoms.
  • What happens if you miss a dose, or forget to take it on time? This greatly depends on the medication so don't guess what to do. If you miss a dose, it is not always good to take twice the amount the next time. Clarify this with your physician.
  • What side effects are usual for each medication? If you have a side effect, what does it feel like? What should you do? When do you call the doctor?
  • What will the side effect look like? Learn the terms used to describe side effects. Sinemet is one medication where "wearing off" may occur over time. At first, there is a beneficial effect (less symptoms of PD) for several hours (therapeutic effect). After a while, the positive effect of medication lasts for a shorter time period and you may become more rigid or have involuntary, abnormal or writhing movements (dyskinesia). This is called "on-off" phenomena. Other side effects may include dystonia (a type of cramping), nausea, vomiting, headaches, hallucinations, or loss of balance. Recording when these side effects occur in relation to when you take your medication will help your physician organize your medication regimen to reduce side effects and increase control.
  • Is there anything you can do to avoid having a side effect, particularly if you are taking several medications for different conditions? How can your Parkinson's medications be coordinated with your other medications to maximize your treatment of each health condition?

Are there medicines you need to avoid when taking Parkinson's medications?

A variety of medications, most of which are compatible with other prescription and non-prescription drugs, are used to treat Parkinson's disease. However, there are a few drugs that can worsen PD symptoms and interfere with PD medications' actions, including some used for hallucinations, for lowering high blood pressure, and for nausea and vomiting. Sometimes problems will occur only with high doses. This should be discussed with your physician. It is important to realize there may be other possible medications you can take. Most medication interactions are reversible, so discuss the topic with your doctor. Check over-the-counter medications for cautions regarding their use when you have PD. Your pharmacist is also a good resource to consult.

The Michigan Parkinson Foundation's Professional Advisory Board has recently revised a Medication Interaction Card which you may wish to order to keep with you for reference. Contact MPF to obtain an updated card.

If you are experiencing problems, such as symptoms not relieved by the medication, or fluctuating symptoms, how can you effectively communicate these to your physician?

It is not unusual to experience symptoms at home and not during your appointment with your health care provider. Your physician may not actually see the difficulties you are having. It is a good idea to keep a detailed, written diary for a few days prior to your office visit, or when you are experiencing difficulty. This will provide a timeline for your doctor. Don't rely on your memory.

KEEP A DIARY AND INCLUDE:

  1. What are your symptoms? Describe them in detail. Explain to your health care provider what the symptoms mean to you, how they affect your quality of life and your functioning. Why is it important to reduce the effects of those particular symptoms? What is troublesome to one person is not to the next.
  2. When do your symptoms start? What time and under what circumstances (e.g. after meals, during certain activities)?
  3. How long do your symptoms last? Does anything relieve them?
  4. When do you take your medications (time, with or without food)?
  5. Are you experiencing any particular stress or anxiety, or are you sick?

Special Notes:

Some people may have difficulty swallowing pills. There are several techniques that can help. Ask your physician or pharmacist what you can do.

Do not abruptly stop your medications without checking with your physician first. Stopping some medicines may result in withdrawal symptoms. If you are to be hospitalized, or undergoing dental or medical procedures, consult your physician about your medications. Do not assume you know what to do.

Note: MPF has a hospital form you can complete before your hospital visit to assist staff in ensuring your treatment regimen is carried out. Call for information.

What are some tips to remember when to take medications on schedule, since timing is very important in managing PD symptoms?

Over time, most people with PD have to take several medications at different times of the day. It is easy to forget when your next dose is. There are several methods to help you to remember to take your medications, such as:

Filling pill containers for each daily dose

Set alarm clock on watch or cell phone

Establish a routine (such as before or after meals)

What are reliable sources of information about the medication I am taking?

Obtain all the information you can about medications that are prescribed. Good sources of information are your physician, pharmacist, or health provider. Additional information can be obtained from websites:

www.drugs.com (costs, drug interactions)

www.medscape.com (free registration, drug interactions, patient information sheets)

www.Rxlist.com (patient comments)

www.webMD.com (patient comments)

What can I do if I have difficulty paying for my medications?

Speak with your neurologist. Some pharmaceutical companies have medication assistance programs. Your physician may be able to modify the medication regimen to make it more affordable.

