While domestic scientists are working on a new effective drug for Parkinson’s disease (“Diol” - this is the working title of the project), doctors today need drugs to help patients. The main category of medicines used for this diagnosis includes the active substance levodopa. However, the traditional treatment regimen suggests the use of drugs at the latest stage. Consider the features.
general information
Parkinson's disease is a degenerative process that affects the central nervous system. The course is relatively slow, progress is steady. The doctor’s task is to eliminate the symptoms or reduce its severity, prevent the emergence of new problems and the spread of current to other parts of the body, as well as adjust the patient’s lifestyle so that a person can exist adequately for as long as possible. Success requires an integrated approach, the impact on all centers affected by pathology, all available methods. It is believed that medication cannot be dispensed with, but at the initial stage of the disease, exclusively non-drug therapy is allowed.
The treatment is complex and includes taking medications, physiotherapy, gymnastics, rehabilitation of the patient in society, and surgery as needed. Trends are such that suffering from Parkinson’s disease, drugs against this ailment are prescribed only if the symptoms do not allow a person to exist normally. If rigidity, tremor and other first messengers of the disease have just begun to manifest themselves, they do not use medicines.
The nuances of treatment
When choosing a therapeutic program, it is taken into account how a particular pharmaceutical product affects the development mechanism and individual symptoms. When prescribing a drug, the stage of neglect of the case, the speed of progress, the duration of the course, individual nuances are taken into account. It is necessary to select treatment based on the patient’s age and social status, family, personality traits, and professional activity. Consider if there are concomitant health problems.
It is quite difficult to choose among the whole abundance of pharmaceutical products a specific one, useful to a particular patient. This problem is solved by an experienced neuropathologist. Not always the first time it is possible to choose a really successful product in a particular case. With Parkinson’s disease, it’s simply impossible to prescribe the best medicine - what will be indispensable and almost miraculous for one will not help the other at all. Often this can only be verified empirically.
Treatment idea
When choosing a therapeutic program, it is necessary to prescribe means to stabilize the everyday functionality of a person. Drugs should help in the implementation of social functions and professional. Medicines bring current skills to an adequate level. If possible, adhere to the minimum dosage. The volumes of drugs are selected individually, taking into account the characteristics of the patient's condition. It is not always necessary to eliminate manifestations with a cavity - it is enough just to smooth them to such an extent that a person can live a normal life without experiencing great difficulties.
This approach is due to the specific effects of drugs used to treat Parkinson's disease on the sick person. All drugs known to modern medicine provoke side effects, and the higher the volume of drugs entering the body, the greater the risks of serious reactions. The disease is constantly progressing, so sooner or later you still have to increase the dose. Sometimes the situation is such that the patient has already been assigned the maximum permissible dose, while there is still no sufficient effect. To avoid such a dead end, you need to dynamically conduct a case, regularly check the effectiveness of medicines and revise the program based on its features.
Types and Groups
While doctors are only waiting for new medicines for Parkinson's disease from scientists, time-tested ones have to be used. Levodopa-based drugs were mentioned above. In addition to them, amantadines, anticholinergics, dopamine receptor agonists and drugs that inhibit B-monoamine oxidase, catechol-O-methyltransferase are shown. The last two groups are abbreviated as MAO-B and COMT, respectively. The choice in favor of a specific option and a combination of different groups is made by a qualified doctor.
Amantadines
This class includes drugs presented on pharmacy shelves under the names:
- Gludantan.
- "Neomidantan."
- Midantan.
- Amantine.
These agents affect the dopamine release processes, increase the receptivity of the hormone receptors and prevent the reuptake of molecules. This allows you to keep the concentration of the compound stable. Dopamine deficiency inherent in the disease is effectively restored.
Technical Aspects: Amantadine
Doctors currently prescribe over the years proven remedies for their patients, waiting for scientists to finish working on new drugs that are effective in the event of Parkinson’s disease. For treatment, drugs from the class of amantadines are mainly used now. They are prescribed for administration twice or thrice a day in an amount of 0.1 g.
Reception of such pharmaceutical products can provoke swelling of the legs and anxiety. Some suffer from visual hallucinations. Patients noted that they were sick and dizzy. There is a possibility of nausea and a sudden drop in pressure when changing posture from horizontal to vertical. There is a risk of a marble skin tone, cyanosis, expressed by a mesh. More often this is observed on the femoral anterior plane.
IMAO-B
The drugs of this class include:
- "Segan."
- Yumex.
- "Selegilin."
The doctor, choosing which drugs for Parkinson's disease to prescribe to the patient, can focus on this category of pharmaceutical products, since it effectively prevents the breakdown of dopamine. Proper use of funds helps to maintain the concentration of hormonal compounds in brain tissue at a stable level. Means of this class are usually used inside in the morning. A single dose is 5 mg. Sometimes the doctor prescribes medications for use twice a day, both times in the morning. Each dose is 5 mg.
Judging by the reviews, for most patients, medications of this type are well tolerated. Possible side effects include stool disorder, anxiety, and poor sleep quality. Some lose their appetite.
Dopamine receptor agonists
This class of pharmaceutical products includes:
- "Bromocriptine."
- Pronoran.
- "Cabergoline."
Pramipexole, Pergolid are also included here.
