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Parkinson's disease

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sgthuan's version from 2017-07-08 21:52

Parkinson's and Alzheimer's

genericBrandclassdrug pearl
entacaponeComtanCOMT - inhibitor200mg with each dose of carbi/levodopa, SE same as levodopa, SE N/V, dizziness, orthostasis, dyskinesia, *** brown, black or dark urine, *** Positive COOMBS test - hemolytic anemia, reduce in levodopa dose 10-30%
tolcaponeTasmarCOMT - inhibitorold drug --> HEPATOTOXICITY, not used much!
carbidopa/levodopaSinemet, Sinemet CR, Rytary ER, Doupa (feeding tube)Dopamineusual initial dose 25/100 TID, ** 70-100mg/d of carbidopa is required, ** CR formula can be splited in half ER is no way, SE N/V, dizziness, ** ORTHOSTASIS, dyskinesia, ** Priampism, *** brown, black or dark URINE, *** Positive COOMBS test - hemolytic anemia, IRON & Protein can decrease absorption, higher dose of carbidopa will cause nausea
carbidopa/levodopa + entacaponeStalevoDA + COMT-inhibitorsame as carbidopa/levodopa
pramipexoleMirapex, Mirapex ERDA-agonistinitial 0.125mg TID, *** IR is approved for restless leg syndrome QHS, SE somnolence, sudden sleep attack, N/V, dizziness, orthostasis, hallucination, dyskinesia, **** "CrCl < 50 decrease dose 90% renaly cleared"
ropiniroleRequip, Requip XLDA-agonistinitial 0.25mg TID, *** IR is approved for restless leg syndrome QHS, SE somnolence, sudden sleep attack, N/V, dizziness, orthostasis, hallucination, dyskinesia, ** 1A2 substrate
rotigotineNeupro (patch formula)DA-agonistinitial 2mg/24 hour, replace patch daily, do NOT apply to the same area for at least 14 days, remove before MRI, SE orthostasis, somnolence, peripheral edema, *** allergic to SULFITES
apomorphineApokyn (SQ ONLY)DA-agonistinitial 0.2mL, ** use for OFF periods, up to 5x a day, SE sever NAUSEA --> use trimethobenzamide (Tigan), HYPOTENSION, QT prolong, *** CI - do NOT use with 5HT3 antagonist (ondansetron) --> severe hypotension
amantadineSymmetrelDA reuptake inhibitor100mg BID or TID, ** used for mild disease or for dyskinesia in advanced disease, *** decreased dose in renal impairment --> toxic delirium, cutaneous reaction "livedo reticularis", insomnia
selegilineEldepryl, Emsam (depression), Zelapar (ODT)MAO-B inhibitor5mg BID, can be activating, *** do NOT take qHS, **** CI use of cyclobenzaprine, delsym, methadone, propoxyphene, st. John's wort, meperidine, MAOI
rasagilineAzilectMAO-B inhibitor0.5-1mg qd, **** CI use of cyclobenzaprine, delsym, methadone, propoxyphene, st. John's wort, meperidine, MAOI
benztropineCogentincentrally-acting anticholinergics0.5-2mg TID, used primarily for tremor in younger patients, SE dry mouth, constipation, urinary retention, blurred vision --> AVOID use in elderly
trihexyphenidylNONEcentrally-acting anticholinergics1-5mg TID, used primarily for tremor in younger patients, SE dry mouth, constipation, urinary retention, blurred vision --> AVOID use in elderly
donepezilAricept (tab, ODT)Acetylcholinesterase inhibitor - mono or combostart 5mg qHS, SE **NAUSEA --> qHS or change to other formula, Bradycardia, fainting, insomnia
rivastigmineExelon, Exelon patchAcetylcholinesterase inhibitor - mono or combostart 1.5mg BID to 6mg BID WITH FOOD, patch 4.6 - 9.5 - 13.3 QD, SE **NAUSEA --> qHS or change to other formula, Bradycardia, fainting, insomnia
galatamineRazadyne, Razadyne ER (t, sln)Acetylcholinesterase inhibitor - mono or combostart 4mg BID, SE **NAUSEA --> qHS or change to other formula, Bradycardia, fainting, insomnia
memantineNamenda, Namenda XRNMDA antagonist - mono or comboIR 5mg QD --> 5-10 BID, SE dizziness, constipation, HA, *** CrCl < 30 do NOT exceed 5mg BID, XR cap can open and sprinkle on food
memantine + donepezilNamzaricNMDA + AChEONLY for advance and stable with donepezil 10mg qd
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