Parkinson's Disease

Parkinson's Disease

What is Parkinson's Disease:  A progressive, neurological disease first described in 1817 by James Parkinson.

The pathology is not completely understood, but there appears to be consistent changes in the melanin-containing nerve cells in the brainstem.

Parkinson's disease is a progressive disorder of the nervous system that affects movement. It develops gradually, sometimes starting with a barely noticeable tremor in just one hand. But while a tremor may be the most well-known sign of Parkinson's disease, the disorder also commonly causes stiffness or slowing of movement.

In the early stages of Parkinson's disease, your face may show little or no expression, or your arms may not swing when you walk. Your speech may become soft or slurred. Parkinson's disease symptoms worsen as your condition progresses over time.

Although Parkinson's disease can't be cured, medications may markedly improve your symptoms. In occasional cases, your doctor may suggest surgery to regulate certain regions of your brain and improve your symptoms.

Drugs use to treat Parkinson's Disease

Carbidopa and Levodopa Enteral Suspension

• It is used to treat Parkinson's disease.
• It is used to treat signs like Parkinson's disease caused by other health problems.
• It may be given to you for other reasons. Talk with the doctor.

What are some side effects that I need to call my doctor about right away?WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

• Signs of low mood (depression), thoughts of killing yourself, nervousness, emotional ups and downs, thinking that is not normal, anxiety, or lack of interest in life.

• Change in the way you act.

• Hallucinations (seeing or hearing things that are not there).

• Feeling confused.

• Strong urges that are hard to control (such as eating, gambling, sex, or spending money).

• A skin lump or growth.

• Change in color or size of a mole.

• Trouble controlling body movements that is new or worse.

• Throwing up blood or throw up that looks like coffee grounds.

• Black, tarry, or bloody stools.

• Belly pain.

• Chest pain or pressure or a fast heartbeat.

• A heartbeat that does not feel normal.

• Fever or chills.

• Sore throat.

• Any unexplained bruising or bleeding.

• Very bad dizziness or passing out.

• Very bad headache.

• Dark urine or yellow skin or eyes.

• Change in eyesight, eye pain, or very bad eye irritation.

• Shortness of breath.

• Feeling very tired or weak.

• A burning, numbness, or tingling feeling that is not normal.

• Problem with the device or problem where the tube goes into your body.

• Swelling in the arms or legs.

• Stomach or bowel problems can happen with carbidopa and levodopa enteral suspension. Some of these problems may lead to the need for surgery or may be deadly. This includes problems like stomach or bowel bleeding, blockage, or ulcers; infection or other problems where the tube goes into your body; or pancreatitis. Call your doctor right away if you have dark, tarry, or bloody stools; fever; upset stomach or throwing up; constipation that does not go away; or stomach pain.

