On Wed, 30 Oct 1996 14:11:35 -0500 Ralph Reichert wrote: >Subject: Artane or Cogentin for Tremor? >Has anyone found these drugs helpful for PD tremor? Any serious adverse >effects? Compatable with Eldepryl? and on 31 Oct Barbara Jensen asked: >Would really appreciate any input from fellow PWP's with tremor. >I will try Amantadine(Symmetrel) next and then Permax.Would really >appreciate any input from fellow PWP's with tremor. >I will try Amantadine(Symmetrel) next and then Permax. The following is an excerpt from: AN EXAMINATION OF MEDICATIONS BOTH COMMONLY AND OCCASIONALLY USED IN TREATING PARKINSON'S DISEASE, by Neal Slatkin, MD. NOTE: This paper, and much more information can be found in our PD archives and on the web (for those with browsing capability): http://neuro-chief-e.mgh.harvard.edu/parkinsonsweb/Main/PDmain.html The Parkinson's Web. --------- IMPORTANT INFORMATION AND DISCLAIMER The information in this newsletter is provided solely for the purpose of the general information of the reader. It is not in any respect intended as medical advice for patients, nor does it imply treatment recommendations of City of Hope National Medical Center or the National Parkinson's Foundation. Some of the medications listed are not approved by the United States Food and Drug Administration (FDA) for the treatment of Parkinson's disease; and/or may not be approved for the purposes discussed; and/or may not be approved for use within the United States. You are strongly encouraged to consult your doctor should you have questions regarding these or other medications. ELDEPRYL (SELEGILINE) 5 MG WHITE TABLETS, MAXIMUM DOSE _ 10 MG/DAY Eldepryl (selegiline) is a monoamine oxidase type B inhibitor (MAO-B Inhibitor). Monoamine oxidase is an enzyme used by the brain to metabolize, or break down, dopamine. Eldepryl often prolongs the effects of levodopa therapy by prolonging dopamine action in the brain. The metabolism of dopamine can also cause potentially harmful substances (called free radicals) to accumulate in the brain. By inhibiting dopamine metabolism, Eldepryl may inhibit the production of these substances and thereby have a protective action. Eldepryl has been reported to be of value in three situations, as follows: + In the early symptomatic treatment of Parkinson's before levodopa is begun + For "wearing off" problems, by prolonging levodopa action + As a "neuro-protective" agent or "free-radical scavenger" to slow Parkinson's disease progression (controversial) SIDE EFFECTS OF ELDEPRYL + Nausea, stomach upset, light-headedness + Insomnia, especially if taken after 1 or 2 pm + Confusion, hallucinations and nightmares (more commonly encountered in older patients, or those who have had Parkinson's for many years) + Occasionally Eldepryl may worsen dyskinesias or cause other side effects similar to those of levodopa excess CONTRAINDICATIONS When combined with anti-depressant medications, Eldepryl can uncommonly cause a severe syndrome characterized by increased rigidity, jerking movements of the arms and legs, agitation, confusion, restlessness, fever, shivering and sweating ("serotonin syndrome"). The simultaneous use of anti-depressant medications and Demerol-a pain reliever _ should be avoided in patients taking Eldepryl. Patients taking Eldepryl may be advised to wear a Medic-Alert -type bracelet to decrease the likelihood of receiving a medication that may interact with Eldepryl. ANTI-CHOLINERGIC MEDICATIONS ARTANE (TRIHEXYPHENIDYL), COGENTIN (BENZTROPINE MESYLATE) AND OTHERS Anti-cholinergic medications are historically the first type of medications to be successfully used in the treatment of Parkinson's disease and may still be of adjunctive value in reducing tremor and rigidity. Many medications with strong anti-histamine properties such as Benadryl (diphenhydramine) and Periactin (cyproheptadine) also have anti-cholinergic effects and may also be useful. SIDE EFFECTS OF ANTI-CHOLINERGIC MEDICATIONS + Dry mouth, blurring of near vision, constipation, urinary