The following websites provide access to various sources of low cost or free medication, including Pharmaceutical Assistance Programs:

www.needymeds.com (information about qualifying for assistance programs)

www.Pparx.org (Partnership for Prescription Assistance)

Rxassist.org (Patient Assistance Program Center)

The Michigan Parkinson Foundation has a small fund to assist people with financing their medications. In order to be eligible, consideration is given both to financial information and costs for healthcare for the entire family. Contact the MPF office at 248-433-1011 or 800-852-9781.

How should I dispose of unused or expired medications?

In order to keep people safer, protect young people from the harmful misuse of prescription drugs, understand the needs of seniors, and the environmental implications related to improper disposal of medication (e.g. flushing them down the sink or toilet), Operation Medicine Cabinet™ was launched in 2009 at the Oakland County Sheriff's Office, partnering with Home Instead Senior Care. There are now several prescription drop-off locations in Oakland County. Check for similar programs in your county. For information, visit www.operationmedicinecabinetmi.com.

Caution: There are many advertisements for unproven therapies.

Often, people end up paying lots of money for treatments that do not work. Discuss these therapies with your neurologist first. Also, check the company out with the Better Business Bureau, or www.quackwatch.com.

 

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Dr. Paul Cullis, MD, is Section Chief of Neurology at St. John Hospital
and Medical Center in Detroit, MI, and Clinical Associate Professor of Neurology at Wayne State University School of Medicine in Detroit, MI. He is a neurologist with special training
and expertise in movement disorders, such as dystonia and Parkinson's disease. Dr. Cullis is the Vice Chairman of the MPF Board of Directors, a Member and past Chairman of its Professional Advisory Board.

Dopamine agonists directly stimulate the receptors on nerves in the brain that would normally react to dopamine, the chemical that is deficient in the brains of patients with Parkinson's disease (PD). Unlike levodopa (SinemetR), a dopamine agonist is not converted to dopamine in the body, but it acts like dopamine directly. Dopamine agonists may be used alone in mild to moderate PD (Stages I-III/V on the Hohn and Yahr Scale) to effectively reduce symptoms.

This approach is often effective in people recently diagnosed with PD, especially those younger than 70. It can delay the need for levodopa, thereby postponing the motor fluctuations that may occur with long-term levodopa therapy. A dopamine agonist can be added to treatment with levodopa in the later stages of PD, when levodopa alone may no longer adequately control symptoms, when increasing the dose to provide adequate control of symptoms would cause excessive side effects, or when motor fluctuations occur.

The first-generation dopamine agonists were chemically related to ergotamine, which produces St. Anthony's Fire, a dreaded illness common in the Middle Ages. Its cause was poisoning from a fungus (ergot), which grew on rye grass and contaminated rye flour used in making bread. It resulted in severe burning of arms and legs. This similarity gave these first-generation agonists, bromocriptine (ParlodelR) and pergolide (PermaxR), significant adverse effects. In March 2007, the U.S. Food and Drug Administration (FDA) announced that the makers of PermaxR had agreed to stop selling it because of serious side effects, such as damage to heart valves. ParlodelR is still on the market, but isn't often used to treat PD.

The second-generation dopamine agonists have a chemical structure distinct from ergotamine: therefore, they lack some of its side effects. Ropinirole (RequipR) and pramipexole (MirapexR) are used increasingly as initial therapy in people with newly diagnosed PD, especially those younger than 70, in order to delay treatment with levodopa and forestall its attendant side effects. They can provide effective treatment for many patients without the addition of levodopa. A patch containing rotigotine (NeuproR), another second-generation agonist, was available recently for a short time in the U.S. Because it produces a steady level of the medication, its delivery method was attractive in the blood. Unfortunately, the manufacturer withdrew the drug because of problems with the patches. The drug may be on the market again, some time in the future.

It is believed that abnormal, pulsatile stimulation of dopamine receptors in the brain may be responsible for motor fluctuations in PD. This concept was suggested by work in primates by Peter Jenner in London. The PD brain becomes unable to smoothly regulate production of dopamine from levodopa. Therefore, administering levodopa or short-acting agonists may be harmful in the long term. Theoretically, smooth, continuous stimulation of dopamine receptors might avoid these long-term complications.

