Elton Fortuin (2866053) Case Study: Antiparkinsonian Agents

Clydene Adonis (2807249) 27 August 2010

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HT, a white, 59-year-old male was diagnosed with idiopathic Parkinsonism 6 months
ago. He complains to you that his medicine (Laradopa; L-dopa, Compound 1) no longer
controls the tremor in his left hand. Upon inquiry regarding other medication, you
discover that HT has recently decided to take ProstaKit, a product he purchased through
the internet because he was concerned about the “health of his prostate gland”. ProstaKit
contains three separate products. Formula 1: Palmitol containing saw palmetto berries
(Compound 2), zinc (50 mg), and vitamin B6 (120 mg, Compound 3). Formula 2: Flax-O-
Mega containing cold pressed flaxseed oil (Compound 4) and Formula 3: Pro-Essence
containing burdock root, juniper berry, prickly ash bark, slippery elm bark, and uva ursi.
Is HT experiencing an advancement of his Parkinsonism or is something else taking place
here?

11. Identify the therapeutic problem(s) where the pharmacist's intervention may
benefit the patient.
1
22. Identify and prioritize the patient specific factors that must be considered to
achieve the desired therapeutic outcomes.
1
23. Conduct a thorough and mechanistically oriented structure-activity analysis of
all therapeutic alternatives provided in the case.

 Saw palmetto berries contain large quantities of beta-sitosterol and other plant
sterols, as well as free and esterified fatty acids. Sterols are essential components
of cell membranes, and both animals and plants produce them. The sterol ring
 system is common to all sterols; the differences are in the side chain. They are 28-
or 29-carbon alcohols. β-sitosterol is the most common plant sterol and is
structurally similar to cholesterol. Because of this structural similarity, β-sitosterol
can replace cholesterol in the human body. β-sitosterol is a 4-desmethyl sterol
(containing no methyl groups at carbon atom number 4). It has a double bond at
the C-5 position in the ring, and it is usually esterified with fatty acids for
incorporation into margarine [2].
 Beta-sitosterol is termed a plant sterol, or a cholesterol-like chemical derived from
plants. Sterols, and more specifically beta-sitosterol, are also useful for male
hormone balance and prostate health. Beta-sitosterol can inhibit the function of
the enzyme 5 alpha-reductase, which works to convert testosterone to a metabolite
known as 5 hydroxytestosterone.14-16 5 hydroxytestosterone may have negative
effects on the prostate gland. By inhibiting the 5 alpha-reductase enzyme, beta
sitosterol helps to maintain testosterone levels and prevent loss to testosterone
metabolites that contribute to negative prostate health [1].

4. Evaluate the SAR findings against the patient specific factors and desired
therapeutic outcomes and make a therapeutic decision.

5. Counsel your patient.

References:

1. http://www.vrp.com/articles.aspx?ProdID=2341 (retrieved on 26 August 2010, at

21h33)
2. http://www.drugs.com/npp/beta-sitosterol.html (retrieved on 26 August 2010, at
21h36)