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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HEALING OF PARKINSON'S DISEASE THRU MEDICINE (ANTICHOLINERGICS)

     The mechanism of action of anticholinergics is believed be involved in correcting the disequilibrium between striatal dopamine and acetylcholine neurotransmission. Some anticholinergics, e.g. benzotropine, can also block dopamine uptake in central dopaminergic neurons. The anticholinergics used to treat PD specifically block muscarinic receptors. These drugs have only a small effect on PD symptoms, and that evidence for a special effect on tremor is inconclusive. Because of the risk of side effects, centrally acting anticholinergics are usually not advised for the therapy of non - motor, i.e. autonomic, dysfunctions.

    

      The clinical use of anticholinergics has been limited by their side- effect profiles and contraindications. The most commonly reported side effects are blurred vision,urinary retention, nausea, constipation (rarely leading to paralytic ileus), and dry mouth. The incidence of reduced sweating, particularly in those patients on neuroleptics, can lead to fatal heat stroke.

    

       Anticholinergics are contraindicated in patients with narrow-angle glaucoma, tachycardia, hypertrophy of the prostate, gastrointestinal obstruction, and   megacolon. Impaired mental function (mainly immediate memory and  memory acquisition) and acute confusional state are a well documented central side effect that resolves after drug withdrawal. Therefore, if dementia is present, the use of anticholinergics is contraindicated. The abrupt withdrawal of anticholinergics may lead to a rebound effect with marked deterioration of parkinsonism. Consequently, anticholinergics should be discontinued gradually and with caution.

      An anticholinergic preparation  which is commercially available in the Philippines is biperiden  HCl. The brand names are (AKINETON) by ABBOTT,  (AKIDIN) by MED CHOICE PHARMA and (AKETON) by YOO YOUNG. The indications, dosage, manner of administration, contraindications, special precautions, adverse reactions and drug interactions are as follows:

INDICATIONS:  
   TAB: Adjunct therapy of all forms of parkinsonism (post-encephalitic, arteriosclerotic and idiopathic)
   AMP: Symptomatic treatment of parkinsonism including the alleviation of the extrapyramidal syndrome induced by drugs


DOSAGE:
   TAB: Adult Parkinsonism : Initially 1 mg BID, increased by 2 mg/day. Maximum: 16 mg daily
        Drug-induced movement disorders : 1-4 mg once-QID
        Children : 3-15 yr 1-2 mg once-TID


ADMINISTRATION: May be taken with or without food



CONTRAINDICATIONS:
     Untreated narrow-angle glaucoma
     Intestinal stenoses or obstruction
     Megacolon
     Prostatic hypertrophy
     Life-threatening tachycardia


SPECIAL PRECAUTIONS:    
     Avoid abrupt discontinuation.
     Increased sensitivity to side effects especially elderly.
     Enhanced risk of cerebral seizures in predisposed persons.
     Abuse
     Impaired ability to drive or operate machinery.


ADVERSE REACTIONS:    
     Fatigue
     Dizziness
     Drowsiness
     Dry mouth
     Rarely : Swelling of salivary glands
              Accommodation difficulties
              Mydriasis
              Photophobia
              Hypohydrosis
              Constipation
              Gastric symptoms
              Nausea
              Tachycardia
     Very rarely: Bradycardia, especially at higher doses
              Restlessness
              Agitation
              Anxiety
              Confusion
              Euphoria
     Occasionally: Impairment of memory
     In rare cases: Delirium
              Hallucinations
              Nervousness
              Headache
              Insomnia
              Dyskinesia
              Ataxia
              Muscle twitching
              Speech Impairment


DRUG INTERACTIONS:   
    Enhanced anticholinergic effects in combination with other psychotropic drugs
    Antihistamines
    Antiparkinsonism drugs
    Antispasmodics
    Quinidine
    Pethidine
    Dyskinesia induced by levodopa may be potentiated
    Effects of alcohol may be enhanced
    Antagonistic influence on the action of metoclopramide and compound of similar activity in the GIT.
   
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. EXTENDED 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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HEALING OF PARKINSON'S DISEASE THRU MEDICINE (DOPAMINE AGONIST)

It is a known fact the Parkinson’s disease or PD has no cure.  In the early stages of uncomplicated Parkinson’s disease, the use of pharmacological agents is still the primary mode of treatment and also the most common therapy for PD. Aside from levodopa, dopamine agonists are the other recommended antiparkinson drugs during the early stages of the disease. There are 3 dopamine agonists which are commercially available in the Philippines, namely:

 BROMOCRIPTINE MESYLATE

(PARLODEL)
NOVARTIS HEALTHCARE
[ZUELLIG] {P141.50}

 PRAMIPEXOLE diHCl
(SIFROL)
BOEHRINGER INGELHEIM
[METRO DRUG]
{P151.00} of 1 mg/tab

 PIRIBEDIL
(TRIVASTAL RETARD 50)
SERVIER
[ZUELLIG]
{P38.50}

LEGEND:

GENERIC NAME
(BRAND NAME)
MANUFACTURER
[DISTRIBUTOR]
{SUGGESTED RETAIL PRICE}

However, I will only discuss one of the three dopamine agonists ,PRAMIPEXOLE, which is a non-ergot derivative.