Two developments have occurred recently. Firstly, generic ropinirole has become available, lowering the price. Secondly, a long-acting form of ropinirole (Requip XLR) has been approved by the FDA as a once-daily medication. Requip XLR provides a near-constant level of medication in the blood during the day and a lower concentration at night. This potentially may lead to a decreased risk of troubling motor fluctuations. The drug is indicated for the treatment of the signs and symptoms of idiopathic Parkinson's disease. A recent study by F. Stocchi et al. demonstrated that, at the doses reached in their study, treatment with Requip XLR was almost twice as likely to achieve a greater than or equal to 20% maintained reduction in daily awake time spent "off" as ropinirole immediate release given three times a day. Unfortunately, the sustained-release preparation may still cause excessive daytime sleepiness and increase the risk of compulsive behavior, such as gambling. These potential risks should be weighed against the benefit.

Another dopamine agonist, apomorphine (ApokynR), is available in the U.S. for use by injection. It is a rapid-acting rescue medication for occasional episodes of immobility, when muscles become frozen and the patient is unable to function. ApokynR will improve mobility until an oral medication can take effect. It should not be used on a regular basis for first-line treatment. It can produce intense nausea and vomiting when first administered.

When taken in combination with levodopa, dopamine agonists may reduce the amount of levodopa needed to control symptoms, thereby reducing some side effects. They may improve motor function during both "on" and "off" periods. They may reduce dyskinesias associated with long-term levodopa therapy, by lowering the need for levodopa. They may also reduce the wearing-off effect of levodopa.

Proper treatment for your PD can only be decided on an individual basis by your physician considering your special circumstances and co-existing illnesses. Inform your doctors of all the effects and side effects of your medications, so that they can prescribe the treatment that will be most effective in managing your disease.

 

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Peter A. LeWitt, M.D.

In 1957, Arvid Carlsson reported on experiments in an animal model of Parkinsonism that eventually led to the use of levodopa as a symptomatic treatment for Parkinson's disease (PD). This amino acid precursor of levodopa is taken up in the gut by a facilitated transport mechanism that also operates through the blood-brain barrier. Once levodopa has gained entry into the brain, it undergoes rapid transformation to dopamine in striatal nerve terminals. Restoration of this deficient neurotransmitter in the Parkinsonian brain has constituted the major therapeutic option for treating PD for almost four decades. For some patients, all symptomatology of PD can be reversed temporarily from this drug. Although still the mainstay of PD therapeutics, levodopa presents many challenges for long-term use because of various adverse effects that can develop. These include the eventual loss of symptomatic improvements lasting longer than the rise and fall of blood concentrations of the drug (the long-duration effect). Other problems that can arise include the induction of involuntary movements (dyskinesias) that, once initiated, never remit. Patients chronically receiving levodopa can experience prominent wearing-off of benefits between doses, vivid dreams and hallucinations and, rarely, impulse control disorders.

Adjunctive medications that can extend upon the benefits of levodopa (such as inhibitors of monoamine oxidase-B and catechol-O-methyl transferase) have improved its utility for patients with wearing-off responses, the most common problem associated with chronic levodopa therapy. Currently under development are novel means for enhancing its pharmacokinetic profile, including parenteral and transdermal levodopa delivery, and improved sustained-release preparations. Levodopa prod-rugs have also been investigated. A novel therapy currently undergoing a clinical trial was designed for intrastriatal generation of levodopa by means of implanted human retinal cells (Spheramine). Co-administration of a dopaminergic agonist with levodopa have been shown in several clinical trials to lessen the risk for developing involuntary movements and motor fluctuations, though how this is accomplished remains to be learned. Another puzzling aspect of levodopa's neuropharmacology is whether it acts as a neuromodulator independently of its role as a dopamine precursor.

Despite suspicions to the contrary for many years, the current consensus is that levodopa lacks neurotoxicity. A dose-response study investigating for neuroprotective effects against progression of PD (the ELLDOPA study, carried out in North America) provided evidence for this possibil-ity. Based on its potency as a symptomatic action against Parkinsonism, levodopa belongs in the therapeutic armamentarium for treating all stages of this disorder.


Peter LeWitt, M.D.

