On Fri, 20 Dec 1996 14:40:05 -0500
Allan Netick asked about PD drugs and possible surgery complications.
There are many postings in our archive, but here are a few to start with.
These case histories are not meant to cause panic -- just awareness.
I wish you a speedy recovery.
Holiday Greetings to ALL!!
Margaret
--------------------------------
Problem Drugs in PD
Contributed by Alan Bonander
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Surgery Problems
There has been much concern about drugs that might cause problems in
hospitals. There are
plenty and the anesthesiologists are not aware of any problems specific to PD
patients. The
patient will need to do the following:
* Talk to the anesthesiologist before surgery giving them a copy of this drug
list.
* Upon registration for services at a hospital, give them a copy of this list.
* Make sure your neurologist has a copy of this drug list and is involved in
your reason for surgery.
In one support group I know of, a women who had taken her husband to the
hospital for what was
to be over-night surgery. Her husband walked in, had the surgery and died on
or about the fifth
day in the hospital. The wife did not inform the powers to be that her husband
was taking Eldepryl
much less that he had PD.
In my support group, I know of three who have had minor surgery about three
years ago. What
was to be an over-nighter ended being a six to ten day hell. They were in and
out of comas,
transported to psy ward, and almost killed due to drug conflicts during
surgery.
DRUGS THAT MAY INTERFERE IN THE MANAGEMENT OF PARKINSON'S DISEASE
Published by Young Parkinson's Support Network of California
Revision: 04/95 YPSN of CA
This list has been reviewed by our medical adviser. Always notify your
physician of any adverse
effects of drug therapy.
Warning to Users of ELDEPRYL Contemplating Surgery
Sandoz Pharmaceuticals has issued a warning of reports of fatal interactions
between Eldepryl
(Selegiline Hydrochloride) and merperidine known as Demerol, and other trade
names. Patients
contemplating surgery are advised to bring this notice to the attention of
their physician. Further
information can be obtained from pharmacies - ask for prescribing information
- or contact Sandoz
Pharmaceuticals at 1-800-631-8184.
OTHER DRUGS WITH POTENTIAL TO ALTER THE SYMPTOMS OF PARKINSON'S DISEASE
Some drugs employed in the treatment of non-neurologic conditions may alter or
influence the
brain's dopamine system. These drugs, when given to a Parkinson's patient,
have the potential to
alter the symptoms of Parkinson's disease. Should a physician prescribe a drug
on this list, the
patient should make sure the prescribing physician:
* is aware of the patient's Parkinson's disease and the drug's potential for
altering disease
symptoms,
* is aware of the patient's current drug therapy for Parkinson's disease and
any other disease(s),
* explains to the patient both the benefits and the potential side effects of
the drug therapy and
what action to take for adverse side effects.
Drug Type:
Trade Name Generic Name
------------------ -----------------
Antidepressant:
Asendin Amoxapine
Nardil Phenelzine
Parnate Tranylcypromine
Triavil (Contains Perphenazine)
Antipsychotic:
Haldol Haloperidol
Loxitane Loxapine
Mellaril Thioridazine
(Mellaril in low dosage is acceptable)
Moban Molindone
Navane Thiothixene
Orap Pimozide
Prolixin Fluphenazine
Permitil Fluphenazine
Serentil Mesoridazine
Stelazine Trifluoperazine
Taractan Chlorprothixene
Thorazine Chlorpromazine
Tindal Acetophenazine
Trilafon Perphenazine
Vesprin Triflupromazine
Antivomiting/Gastrointestinal:
Compazine Prochlorperazine
Reglan Metoclopramide
Torecan Thiethylperazine
Blood Pressure:
Raudixin Rauwolfia Serpentina
Miscellaneous:
Serpasil Reserpine
Post-Op Medication:
Harmonyl Deserpine
Moderil Rescinnamine
Rauverid None
Rauwiloid None
Wolfina None
Possible Potential:
Aldomet Alpha-methyldopa
Buspar Buspirone
Lithobid Lithium
Contributed by:Alan Bonander([log in to unmask])
Last modified: Mon May 15 10:49:38 1995
-----------------------------------
Subj: Abdominal surgery & PD.
Date: 95-11-15 01:16:33 EST
From: [log in to unmask] (Will Johnston)
Dear Peter,
I went through hernia repair last December & it was no fun for me. I had
it done under general anesthhetic which I thought [erroneously] wouuld be
better than local / spinal tap etc. I also took Eldepryl up to an hour before
surgery.
Operation was done as outpatient surgery. I was slow to come out of
anesthesia. I came out very "off." as respects PD. Whole digestive system
shut down and would not respond to various laxatives. Magnesium Citrate i.e.,
dynamite of sorts had no effect. Five days at home with lpn nurse very much
needed. Then a fainting spell & woke up on floor. Back to hospital as
inpatient for three days.