hesitancy and retention (especially in men) + Mental confusion, decreased memory and hallucinations (especially in older patients or those who are already having problems with mental clarity) + Patients with hiatal hernia and gastroesophageal reflux may experience increased symptoms of "heart burn" CONTRAINDICATIONS Patients who have certain types of glaucoma, who have severe problems with urination, or who have unusually severe problems with confusion or forgetfulness, should not take anti-cholinergic medications. ANTI-CHOLINERGIC MEDICATIONS ARTANE (TRIHEXYPHENIDYL), COGENTIN (BENZTROPINE MESYLATE) AND OTHERS Anti-cholinergic medications are historically the first type of medications to be successfully used in the treatment of Parkinson's disease and may still be of adjunctive value in reducing tremor and rigidity. Many medications with strong anti-histamine properties such as Benadryl (diphenhydramine) and Periactin (cyproheptadine) also have anti-cholinergic effects and may also be useful. SIDE EFFECTS OF ANTI-CHOLINERGIC MEDICATIONS + Dry mouth, blurring of near vision, constipation, urinary hesitancy and retention (especially in men) + Mental confusion, decreased memory and hallucinations (especially in older patients or those who are already having problems with mental clarity) + Patients with hiatal hernia and gastroesophageal reflux may experience increased symptoms of "heart burn" CONTRAINDICATIONS Patients who have certain types of glaucoma, who have severe problems with urination, or who have unusually severe problems with confusion or forgetfulness, should not take anti-cholinergic medications. SYMMETREL (AMANTADINE) 100 MG CAPSULES (RED, YELLOW), SUSPENSION (50 MG / 5 CC = TEASPOON) Symmetrel (amantadine) is most frequently used as an adjunctive agent in the treatment of motor symptoms. It was initially introduced to prevent infection with influenza A virus. After its introduction, however, it was serendipitously found to have anti-Parkinson's effects. The mechanism of anti-parkinsonian action of this medication is still unclear, though it may increase dopamine release or block certain excitatory brain receptors (the NMDA receptors) and thereby improve movement. SIDE EFFECTS OF SYMMETREL (AMANTADINE) + Nausea, light-headedness, difficulty with sleep, ankle swelling or edema, hallucinations + Anxiety, bad dreams, dry mouth, difficulty with urination and increased problems of constipation + Occasional mottling of the skin (livedo reticularis), which may require discontinuation of this medication + Symmetrel should be slowly discontinued or malignant hyperthermia could result. (See earlier discussion on stopping carbidopa/levodopa.) DOPAMINE AGONISTS PERMAX (PERGOLIDE), PARLODEL (BROMOCRIPTINE), APOMORPHINE INVESTIGATIONAL AGENTS: CABERGOLINE, ROPINEROLE, PRAMIPEXOLE Dopamine agonists are commonly used as adjuncts to Sinemet in treating the motor symptoms of Parkinson's disease. Drugs in this class stimulate the brain directly by mimicking dopamine and do not have to be converted into other compounds. Although generally not as effective as Sinemet in decreasing symptoms, these agents may offer the Parkinson's patient other treatment advantages including: (a) a longer duration of action, (b) absorption which is generally not limited by the presence of food or protein; and, (c) effectiveness even when levodopa ceases to be effective (controversial). SIDE EFFECTS OF DOPAMINE AGONISTS + Low blood pressure upon standing, causing symptoms of light-headedness, dizziness, neck pain and imbalance + Hallucinations, confusion, or bad dreams + Nausea, stomach upset, constipation and occasional vomiting + Ankle swelling, or edema + New or worse dyskinesias, though these generally subside with lowering of the levodopa dose + Note: A rare side effect of treatment with some of these drugs is increased shortness of breath, caused by scarring around the heart or within the lung. This complication requires that the patient be promptly tapered off this medication.