What follows is a listing of all the major anti-Parkinson drugs, their effects and side effects, and their most common dosages. If you have specific questions about the drugs you are currently taking, please consult your physician.

Dopaminergics

Drugs used to replace or mimic the actions of dopamine.

Sinemet

Chemical name: Carbidopa-Levodopa

Indications: Helps all symptoms of PD. It is the primary anti-Parkinson drug. It is a combination of levodopa and carbidopa. Carbidopa allows levodopa to enter the brain, where it is converted to dopamine.

Dosages: Expressed as fractions, with top number referring to amount of carbidopa and the bottom number of levodopa, in milligrams. Common dosages are 10/100, 25/100, 25/250.

Range of daily dosage: 75-150 mg carbidopa; 75-1,000 mg levodopa.

Side effects: Nausea, daytime sleepiness, orthostatic hypotension, involuntary movements, decreased appetite, insomnia, cramping. In some patients, it may cause hallucinations, confusion, "on-off" effect.

Special considerations: Sinemet should be taken one hour before meals for maximium benefit. Should be taken with a whole glass of water or juice. Crackers should be taken if Sinemet causes stomach upset.

Sinemet CR

Indications: The same as Sinemet. It is a controlled-release form of Sinemet.

Dosages: 50/200, 25/100.

Range of daily dosage: 75-200 mg carbidopa; 200-1,000 mg levodopa.

Side effects: Same side effects as regular Sinemet.

Special considerations: May be especially useful in patients with "on-off" effects.

Anticholinergics

Anticholinergics block the action of the neurotransmitter acetycholine, helping to regain balance between acetylcholine and dopamine. Effective against rigidity and tremor, not against bradykinesia or akinesia. May be used alone early in the treatment of PD, or with Sinemet. Poor response or side effects with one anticholinergic does not exclude a trial with another one

Artane

Chemical name: Trihexyphenidyl HCL. Indications: Reduces tremor, drooling, and rigidity. This medication, like Cogentin, is a synthetic antispasmodic drug which has a relaxing effect on smooth muscle.

Dosages: Tablets of 2 mg, 5 mg, and long-acting 5 mg.

Range of daily dosage: 2-15 mg.

Side effects: Dry mouth, nausea, vomiting, confusion, difficulty swallowing or speaking, blurred vision, loss of appetite and/or weight, depression, hallucinations, constipation, urinary retention. Can worsen glaucoma.

Special considerations: Report side effects.

Cogentin

Chemical name: Benzotropine mesylate.

Qualities: Reduces tremor, rigidity, and drooling.

Dosages: 0.5 mg, 1 mg, 2 mg.

Range of daily dosage: 0.5-6 mg.

Side effects:Similar to Artane.

Special considerations: Use cautiously in elderly patients and patients with a history of confusion. Use cautiously in men with enlarged prostate gland.

Dopamine Agonists

Dopamine Agonists mimic the effects of dopamine by directly stimulating the dopamine receptors. Most commonly used early in combination with Sinemet. Agonists may also be started when patients are no longer responding satisfactorily to Sinemet used alone. Agonists may smooth out the fluctuating effect (wearing off or on-off ) often seen in Parkinson's patients on long term levodopa treatment. They are started at low doses and built up gradually over several weeks before therapeutic results are achieved. If dyskinesias increase, then a reduction in levodopa is indicated.

Parlodel

Chemical name: Bromocriptine mesylate.

Indications: Helps all aspects of Parkinson's disease. Used in combination with Sinemet to reduce symptoms and ameliorate severity of adverse reactions associated with long-term levodopa therapy, especially dyskinesias, wearing off and on-off.

Dosages: Tablet, 2.5 mg; capsule, 5 mg

Range of daily dosage: 1.25-30 mg

Side effects: Orthostatic hypotension, nausea, blurred vision, hallucinations.

Special considerations: May take several weeks for an effect to occur.

Permax

Chemical name: Pergolide mesylate.

Indications: Helps all aspects. Used in combination with Sinemet to reduce symptoms, may allow reduction in amount of Sinemet.

Dosages: Tablets 0.05 mg, 0.25 mg, 1 mg.

Range of daily dosage: 0.05-5 mg

Side effects: Similar to Parlodel.

Special considerations: Similar to Parlodel, may be effective in some patients who do not respond to Parlodel and vice versa.

Other Medications

Symmetrel

Chemical name: Amantadine.

Indications: An antiviral compound; it relieves tremors, rigidity, and bradykinesia.

Dosage: 100 mg capsules.

Range of daily dosage: 100-300 mg

Side effects: Swelling of the feet, loss of appetite, dizziness, anxiety, depression, hallucinations, urinary retention, blotchy legs, insomnia.

Special considerations: Should be used carefully in elderly patients.

Eldepryl

Chemical name: deprenyl, selegiline

Indications: An MAO-B inhibitor. Increases effect of dopamine by blocking the enzyme MAO-B that normally breaks down dopamine. Leads to increase in amount of dopamine in brain. Usually used in conjunction with Sinemet. There is a strong suggestion that Eldepryl may slow progression of PD

Dosage: Capsule, 5 mg

Range of daily dosage: 10 mg.

Side effects: Loss of appetite, nausea, dizziness, anxiety, insomnia. In some individuals it may cause confusion, hallucinations.

Inderal

Chemical name: Propranolol.

Indications: May reduce tremors.

Side effects: Lightheadedness, insomnia, weakness, depression, fatigue. In men it may cause impotence.

Trademarks

The following product names are registered trademarks of of Pharmaceutical Companies:

     Product           Company

     Artane            Lederle
     Atamet            Athena
     Ativan            Wyeth
     Benadryl          Parke-Davis
     Cogentin          Merck
     Compazine         Smith, Kline & Beecham
     Depakote          Abbott Laboratories
     Desyrel           Mead Johnson
     Diamox            Lederle
     Domperidone       Janssen Pharmaceutica
     Elavil            Merck
     Eldepryl          Somerset
     Haldol            McNeil
     Inderal           Ayerst
     Librium           Roche
     Madopar           Roche
     Pamelor           Sandoz
     Parlodel          Sandoz
     Permax            Lilly
     Prolixin          Bristol-Meyers Squibb
     Prozac            Lilly
     Reglan            Robins
     Ritalin           Robins
     Sinemet           DuPont Pharma
     Sinemet CR        DuPont Pharma
     Stelazine         Smith, Kline & Beecham
     Symmetral         DuPont Pharma
     Thorazine         Smith, Kline & Beecham
     Tofranil          Geigy
     Valium            Roche
     Wellbutrin        Burroughs-Wellcome
     Xanax             Upjohn

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