Please, read the list again, carefully.

Amitriptyline is NOT contraindicated in Parkinson's disease.  Only when it
is combined with perphenazine in the form of Triavil is there any concern
about amitryptiline.  In that case, the combination is contraindicated
because perphenazine (Trilafon) is contraindicated because it is a dopamine
blocker and makes the symptoms of Parkinson's Disease worse.

Indeed, amitryptiline would be one of the antidepressants OF CHOICE in
Parkinson's Disease.  Its ability to block reuptake of catecholamines
(including dopamine) would be helpful in Parkinson's Disease, by prolonging
the action of dopamine.  Furthermore, it's ability to block the
acetylcholine receptor makes it act in ways that are similar to those of
benztropine (Cogentin) and trihexyphenidyl (Artane), which are drugs which
are helpful in Parkinsonism.  (At one point before levodopa came out, those
were the ONLY drugs capable of ameliorating the tremor and stiffness.  Today
they are still used occasionally in people who have tremor not controlled by
levodopa or the dopamine agonists.)  In summary - amitryptiline is NOT
contraindicated.

Be very cautious about this list - it is not completely accurate.  Notice
that quetiapine (Seroquel) and clozapine (Clozaril) are also included in
this list when they are the antipsychotic agents OF CHOICE in the treatment
of psychosis and hallucinations in PWP.  In the treatment of nausea in PWP,
trimethobenzamide (Tigan) seems also to be the better choice.

In medical circles there are absolute and relative contraindications.  An
absolute contraindication would mean that the drug should never be used
under any circumstances.  In relative contraindications, the drug may be
used at the judgement and discretion of your physician if the benefits
expected outweigh the potential risks.  It is important to keep in mind this
distinction.

Jorge Romero, MD


----- Original Message -----
From: "Schaaf Angus / Meadow Creek Ranch" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, August 05, 2001 11:27 PM
Subject: Amitryptiline Use-From NPF Book


PLEASE list members check the do not take list when taking PD drugs.
Amitryptiline is ON IT.!!!!!
It is a contraindicated DRUG. Plese read for your own health.  Rob
Possible Potential

The term 'contraindicated' essentially means that the drug in question
cannot be given to a patient. In people with Parkinson Disease, the basic
problem is the chemical nature of the disease itself. Many drugs alter the
brain's dopamine system and may not be recognized as having a potential to
markedly alter the symptoms of Parkinson Disease simply because the drugs
are employed for the treatment of non-neurologic conditions. Every patient
with Parkinson Disease should have a list of these agents available for
their physician's reference. If you would like to receive a listing of these
medications for your wallet, please call the WPA at 800-972-5455, or write
to us at:

Wisconsin Parkinson Association
3070 N. 51st Street, Suite 206
Milwaukee, WI 53210

Trade Name..........................Generic Name

Aldomet.................................Alpha-methyldopa
Dilantin..................................Phenytoin
Lithium..................................None
Buspar...................................Buspirone
Pavabid.................................Papaverine
Depakote...............................Valproate

Demerol/Meperidine cannot be used with Eldepryl treatment

Trade Name..............................Generic Name

Compazine................................Prochlorperazine
Reglan.......................................Metoclopramide
Torecan.....................................Thiethylperazine
Inapsine.....................................Droperidol
Serapsil.................................Resperine
Raudixin................................Rauwolfia Serpentina
Rauverid................................None
Wolfina..................................None
Harmonyl...............................Deserpine
Moderil..................................Rescinnamine
Rauwiloid..............................None
Haldol.........................................Haloperidol
Trilafon.......................................Pephenazine
Thorazine...................................Chlorpromazine
Stelazine....................................Trifluoperazine
Prolixin, Permitil.........................Flufenazine
Navane.......................................Thiothixene
Moban........................................Molindone
Mellaril (high dosage).................Thioridazine
Loxitane......................................Loxapine HCL
Serentil.......................................Mesoridazine Besylate
Taractan.....................................Chlorprocthixene
Triavil....................................Combination of Perphenazine &
Amitriptyline
Nardil.....................................Phenelzine
Parnate..................................Tranylcypromine
Ascendin................................Amoxapine


 Appendix D
Drugs Contraindicated in Parkinson's Disease


Some medications can induce or worsen the primary features of Parkinson's
disease. These drugs are intended to treat illnesses or symptoms other than
those of PD; various ones can cause tremor, muscle rigidity, and
bradykinesia by blocking the effects of dopamine within the brain. These
parkinsonian drug side effects can appear in individuals who have no
pre-existing history of Parkinson's disease.

In such cases, the Parkinson-like symptoms are usually mild and gradually
resolve when the medication is withdrawn. In the case where a patient
receiving such medications already has idiopathic Parkinson's disease, they
can cause abrupt and severe worsening of PD symptoms resulting in an
immobile state. In some instances, the patient with Parkinson's disease may
require hospitalization as the offending medication is withdrawn.

Most of these dopamine blocking drugs are used to treat psychiatric problems
such as hallucinations or gastrointestinal problems. Examples of medications
used to treat psychosis, hallucinations, and confusion include:

haloperidol (Haldol®)
chlorpromazine (Thorazine®)
thioridazine (Mellaril®)
molindone (Moban®)
perphenazine (Trilafon®)
perphenazine and amitriptyline (Triavil®)
thiothixene (Navane®)
flufenazine (Prolixin®)
olanzapine (Zyprexa®)
risperidone (Risperdol®)
quetiapine fumarate (Seroquel®)
clozapine (Clozaril®)

Examples of medications used to treat nausea, vomiting and other
gastrointestinal symptoms include:
metoclopramide (Reglan®)
prochlorperazine (Compazine®)
trimethobenzamide (Tigan®)
The drugs identified in this appendix should be avoided in Parkinson's
disease if at all possible. Unfortunately, some patients with PD develop
symptoms such as hallucinations or nausea which may indicate use of some of
the milder drugs in these categories.

The term "drug-drug interaction" refers to side effects or reactions due to
combined use of two or more medications. The number of potential drug-drug
interactions is enormous. Most happen due to alterations of drug breakdown
(metabolism) which occurs when medications are used together. Fortunately,
most of these interactions do not result in serious illness or death.

There is no evidence that the antiparkinson medications react poorly with
each other in this way. Various other categories of drug-drug interactions
have been identified and actual risks explained in the text of this manual.
The potential for drug-drug interactions makes it imperative that patients
fully disclose all prescription and over-the-counter medications to all
doctors and pharmacists involved in their care.

A Medical Alert card listing medications contraindicated for use in PD is
available at no charge from the National Parkinson Foundation.

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