Clinico-Therapeutic Cases

Parkinson’s Disease

Transers: RXmen
 PARKINSON
DISEASE

neurocognitive disorder
characterized by a syndrome
composed of combinations of
bradykinesia, rigidity, tremor
and postural instability
 PARKINSON
DISEASE
 first described in 1817 by James
Parkinson as the “shaking palsy”
second most prevalent neurodegenerative
disorder after Alzheimer’s disease
typical age of onset is between 50-70 y/o

Diagnosis
1. Presence of at least two of the three
cardinal features of parkinsonism:
- tremor
- rigidity
- bradykinesia
2. Presence of at least two of the following:
- marked response to levodopa
- asymmetry of signs
- asymmetry at onset
3. Evidence of disease progression
4. Absence of clinical features of alternative
diagnosis
5. Absence of etiology known to cause
similar features
 PARKINSON
DISEASE
No Functional Impairment
Pharmacological treatment is not
needed
Non-pharmacologic interventions may
be initiated during this time, which
include:
 Education
 Support services,
 Management of emotional needs of the
patient and caregiver
 Exercise
 Nutrition
 Physical therapy

Presence of Functional Impairment

Pharmacologic therapy is appropriate
once a patient is determined to be
functionally impaired, which include:
 Dopaminergic agents (levodopa and
dopamine agonists)
 More potent
 Anticholinergics
 Amantadine
 Selegiline
Management Algorithm of Parkinson
Disease
DRUGS for PARKINSON’s
DISEASE
 LEVODOPA and CARBIDOPA

Levodopa
• a precursor of dopamine
• Most effective antiparkinsonian drug
• Gold standard of treating PD
• Absorption is interfered by dietary
amino acids coming from foods rich in
protein  taken on an empty stomach
• For patients older than 60 years old

Carbidopa (or Benserazide)

• Peripheral decarboxylase inhibitor
• Combined with Levodopa to reduce
the peripheral degradation of
levodopa before it reaches the brain
• Prevents peripheral SE like N/V and
allows more of the levodopa to be
available for use by the brain
 Medication for
Parkinson Disease

LEVODOPA + CARBIDOPA
(Sinemet)

100/25mg, tablet
# 30 tablets

Sig: Take 1 tablet TID.

Taken on an empty stomach.
Max: 8 tablets

Refill: 0

Warning: Watch out for the following: anorexia,

nausea, vomiting, dizziness,
hypotension, motor fluctuations,
confusion, and hallucinations
 Medication for
Parkinson Disease

LEVODOPA + CARBIDOPA
(Sinemet CR)

200/50mg, controlled release tablet

# 30 tablets

Take 1 tablet OD.

Sig: May be increased to 1 tablet BID-TID.
Should not be given at interval <6 hrs.
Taken on an empty stomach.

Refill: 0

Warning: Watch out for the following: anorexia,

nausea, vomiting, dizziness,
hypotension, motor fluctuations,
confusion, and hallucinations
 Medication for
Parkinson Disease

LEVODOPA + BENSERAZIDE HCl

(Madopar)

200/50mg, tablet
# 30 tablets

Take 1 tablet TID.

Sig: Best taken at least 30 mins before or 1 hr
after meals.
May broken into small pieces to facilitate
swallowing.
Refill: 0

Warning: Watch out for the following: anorexia,

nausea, vomiting, dizziness,
hypotension, motor fluctuations,
confusion, and hallucinations
 Medication for
Parkinson Disease
(for all types of fluctuations in plasma levels especially
peak dose dyskinesia & end-dose deterioration, nocturnal
symptoms)

LEVODOPA + BENSERAZIDE HCl

(Madopar HBS)

100/25mg, capsule
# 30 tablets

Take 1 tablet TID.

Sig: Best taken at least 30 mins before or 1 hr
after meals.
May broken into small pieces to facilitate
swallowing.
Refill: 0

Warning: Watch out for the following: anorexia,

nausea, vomiting, dizziness,
hypotension, motor fluctuations,
confusion, and hallucinations
 Medication for
Parkinson Disease
(for end-dose motor fluctuations not stabilized on
levodopa/dopa carboxylase inhibitor treatment)

LEVODOPA + CARBIDOPA +
ENTACAPONE
(Stalev)

50 / 12.5 / 200 mg, tablet

# 30 tablets

Sig: Take 1 tablet OD.

Max: 8 tablets/day.

Refill: 0

Warning: Watch out for the following: anorexia,

nausea, vomiting, diarrhea, dizziness,
hypotension, discoloration of urine,
motor fluctuations, confusion, and
hallucinations,
 DOPAMINE AGONISTS

 directly activate dopamine receptors

 slightly less effective than levodopa

 alternative first line drugs for PD

 not affected by dietary amino acids 

can be taken with or after meals

 associated with a reduced risk of

dyskinesias and motor fluctuation

 For patients 60 years old and younger

 Medication for
Parkinson Disease
(for end-of-dose or on-off fluctuations in response)

PRAMIPEXOLE HCl
(Ramipex)

250 mcg, tablet

# 30 tablets

Week 1: Take ½ tablet TID.

Week 2: Take 1 tablet TID.
Sig: Week 3: Take 2 tablets TID.
Thereafter: may be increased by 750mcg at
weekly intervals.
Max: 4.5 mg daily.
Refill: 0

Warning:
Watch out for the following: nausea,
vomiting, dizziness, hypotension, and
syncope.
 Medication for
Parkinson Disease

PRIBEDIL
(Trivastal Retard)

50 mg, tablet
# 30 tablets

Take 1 tablet OD at the end of a main meal.

Sig: May be increased to 3-5 tablets in divided
doses.
Max: 5 tablets daily.

Refill: 0

Warning: Watch out for the following: nausea,

vomiting, flatulence, drowsiness, and
sudden sleep fits.
ANTICHOLINERGIC,
AMANTADINE, AND
SELEGILINE
 Medication for
Parkinson Disease

BIPERIDEN HCl
(Akineton/Akidin)

2 mg, tablet
# 30 tablets

Sig: Take 1 tablet OD-TID.

Max: 8 tablets daily.

Refill: 0

Warning: Watch out for the following: dry

mouth with difficulty in swallowing
and talking, thirst, dryness of skin,
and constipation.
 Medication for
Parkinson Disease

AMANTADINE SULFATE
(PK-MERZ)

100 mg, tablet

# 30 tablets

Take 1 tablet OD for first 4-7 days.

Sig: Increased by the same amount once a
week until MD of 1-3 tablets BID.
Max: 6 tablets daily.

Refill: 0

Warning: Watch out for the following: urinary

retention, sleep disturbances, and
restlessness.