Usual Adult Dose for Parkinson's DiseaseOptimum dosage is determined by careful individual titration: All doses expressed as CARBIDOPA-LEVODOPA
Immediate-release including Oral disintegrating tablets:
Initial dose: 25 mg-100 mg orally three times a day or 10 mg-100 mg orally 3 or 4 times a day
-Increase by 1 tablet every day or every other day as needed until a dose of 8 tablets is reached; may use a combination of tablets from both ratios (1:4 or 1:10) to provide the optimum dose.
Conversion from LEVODOPA:
-Levodopa should be discontinued at least 12 hours before starting carbidopa-levodopa; initiate with approximately 25% of the previous levodopa dose.
-Suggested dose for patients receiving less than levodopa 1500 mg per day: 25 mg-100 mg orally 3 or 4 times a day.
-Suggested dose for patients receiving more than levodopa 1500 mg per day: 25 mg-250 mg orally 3 or 4 times a day.
Sustained-Release Tablets (SINEMET CR):
-Initial dose (levodopa-naive): 50 mg-200 mg orally twice a day; initial dosage should be given at intervals of more than 6 hours
-Dose and dosing interval may be increased or decreased at intervals of at least 3 days based on therapeutic response
-Dose range: Most patients will require levodopa 400 to 1600 mg/day in divided doses every 4 to 8 hours during waking hours; doses of 2400 mg/day at intervals of less than 4 hours have been used, but are generally not recommended.
Conversion from IMMEDIATE-RELEASE levodopa with or without a decarboxylase inhibitor:
-For patients receiving levodopa with a decarboxylase inhibitor: Dosage with Sinemet CR should be approximately 10% higher than previous levodopa dosage; this may need to be increased to up to 30% higher depending on clinical response.
-For patients receiving levodopa without a decarboxylase inhibitor: Dosage with sustained release should be approximately 25% of previous levodopa dosage; levodopa should be discontinued at least 12 hours before starting carbidopa-levodopa
Extended-Release Capsules (RYTARY):
-Initial dose (levodopa-naive): 23.75 mg-95 mg orally 3 times a day for 3 days; on the fourth day, may increase to 36.25 mg-145 mg 3 times a day
-Dosing interval may be increased up to a maximum of 5 times a day, if tolerated
-Maximum daily dose: 612.5 mg-2450 mg
Conversion from IMMEDIATE-RELEASE carbidopa-levodopa to RYTARY: These recommended starting doses should be divided and given 3 times a day:
-For patients receiving levodopa 400 to 549 mg/day: RYTARY levodopa dose should be 855 mg/day
-For patients receiving levodopa 550 to 749 mg/day: RYTARY levodopa dose should be 1140 mg/day
-For patients receiving levodopa 750 to 949 mg/day: RYTARY levodopa dose should be 1305 mg/day
-For patients receiving levodopa 950 to 1249 mg/day: RYTARY levodopa dose should be 1755 mg/day
-For patients receiving levodopa equal or greater than 1250 mg/day: RYTARY levodopa dose should be 2205 or 2340 mg/day
Comments:
-Peripheral dopa decarboxylase is saturated by carbidopa at approximately 70 to 100 mg/day; patient's receiving less than this amount of carbidopa are more likely to experience nausea and vomiting; experience with carbidopa doses greater than 200 mg/day is limited.
-RYTARY products are not interchangeable with other carbidopa-levodopa products; for patients receiving carbidopa-levodopa plus catechol-O-methyl transferase (COMT) inhibitors, the initial recommended total daily dose of levodopa may need to be increased.
Use: For the treatment of the symptoms of idiopathic Parkinson's disease, postencephalitic parkinsonism, and symptomatic parkinsonism which may follow injury to the nervous system by carbon monoxide intoxication and/or manganese intoxication.
DUOPA Enteral Suspension (carbidopa 4.63 mg-levodopa 20 mg per mL) is indicated for the treatment of motor fluctuations in patients with advanced Parkinson's disease.
-Administered into the jejunum through a PEG-J tube using a CADD-Legacy 1400 portable infusion pump; for short term administration, a naso-jejunal tube may be used.
-Total dose is composed of 3 individually adjusted doses: the MORNING bolus dose, the CONTINUOUS maintenance dose, and EXTRA BOLUS doses.
Initiation: Convert all forms of levodopa to oral immediate-release carbidopa-levodopa tablets using 1:4 ratio tablets.
-Day 1 morning dose: Provide a dose of levodopa equivalent to previous day's first levodopa dose; calculate by converting levodopa dose from mg to milliliters and add 3 milliliters of volume to prime the intestinal tube; administer over 10 to 30 minutes.
-Day 1 continuous dose: Provide levodopa dose necessary for 16 waking hours; calculate by determining the amount of levodopa received the previous day, omitting the morning and night dose.
-Extra bolus dose function is available to manage acute "off" symptoms; initially it should be set to 20 mg (1 mL), may titrate in 0.2 mL increments; extra doses should be limited to once every 2 hours.
Adjust doses based on clinical response:
MORNING DOSE is administered rapidly (over 10 to 30 minutes) to achieve a therapeutic dose level; this dose should be adjusted if there is an inadequate clinical response within 1 hour of the morning dose on the preceding day:
-For doses less than or equal to 6 mL (excluding the 3 mL to prime the tube): increase by 1 mL.
-For doses greater than 6 mL (excluding the 3 mL to prime the tube): increase by 2 mL.
-If dyskinesia or levodopa-related adverse reactions occur within 1 hour of the morning dose on the preceding day, decrease morning dose by 1 mL.
CONTINUOUS DOSE:
-Consider increasing the dose based on the number and volume of extra doses provided on the previous day and the patient's clinical response.
-Consider decreasing the dose for troublesome dyskinesia or other adverse reactions; for reactions lasting for a period of 1 hour or more decrease by 0.3 mL/hr; for reactions lasting for periods of 2 hours or more decrease by 0.6 mL/hr.
MAXIMUM DOSE: 1 cassette (levodopa 2000 mg) over 16 hours; patient will take their night-time dose of oral immediate-release carbidopa-levodopa.