Patients taking one or more Parkinson's disease medications, especially for a long time, sometimes have the odd experiences of extremely vivid dreams, peculiar illusions, or even hallucinations. These occurrences are generally side effects of medication (and sometimes brought on by increases in dose or combination with pain medications). Although medication-induced illusions and hallucinations can be quite distressing, lowering the dose or discontinuing the PD drugs can usually help. Additionally, certain drugs like clozapine (Clozaril) and quetiapine (Seroquel) offer further benefit for suppressing these problems. These psychic events have been understood on the basis of known properties that PD medications possess. Dopamine, a brain chemical that is deficient in PD, provides the clue to vivid dreaming and hallucinations, since ways to increase or mimic its actions appear to be responsible for causing these side-effects. However, the location in the brain that creates the thought process behind illusions and hallucinations has been a matter of speculation.

A recent scientific publication has provided some insight into where in such phenomena might come from. Writing in the journal Nature, a Swiss scientist named Olaf Blanke recently reported that the illusion (or hallucination) of someone following closely (or even being sensed in bed) can be experimentally induced by electrical stimulation of a particular brain region. At this site, the left angular gyrus, the patient in Dr. Blanke's report repeatedly had the feeling of being 'shadowed' by a ghostly presence, an effect that went away when the electrical stimulation was halted. PD patients receiving medications with dopamine effects commonly can have experiences of this sort. Among the many types of illusory events reported to me are perceptions of familiar or unfamiliar people (often small and silent) sitting nearby on furniture, partly hidden in the shadows of a room, or moving in the periphery of vision. Because they can be so real, such experiences can be extremely distressing. However, with reassurance and the proper steps taken with medications, this problem usually can be managed successfully.


Peter A. LeWitt M.D.

In both small steps and optimistic leaps and bounds, drug development for Parkinson's disease (PD) continues to make progress.

MONOAMINE OXIDASE-B MEDICATIONS ARE RELEASED

Therapeutics for this disorder involves a growing list of medications, the latest of which are two new drugs of the monoamine oxidase-B (MAO-B) class. Both rasagiline (Azilect) and selegiline (Zeldapar) have recently achieved approval from the FDA for marketing and are
now available.

Each acts for PD by blocking the breakdown of dopamine, the brain chemical deficient in PD and responsible for most of its symptoms. Extending the duration of action for dopamine makes for less wearing-off between doses and otherwise amplifies the anti-Parkinsonian effects of levodopa (the active ingredient of Sinemet).

These MAO-B inhibitors don't represent a new treatment concept, however. Selegiline has already been available for more than 15 years in a tablet form (marketed as Eldepryl) and is not all that widely used for PD because of its limited efficacy. With the new products serving as MAO-B inhibitors, there will be the opportunity to re-assess the value of this class of drugs for PD.

In addition to extending the dose-by-dose effects of levodopa, both selegiline and rasagiline have also been evaluated as possible ways to slow down the progression of PD. This elusive goal may have been met with rasagiline, which has a published study indicating that this drug produced a small but scientifically intriguing lessening of disease progression in a group of patients. Selegiline has also shown some evidence for this property to a limited extent, although no drug to date has shown any dramatic effect at achieving neuroprotection for PD. This is why research into new therapeutic options against the underlying disorder is continuing and needs to test other potential protective agents.

Neuroprotective Strategies

Under the support of the National Institutes of Health, a nationwide consortium of PD research centers has been investigating promising neuroprotective strategies. In recent months, completed pilot studies have shown that various compounds, including minocycline, coenzyme Q-10, and creatinine, may slow the progression of PD (at least partially). Since these potential treatments seem safe and well tolerated, more extensive studies are planned to answer these important questions. The next study to begin is planned to start later this year. Other trials recently completed with the intent of finding a possible neuroprotective therapy haven't been successful; a study with a compound named TCH-346 was negative. The search for a possible cause (or causes) of PD has generated several approaches for treatment, and additional neuroprotection studies are in various stages of planning.

Suffice it to say, at the moment nothing is proven to work against the progression of PD except a bit of luck. Fortunately, for many patients, PD is not a disorder of progressive disability. Often there is no major change in PD status after a few years, and usually levodopa and the other PD medications continue to be beneficial even after 10 or more years of continued use.

Searching to Control Symptoms: new methods of delivery

In recent months, symptomatic treatment of PD has had some new developments as well. A new drug for PD, rotigotine, has been introduced in Europe and elsewhere as Neupro. This compound is a dopaminergic agonist, a class of drugs that also includes drugs that have been available for many years in the U.S., including Mirapex, Requip, and Permax (pergolide). Neupro is unique in how it is delivered: it is absorbed through the skin and so has been marketed as a transdermal patch with continuous delivery over 24 hours. So far, experience with Neupro suggests that it is effective and well tolerated. However, whether this drug or its unique mode of delivery will offer a significant advantage over currently marketed medications of the same class still remains to be learned.

All of the dopaminergic agonists can serve as alternatives or supplements to levodopa, boosting its effects and helping against "freezing" or wearing-off problems that are common with levodopa alone. The use of dopaminergic agonists may also help to avoid dyskinesias when used as initial treatment as alternative or added to levodopa from the start. Some studies have suggested that dopaminergic agonists may also have a neuroprotective role in addition to their symptom-treating effects. They are expensive, however, and can have a number of side effects: sedation and light-headedness more than that caused by levodopa.
Dopaminergic agonists have also been recognized to have rare, but sometimes severe, problems, including the triggering of compulsive behaviors such as excessive gambling
and excessive eating.

Several medications are undergoing research trials for improving side effects occurring with chronic PD. These include two drugs that are undergoing testing for suppressing involuntary movements (dyskinesias) and one for controlling hallucinations resulting from PD medications. Further information about these studies is available from my office (248-355-2452), or from two online sites compiling information about PD trials, www.ClinicalTrials.
gov and www.PDtrials.org. Other exciting news is that a transdermal (skin patch) form of levodopa is under development. The Michael J. Fox Foundation for Parkinson's Research recently announced that it has awarded a halfmillion dollar grant for further research and development of this transdermal product. For many patients, achieving more constant levels of levodopa than currently provided by oral levodopa formulations would be the means for improving control of motor fluctuations. If successful, the transdermal form of levodopa could be quite revolutionary in treatment of advanced Parkinsonism.

Another novel means of drug delivery under development in Europe is a nasal spray version of apomorphine. Currently, an injectable form of apomorphine (Apokyn) is marketed in the  U.S. for the purpose of rapid rescue from "frozen" states. When needed, PD patients can give themselves an injection of Apokyn in order to promptly return to an "on" state; this can occur within a few minutes, even when the oral medications have failed to take effect. A more convenient rapid-acting form of apomorphine (such as a nasal spray) would make this drug more acceptable to PD patients than the current injected form. There is also the possibility for development of continuous delivery forms of apomorphine (delivered by subcutaneous infusion or by patch form). A patch form of apomorphine has been prototyped, while continuous infusion is available in several European countries and elsewhere.

PD still presents many challenges for the medications of the future. Among the unmet needs are ways to reverse the problem of imbalance, especially falling backward. The flexed posture of PD, swallowing and speech difficulties, and situation-specific "freezing" (such as can occur while starting to walk, or at doorways) are all challenges for improved drug therapy. Scientists have not yet determined where in the brain and what types of biochemical disturbance underlie these problems.

Amplifying the effects of levodopa and dopaminergic agonists for increased PD control is another need, especially for the patient with long-standing PD. There are some new ideas that have led to novel classes of medications. For example, a drug currently under development, istradefylline (KW-6002), has been demonstrated to improve motor fluctuations. This compound is the first representative of a new class of PD medications called adenosine A2a antagonists. Like deep brain stimulation of the subthalamic nucleus, (a surgical procedure in which electrodes are placed in selected targets in the brain for relief of PD symptoms), istradefylline appears to turn off a particular brain pathway responsible for fluctuations in control of Parkinsonism. This drug and others related to it may lead to expanded opportunities for restoring the kind of benefit most patients have from levodopa in the first few years of PD therapy.

Editor's Note: The Michigan Parkinson Foundation wishes to acknowledge Dr. Peter LeWitt for his continuing participation in all activities of this organization in order to better the lives of people with Parkinson's and their families. He selflessly contributes articles regularly to The Messenger with breaking news in research and treatment of PD.

 

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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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