Please excuse the formatting, this was converted to text from a msword=20
document.  Thought this would be the best way to get the list out the=20
quickest.


Margaret,



DRUGS TO BE GIVEN WITH CAUTION
 TO PEOPLE WITH PARKINSON=D5S DISEASE

Parkinson=D5s disease is a neurological disorder which is characterised b=
y=20
tremor, stiffness and slowness of movement. The symptoms of this disorder=
=20
are due to a deficiency in the brain of a chemical substance called=20
dopamine.  Many drugs used for the treatment of other medical
conditions have the potential to alter or interfere with the brain=D5s=20
dopamine system and are sometimes overlooked as having a detrimental effe=
ct=20
on Parkinson=D5s disease.=20

The need to effectively treat other medical conditions and the possibilit=
y=20
of causing or worsening existing Parkinson=D5s disease has to be consider=
ed.

Potentially fatal interactions can occur when some drugs are combined wit=
h=20
medications to treat Parkinson=D5s disease.  These drugs or drug combinat=
ions=20
must not be given to people with Parkinson=D5s disease (see A below).

Some drugs such as anti-emetics and powerful tranquillisers can induce a=20
form of Parkinsonism which may take weeks or months to appear.  If given =
to=20
people who already have Parkinson=D5s disease their symptoms may worsen.=20
Several months may elapse after the  offending medication is stopped befo=
re=20
the symptoms decrease or disappear.

When commencing cardiovascular drugs (for example drugs to treat high blo=
od=20
pressure or angina) a check of lying and standing blood pressure is=20
extremely important.  The addition of these drugs to=20
anti-Parkinson=D5smedication may cause extremely low blood pressure.

If you are contemplating surgery, you should:=20

-       Talk to your doctor and anaesthetist before surgery and give him/her a=20
        copy of this list;
-       If admitted to hospital, give staff a copy of this list;
-       Make sure your neurologist has a copy of this drug list and is aware of=
=20
        your reason for surgery.

Note    It is particularly important that the potentially fatal interaction=20
between Selegiline [DEPRENYL/ELDEPRYL] and Pethidine is noted.

For all of the above reasons you should always tell your doctor and=20
pharmacist about all the medications you are taking, particularly if you=20
have been started on a new medication.

This list of medications has been produced for you to have available in=20
emergency situations and as a reminder for your doctor and pharmacist. =20
Please discuss any concerns and questions which you may have with them.

Prepared by Dr B I Vieira, Consultant Physician and Graham Greenhill, F.P=
.S.=20

Consultant Clinical Pharmacist, with assistance from Neurologists Prof.=20
Frank Mastaglia and Dr Keith Grainger, as advisors to the:

Parkinson=D5s Association of Western Australia Neurological Lotteries Hou=
se,
320 Rokeby Rd, Subiaco WA  6008 Ph: 381 8699   Fax: 382 1149

Produced with assistance from Be Wise With Medicines A Federal Government=
=20
initiative to promote the wise use of  medicines.
May 1996



Note:   Brand names are listed in capitals.

A. The following drug combinations are contraindicated

(1) Antidepressants (to treat depression)
        (1A) monoamine oxidase inhibitors - not to be used in combination
        with levodopa containing drugs (e.g. SINEMET, MADOPAR, KINSON,=20
SINACARB)
         or with Selegiline [DEPRENYL/ELDEPRYL].

        Type A (non-selective)=09
                Phenelzine              NARDIL
                Tranylcypromine PARNATE (in PARSTELIN)

        Type A (selective)
                Moclobemide*    AURORIX*
*Combination with levodopa (SINEMET, MADOPAR, SINACARB, KINSON) may requi=
re=20
a reduction in dose of  levodopa.  Your doctor will advise.

        (1B) selective serotonin re-uptake inhibitors (SSRI's) - not to be used=20

in combination with
Selegiline [DEPRENYL/ELDEPRYL].
                Fluoxetine              LOVAN, PROZAC, ZACTIN
                Paroxetine              AROPAX
                Sertraline              ZOLOFT

        (1C) serotonin-noradrenaline re-uptake inhibitors (SNRI's)
-        not to be used with Selegiline  [DEPRENYL/ELDEPRYL].
                Venlafaxine             EFEXOR

(2) Analgesics (for pain) - not to be used in conjunction with Selegiline=
 =09
[DEPRENYL/ELDEPRY
L].
                Pethidine [Meperidine(USA)]     [DEMEROL(USA)]


B. The following drugs have the potential to
worsen Parkinson=D5s Disease. Your doctor may decide their use is justifi=
ed.

(1) Anti-emetics (to treat nausea and vomiting)

        Metoclopramide          MAXOLON, PRAMIN
        Prochlorperazine                STEMETIL
        Thiethylperazine                TORECAN  (Note: this drug is
                                        no longer available in Aust.
                                        but I have left it on the list)


(2) Antipsychotics (also known as major tranquillisers)

        Chlorpromazine  LARGACTIL
        Flupenthixol            FLUANXOL
        Fluphenazine            ANATENSOL, MODECATE
        Haloperidol             HALDOL, SERENACE
        Methdilazine            DILOSYN
        Pericyazine             NEULACTIL
        Perphenazine            TRILAFON, (in MUTABON D)
        Pimozide                ORAP
        Promethazine            AVOMINE, PHENERGAN (also in some
                        cough/cold preparations)
        Risperidone             RISPERDAL
        Thiothixine             NAVANE
        Thioridazine            ALDAZINE, MELLERIL
        Trifluoperazine STELAZINE, (in PARSTELIN)
        Trimeprazine            VALLERGAN

(3) Cardiovascular (blood pressure and heart drugs)

        Amlodipine              NORVASC
        Diltiazem               CARDCAL, CORAS, DILTIAZEM
        Felodipine              AGON, PLENDIL
        Methyldopa              ALDOMET, ALDOPREN, HYDOPA, NUDOPA
        Nifedipine              ADALAT, NIFECARD, NYEFAX
        Verapamil               ANPEC, CORDILOX, ISOPTIN,VERACAPS

(4) Anti-anxiety

        Buspirone               BUSPAR

(5) Others (less common) which may exacerbate Parkinson's

        Captopril               ACENORM  CAPOTEN=7F
        Lithium         LITHICARB
        Phenytoin               DILANTIN
        Tetrabenazine   NITOMAN

Note    The intake of caffeine (tea/coffee) should be limited whilst taking
Amantadine/SYMMETREL.

Note    Many older drugs which have been removed from the Australian
         market may still be available in some overseas countries; ensure
        you have adequate supplies of all medications when travelling.

This list is not exhaustive but contains many drugs known to cause
problems or which can be anticipated to cause problems in some
Parkinsons patients.  Space has been left below for you to add new
drug information as it becomes available.

        ..................................      =09
.....................................
        .............................           ...............................
        ..............................          ...............................

YOUR NAME                               TELEPHONE       =09

GENERAL PRACTITIONER                                    =09

NEUROLOGIST/SPECIALIST                          =09

PHARMACIST                                              =09