What are the INDICATIONS for the use of pramipexole?

1. Treatment of signs and symptoms of idiopathic Parkinson's disease
2. As monotherapy or in combination with levodopa
3. Symptomatic treatment of idiopathic restless leg syndrome

What is the usual DOSAGE of pramipexole?:

1. Parkinson's disease

 Week 1  - 0.125 mg 3x a day
 Week 2  - 0.25 mg 3x a day
 Week 3  - 0.5 mg 3x a day
 Maximum 4.5 mg/day

2. Restless Leg Syndrome

Step 1: 0.125 mg
Step 2: 0.25 mg
Step 3: 0.5 mg
Step 4: 0.75 mg (Maximum dose)
All doses taken once daily 2-3 hours before bedtime. If needed, titrate to each step every 4-7 days.

How do you ADMINISTER oral Pramipexole?

Pramipexole may also be taken with meals to minimize gastrointestinal upset.

What are the SPECIAL PRECAUTIONS in the use of parmipexole?

The dose must be reduced in patients with renal impairment or creatinine clearance (CrCl) of less than 50 ml/min.

What are the ADVERSE REACTIONS of pramipexole? (DiCoFISHPEN)

1. Dizziness
2. Dyskinesia
3. Constipation
4. Confusion
5. Falling asleep during activities of daily living
6. Insomnia
7. Somnolence
8. Hallucination
9. Peripheral edema
10. Nausea

What are the PREPARATIONS of pramipexole?

Pramipexole is available in either 250 mcg/tab or 1 mg/tab.

To learn more about the recent updates in the diagnosis and management of Parkinson's disease, attend the first annual convention of Pinoy PD, entitled: "HEALING OF PARKINSON'S DISEASE THRU G-MEN (GOD, MEDICINE, EXERCISE and NUTRITION).

P.S. Register for FREE on or before September 30, 2011.

P.P.S. Register for a GUARANTEED SEAT and SLOT in the workshop to a LIMITED NUMBER of participants on or before September 30, 2011.

P.P.P.S. Submit REGISTRATION DETAILS (Name, Age, Contact number and E-mail address) on or before September 30, 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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HEALING OF PARKINSON'S DISEASE THRU KINDNESS

We are glad to announce that through the kindness and generosity of some individuals, we are offering the convention on "HEALING OF PAKINSON'S DISEASE THRU G-MEN (GOD, MEDICINE, EXERCISE AND NUTRITION)" for FREE with a GUARANTEED SEAT and SLOT to a LIMITED NUMBER OF PARTICIPANTS on or before SEPTEMBER 30, 2011.

SCRIPTURES:

"Thus says the Lord: Let not the wise man glory in his kingdom, nor the strong man glory in his strength, nor the rich ma glory in his riches; But rather, let him who glories, glory in this, that in his prudence he knows me, Knows that I, the Lord, bring about KINDNESS, justice and uprightness on the earth; For with such am I pleased, says the Lord.

                                                                         Jeremiah 9: 22-23

"A slave of the Lord should not quarrel, but should be gentle with everyone, able to teach, tolerant, correcting opponents with KINDNESS. It may be that God will grant them repentance that leads to knowledge of the truth, and that they may return to their senses out of the devil's snare, where they are entrapped by him, for his will."

                                                                        2 Timothy 2:24-26

"But the Lord's KINDNESS is forever, toward the faithful from age to age. He favors the children's children of those who keep his covenant, who take care to fulfill its precepts."

                                                                        Psalm 103:17-18


PRAYER:

Dearest God, the Father, thank You, for showing us Your endless kindness through other people's deeds. Thank you, Jesus, God the Son, for giving us the courage to pursue the Lord's plan for our lives. May God, the Holy Spirit, grant us the wisdom and the knowledge so that we will know what to say, when to say and how to say the words so we can bring more people closer to God through our generosity. Mother Mary, thank you for your intercession as we await the healing of our mind, body and soul.

ACTION:

Today, I will extend my own act of kindness to anyone who crosses my path through a winning smile, a sincere praise and a shared blessing.

P.S. Register for FREE on or before September 30, 2011.

P.P.S. Register for a GUARANTEED SEAT and SLOT in the workshop to a LIMITED NUMBER of participants on or before September 30, 2011.

P.P.P.S. Submit REGISTRATION DETAILS (Name, Age, Contact number and E-mail address) on or before September 30, 2011 to avail of FREE REGISTRATION and send via email to drajoy31@yahoo.com / drajoy31@gmail.com

Pinoy PD Thru G-MEN

View another webinar from Ness Cabahug