HEALING OF PARKINSON'S DISEASE THRU MEDICINE (COMT INHIBITORS)

It is a known fact that Parkinson’s disease has no cure. In the early stages of uncomplicated Parkinson’s disease, use of pharmacological agents is still the primary mode of treatment. One of the drugs being used in the treatment of PD is the catechol- O - methyltransferase (COMT) inhibitors like entacapone and tolcapone.

MECHANISM OF ACTION:

       COMT INHIBITORS reduce the metabolism of levodopa, extending its plasma half - life and prolonging the action of each levodopa dose. Therapeutic dose of entacapone only acts peripherally and does not alter cerebral COMT activity. It is administered together with each dose of levodopa and is not approved for use in early (uncomplicated) and non- fluctuating PD patients.

 SYMPTOMATIC TREATMENT:

 Symptomatic treatment of parkinsonism using COMT inhibitors as monotherapy is not applicable hence COMT inhibitors should always be given with levodopa. In some studies done on COMT inhibitors, all trials showed a small benefit in the control of the symptoms of parkinsonism, mostly reflected in the activities of daily living but the results  were not consistent.

When the initiation of treatment with levodopa/carbidopa/entacapone was compared to that with levodopa/carbidopa, no difference was found  between the two treatment arms as to the prevention of motor fluctuations and dyskinesia. There are no studies available on the symptomatic treatment of non-motor problems.

 SAFETY

 COMT inhibitors increase levodopa bioavailability, so they can increase the incidence of dopaminergic adverse reactions, including nausea, and cardiovascular and neuropsychiatric complications. Diarrhea and urine discoloration are the most frequently reported non-dopaminergic adverse reactions. The combination with selective MAO-B inhibitors (selegiline) is allowed if the dose of MAO-B inhibitor does not exceed the recommended dose.
           

ENTACAPONE (COMTAN)

 The commercially available preparation of a COMT inhibitor in the Philippines is ENTACAPONE (COMTAN) manufactured by NOVARTIS HEALTHCARE. The indications, dosage, manner of administration, contraindication and special precautions are the following:

INDICATIONS:     Adjunct to levodopa/benserazide or levodopa/carbidopa treatment in patients with Parkinson's disease and end-of-dose motor fluctuations, who cannot be stabilized on those combinations.

DOSAGE:

 One 200-mg tab with each levodopa or dopa decarboxylase inhibitor dose. Maximum: 2 g/day

ADMINISTRATION:

May be taken with or without meals.

CONTRAINDICATIONS:      Pregnancy and lactation
     Pheochromocytoma
     Concommitant use with nonselective MAO inhibitors (MAO-A and MAO-B) or with a selective MAO-A plus a selective MAO-B inhibitor.
     Liver impairment
     History of neuroleptic malignant syndrome &/or nontraumatic rhabdomyolysis

SPECIAL PRECAUTIONS:     Dosage of L-dopa and other antiparkinsonism drugs(e.g. dopamine agonists) may need to be adjusted.
     L-dopa induced orthostatic hypotension may be aggravated.
     Effects of medicinal products metabolized by catechol-O-methyl transferase may be potentiated.
     Caution when discontinuing treatment, when driving or operating machines  due to potential sudden sleep onset episodes.
    

    To get an update in the diagnosis and management of Parkinson's disease, Pinoy Parkinson's Disease or Pinoy PD is holding its First Annual Convention on October 22, 2011 in Makati City.

P.S. FINAL EXTENSION OF FREE REGISTRATION! Register for FREE on or before OCTOBER 15, 2011.

P.P.S. Register for a GUARANTEED SEAT and SLOT in the workshop to a LIMITED NUMBER of participants on or before OCTOBER 15, 2011 including LUNCH, 2 SNACKS and SEMINAR KIT!

P.P.P.S. Submit REGISTRATION DETAILS (Name, Age, Contact number and E-mail address) on or before OCTOBER 15, 2011 to avail of FREE REGISTRATION and send via email to drajoy31@yahoo.com / drajoy31@gmail.com

Pinoy PD Thru G-MEN

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