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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. ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn