Paul, you asked:
>>> P Jones <[log in to unmask]> 02/25/98 12:15pm
Re. Barbara Mallut's post: Notes from Dr. Iacono Discussion.
The paragraph on Selegeline (Eldapryl) scared me. My wife
was put on this drug immediately following diagnosis. She is
still on it three years later. It would seem from Dr. Iacono's
discussion, it is a drug that should be avoided at all costs.
Are there any words of wisdom out there?<<<
Paul:
I can't lay claim to "words of wisdom," except to give you
my views. . . I am not a doctor. Also, below are a few prior
postings to add to your confusion.
Barbara Mallut's notes from the presentation by Dr.
Iacono were not a total surprise . . . . she wrote:
>>>On selegaline (Eldapryl). Within 2 hours of taking
selegaline it turns into methamphetamine in your body.
Methamphetamine causes nerve death, and cell and neuron
death. It also causes hallucinations. Dr. Iacono no longer
prescribes this drug to his patients because he believes it's
harmful.<<<
Dr. Iacono's statement that selegiline metabolizes to
methamphetamine is basically correct. Researchers have
established that selegiline scavenges free radicals,
influences the activity of glutamate receptors and can block
apoptosis of nerve cells, all of which slow the progression of
the disease. However, it also has the disadvantage of being
converted to "amphetamine-type" compounds in the blood
stream, which could be toxic to substantia nigra neurons.
"Clinical Evaluation of Deprenyl in the Treatment of
Parkinson's," Acta Neurol Scand, 1983, 95:117-122. "Effect
of Deprenyl on the Progression of disability in Parkinson's,"
New England Jour of Med, 1989, 321:1364-1371. "Effect of
Tocopherol and Deprenyl on the Progression of Disability in
Parkinson's," New England Jour of Med, 1993, 328:176-183.
The monoamine oxidase inhibitors, like selegiline (which
also include Eutonyl, Nardil and Parnate to treat depression)
block the MAO enzyme. The MAO enzyme normally
functions to prevent excessive accumulation of dopamine,
adrenaline and noradrenaline: which occur in normal amounts
in the body. When they reach excessive levels the body
reacts with high blood pressure, heart pounding, shortness of
breath and nausea - like too much adrenaline.
Other MAO-B inhibitors, that do not convert into
amphetamine-type substances (and do not effect the MAO-A
enzyme) are undergoing clinical tests - Rasagilene Mesylate,
from TEVA Pharm.
-formerly posted-
>>>To: Lionel Modra, Larry Fleming & Nancy V.
You have each asked me for the citation to the
Selegiline study I referred to in my posting of 2/11/98.
>>>Can you point us to the study on the neuroprotective
effect of selegiline that you mention. Or perhaps post it.<<<
>>> Dr. Matthew Stern, M.D., the head of the Movement
Disorders Center, at the University of Pennsylvania, Phila.,
published "A dose-ranging study of selegiline in PD
patients," in the July 1997 supplement to Neurology , 49(1
Supp 1) - S2 - S9. Patients were tested on various doses
(5mg or 10mg daily & 10mg or 20 mg weekly). 24 patients
took part. The conclusion was that 20mg weekly was the
minimal dose necessary to achieve maximum
neuroprotective activity.
>>>Anyone should be able to retrieve a summary of the
study from the National Library of Medicine-Medline search,
using the locator citation PMID: 9222270. To access
Medline I use the URL from my old account:
http://130.14.32.42/cgi-bin/startIGM?account=&password=
however, now you should to be able to gain free access
using -
http://www.nlm.nih.gov/databases/freemedl.html
another source for this information might be Janet Peterson
who occasionally posts Medline Abstracts -
<[log in to unmask]>
>>>Since the beneficial effect of selegiline has been debated
in this forum recently, you may wish to read the following:
>>>From: Stephan Schwartz
Date: 10/29/97 4:19pm
Subject: Re: Selegiline
>>> Brian Collins <[log in to unmask]> 10/29/97
04:32am >>>
>>> Maybe Stephan or Janet can answer this question:
I seem to recollect that most of the reports that come along
deal mostly with Selegiline in combination with Levodopa.
Are there any dealing with Selegiline as the only input ?<<<
>>>Good evening Brian:
Quick answer - yes. In Neurology, February 1996, v.46No.2,
a team of researchers conducted a study of the effects of
selegiline alone and in combination with bromocriptine
(Parlodel). It was called the PARJUPAR STUDY, in
Portugal, by A. Castro-Caldas. The study lasted three years
and found that both (individually and together) meds have a
beneficial effect in delaying the need for levodopa therapy.
The researchers would not go so far as to opine that
selegiline exhibited a neuroprotective effect, but they did
report a lessening of PD symptoms, thereby delaying or
sparing the need for levodopa.<<<
-and-
>>>From: Stephan Schwartz
Date: 10/28/97 4:09pm
Subject: Re: Selegiline - "limited term of Sinemet"
>>>Brian:
>>>My neurologist agrees with your 5 neuros (4 calling
birds, three french hens, oops):
The point in time at which a PWP starts drug therapy
with levodopa (Sinemet) does not activate some doomsday
scenario that results in increased disability after 5, 10, 15
years of treatment.
As the disease (death of brain cells) progresses there is
less natural dopamine released from the nerve cells and
fewer cells to process the levodopa. I do not think eldepryl
(selegiline) is the complete neuroprotective answer, but my
opinion (after 7 years) is that it couldn't hurt (flawed studies
to the contrary). One recent study suggested a positive
result with just 20mg eldepryl (four 5mg pills) in a seven day
period. As a result of this PD list multilogue I discussed with
my neuro cutting my eldepryl to one 5mg pill in the a.m. per
day. He agreed.
To avoid putting all my nerve cells in the same basket, I
also supplement my diet with vitamins, minerals and herbs to
achieve the maximum anti-oxidant affect. I think the cell
death is tied into increased free radicals in the blood.<<<
-end-
Now Paul, just sit back and wait for the torrent of
information to come your way. Good luck!
Stephan 53/7