ADVICE:
Get together with anesthesiologist and decide upon least likely scenario to
avoid ileus. Do not wait till day before operation! Do it now. If possible
avoid Fentanyl. Definitely avoid meperidine. Go easy on other opiates such as
Oxycodone. We Parkies cannot tolerate dopamine antagonists. Realize that
opiates and dopamine go for about the same set of receptors.
After the operation figure on taking it easy for a while. I was led to
believe that I would be virtually recovered in a few days. Give yourself
time!
Good luck..... I had oral surgery last month & made sure
of anesthetics.... no problems.
Will Johnston in Salisbury, Maryland
=================================================
Date: Thu, 2 May 1996 22:59:37 -0400
From: "J.R. Bruman" <[log in to unmask]>
Subject: Re: Demerol-Eldeprel
Demerol (or any related opioid analgesic) is definitely not to be
combined with Eldepryl (or any other MAO inhibitor). The mechanism
of reaction is uncertain but it is severe and can be fatal. See
the PDR articles on both drugs.
As for Demerol with Sinemet, there is no specific warning, but
Demerol by itself can be dangerous.
Sinemet with MAO-A inhibitor (not Eldepryl) is also dangerous,
but that isn't the question here.
Cheers, Joe
------------------------
Subject: Parkinson Alert ID Card
The following is the text of a Parkinson Alert ID Card
which was produced by Hillcrest Hospital in Tulsa,OK
USA in association with the Oklahoma Parkinson Disease
Association. Perhaps you have seen it but do not have
one in your purse or wallet. It includes an explanation
of your symptoms and special attention to drugs that
may be given to you in emergency situations that could
be harmful to you.
Unfortunately, specialized healthcare today tends to
have a "Myopic View" of the patient, treating only what
is broken, overlooking the oath of "Do no Harm" by not
asking the questions. This Alert ID Card may answer
the unasked question in an emergency.
Save this message to a ascii or text file. Load it in
your word processor and adjust the font size so that
each line will be slightly less than the width of a
business card. Courier is a non-proportional type face
so using it will not ruin the line formating.
Internationally, the trade names of the contraindicated
drugs may not translate into local tradenames.
-------------------------------------------------------
Parkinson Alert ID Card
My name is _________________and I have Parkinson's
Disease. Parkinson's disease is a neurological disease
which is neither fatal,painful,nor contagious. Its
symptoms are tremors, rigidity,slowed gait and
low,slurred speaking voice. It can cause gait and
balance impairment, which may resemble intoxication,
but it is not. Judgement and vision remain unimpaired.
These symptoms worsen and lessen several times a day in
an "On-Off" cycle. I usually do not need any special
help, except with tasks requiring physical coordina-
tion or strength. Thank you in advance for your help,
understanding and patience!
CONTRAINDICATED DRUGS IN PARKINSONIAN PATIENTS
The term "contraindicated" essentially means that the
drug in question cannot be given to a patient. In the
parkinsonian, 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.
Your Name: | Physician's Name:
________________|_______________________________
M________________|_______________________________
E________________|_______________________________
D________________|_______________________________
I _______________|_______________________________
C________________|_______________________________
A _______________|_______________________________
T _______________|_______________________________
I________________|_______________________________
O _______________|_______________________________
N________________|_______________________________
S________________|_______________________________
DRUGS THAT MAY INTERFERE SERIOUSLY IN THE
MANAGEMENT OF PARKINSON'S DISEASE
NAMES OF DRUGS
-------------------------------------------------------
Trade Generic
Antidepressant Nardil Phenelzine
Parnate Tranycypromine
Triavil
Neuroleptics Hadol Haloperidol
Loxitane Loxapine
Mellaril Thioridazine
Orap Pimozide
Prolixin Fluphenazine
Permitil Fluphenazine
Serentil Mesoridazine
Stalzine Trifluoperazine
Taractan Chlorprothixene
Thorazine Chlorpromazine
Tindal Acetaphenazine
Trilafon Perphenazine
Vesprin Triflupromazine
Antivomiting/ Compazine Prochlorperazine
Gastrointestinal Reglan Metoclopramide
Torecan Thiethylperazine
Blood Pressure Raudixin Rauwolfia
Serpentina
Post-Op Harmonyl Deserpine
Medication Moderil Rescinamine
Rauverid Niacin
Rauwiloid Nicotinomide
Wolfina B-Complex
B-Complex vitamins If on levodopa without
carbidopa
Possible Aldomet Alpha-Methyldopa
Potential BuSpar Subpirone
Side Effects Lithobid Lithium
Miscellaneous Serpasil Reserpin
WARNING TO USERS OF ELDEPRYL
ELDEPRYL WITH USE OF DEMEROL
CAN BE DEADLY.
DO NOT ACCEPT DEMEROL
(MEPERIDINE) AS A POST-SURGICAL
MEDICATION. FURTHER INFORMATION
CAN BE OBTAINED FROM SANDOZ
PHARMACEUTICALS AT: 1-800-631-8184
Margaret Tuchman(55yrs,dx1980) --NEW JERSEY
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