I received the United Parkinson Foundation newsletter
yesterday, and found an article about interactions between PD
medication and over-the-counter drugs. It was written by Dr. G.
Frederick Wooten, University of Virginia, and discusses
interactions with decongestants (phenylephrine, ephedrine,
pseudoephedrine, e.g. Sudafed), antihistamines (e.g. Benadryl,
Coricidin, Chlortrimeton), H-2 Blockers (Tagamet, Zantac,
Pepcid), antacids (Tums, Rolaids), and non-steroidal
antiinflammatory drugs (e.g. Motrin, Aleve). Excerpts follow
below:
Levodopa
"...actually has few significant potential interactions with
OTC medications. In patients with cardiac arrhythmias,
particularly paroxysmal atrial fibrillation, one should use
decongestants in combination with levodopa cautiously. The
additive effects of levodopa and sympathomimetic compounds such
as pseudoephedrine may predispose to arrhythmias."
"Both antacids and H-2 blockers may actually potentiate the
effects of levodopa by increasing the rate of stomach emptying.
This is rarely an adverse interaction, however, unless peak-dose
side effects such as dyskinesias are caused by the combination."
Dopamine Agonists (Permax, Parlodel, Mirapex, Requip)
"Virtually no significant interactions are recognized."
Anticholinergics (Artane, Cogentin)
"Several OTC drugs also have anticholinergic properties,
particularly the antihistamines... The anticholinergic effects of
these OTC drugs may then produce additive effects with
anticholinergics and lead to toxicity. Symptoms of this adverse
interaction may include urinary retention, memory impairment,
constipation and impaired near vision. Antihistamines should best
be avoided in patients already taking anticholinergics for their
PD."
Amantadine (Symmetrel)
"No significant interactions...should be anticipated."
Selegiline (Deprenyl, eldepryl)
Selegiline is a "selective" monoamine oxidase (MAO) Type B
inhibitor. "When levodopa or decongestant drugs are taken with a
non-selective MAO inhibitor, extremely high blood pressure may
result. Similar complications may occur with ingestion of certain
cheeses, or other tyramine-rich foods, such as smoked fish in
patients taking non-selective MAO inhibitors. In contrast,
selegiline, when take in dosages of up to ten mg per day, is a
highly selective inhibitor of the Type B form of MAO and rarely
has been associated the "cheese effect common to the non-
selective MAO inhibitors."
"Nevertheless, there are isolated reports of patients taking
selegiline, levodopa and decongestants together who developed
hypertensive crises. Therefore the use of decongestants such as
ephedrine, pseudoephedrine and phenylephrine in patents taking
selegiline and levodopa should be approached with caution. PD
patients who have baseline problems with high blood pressure
should probably avoid decongestants altogether to be on the safe
side."
"...bear in mind that many OTC cold remedies contain
decongestants along with antihistamines and/or expectorants."
...CHECK THE LABEL.
"There are no known adverse interactions between any
antiparkinson medications and non-steroidal antiinflammatory
drugs."
*** "While adverse drug interactions between antiparkinson
medications and OTC drugs are quite rare, they may occur...It is
always appropriate to consult with your physician (preferably a
neurologist) before using OTC drugs that have the potential to
interact with antiparkinson medications." ***
- END -
BTW, does anyone know of an effective cold medication that
doesn't contain decongestants?
Linda Herman
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