All funds have proven reliable in Parkinson's disease. Which medications are best prescribed in each case, the doctor decides. These pharmaceutical products activate dopamine receptors. To some extent, this is a chemical deception of the body: the drug molecule replaces dopamine.
Treatment features
Among the well-known drugs in medical practice, the most widely prescribed is Mirapeks. A similar drug is presented under the name Pramipexole.
Usually, treatment begins with a dose of 0.125 mg. The drug is used three times daily. The maximum daily volume is 4.5 mg. Against the background of a therapeutic program, it can vomit, swelling is possible. Some have disturbed sleep. Cases of hallucinations are known.
Anticholinergics
It is quite difficult for a modern doctor to find treatment for Parkinson's disease. Medicines with a good reputation are classified as anticholinergics. In drugstores they are presented under the names:
- "Akineton."
- "Cyclodolum."
- "Parkopan."
These pharmaceutical products, studies have shown, are effective in the case of tremor. They correct the imbalance of dopamine and acetylcholine. The therapeutic course usually begins with taking 1 mg of the drug twice daily. If necessary, increase the dose until a significant therapeutic effect is achieved.
Features of the reception
Drugs of this class are strictly forbidden to suddenly cancel, because there is a danger of withdrawal syndrome, in which the symptoms of the initial disease becomes sharply and strongly pronounced.
The possibility of side effects is noted. Of course, scientists promise to develop new drugs that are effective in Parkinson's disease, but so far they have to use existing ones, and they can cause an increase in intraocular pressure and visual impairment. In some, it dries the mucous membranes of the oral cavity; in other patients, the heart contracts more often under the influence of drugs. There is a risk of worsening stool, an increase in the frequency of urges to empty the bladder. Currently, drugs of this class are used less often than before.
Levodopa
According to many, among the new drugs that help with Parkinson's disease, the most effective and effective drugs are those based on levodopa. This is a simple chemical compound, a substance that precedes dopamine in biochemical reactions taking place in the human body. Once in the body, it becomes dopamine, thereby correcting the lack of this hormone inherent in the disease. Levodopa-based drugs are used in combination with carbidopa or benserazide. These two compounds prevent premature breakdown of the molecule in tissues and organs, due to which levodopa is completely transported to the brain. Accordingly, even a small dose gives a good effect. Auxiliary components are not able to penetrate the central nervous system.
Levodopa-based combined preparations are presented on the pharmaceutical market under the names “Hexal”, “Nakom”. They, like Levocarb, Sinemet, contain carbidopa. A two-component medicine that includes benserazide is manufactured under the name Madopar.
Technical aspects of treatment
When prescribing a drug containing Levodopa in Parkinson's disease, the half-life of this compound, not exceeding three hours, is taken into account. Accordingly, drugs with this substance should be ingested with a 3-4-hour pause. This increases the risk of side effects. To solve this problem, created special long-acting products. Such enough to use twice a day. They are presented on the pharmacy shelves under the names:
- "Cinema CR".
- "Madopar HBS."
In any of the applications, levodopa can provoke an undesirable reaction of the body. Observations have shown the danger of soreness in the abdomen, nausea and vomiting. Occasionally, gastrointestinal bleeding was observed in patients. Perhaps a violation of the rhythm of the heartbeat and dilated pupils. There are known cases of complicated breathing, active sweating, low blood pressure, psychosis. In some, medications provoked tonic activity of the eyelids, involuntary movements of arms, legs. There is a possibility of psychomotor agitation.
About combinations
When choosing which medicine for Parkinson's disease to prescribe, the doctor will definitely consider the possibility of using a combined medicinal composition based on levodopa and ICOMT. On sale such a drug is presented under the name "Comtan". A similar product is produced under the name Entacapon. ICOMT prolongs the activity of levodopa.
There is a three-component drug in which levodopa, ICOMT, carbidopa are present. It is produced under the name "Stalevo".
What to use?
Levodopa-based drugs are currently considered the most effective drugs for Parkinson's disease, designed to combat the symptoms of pathology. Current practice is that funds of this class are prescribed as late as possible. To some extent, levodopa is an analogue, the twin of dopamine, so the introduction of such drugs into the drug course provokes the wear of the hormone receptors. Among all drugs effective for the disease, this one is prescribed last, representing "heavy artillery." If this tool does not give the desired effect, we can confidently talk about the inefficiency of any drug program.
If a drug based on levodopa has become the drug of choice for a patient with Parkinson's disease, there is a danger of drug dyskinesia. So called involuntary contractions in different parts of the patient's body. Such conditions often interfere very strongly - even more significantly than the initial symptoms of the pathology.
About practice and opinions
Parkinson’s patients themselves rarely give reviews of drug therapy. More often you can find feedback and observations from those who care for patients. It is noted that modern drugs are to some extent good, because they extend the patient's life and improve its quality. At the same time, it is recognized that all drugs provoke side effects.
As observations show, the use of drugs based on levodopa is gradually becoming less and less effective. The doctor must regularly check the effectiveness of the course and review the dosage. On average, volume increases are needed every three or four years. In medicine, the phenomenon was called the phenomenon of depletion of the end of the dose. In the pauses between the receipt of the pharmaceutical product into the body, the symptoms of the initial disease appear, which seem to turn off when a new portion of the drug is absorbed.