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Dear Barb-

I recently replied to an earlier post about Cogentin.  Artane is in the same
class of medications as Cogentin called anticholinergics.  Anticholinergics
tend to have a common side effect of confusion and blurred vision because
they tend to block the effects of acetylcholine.  Acetylcholine is a major
stimulatory neurotransmitter thought to be involved in memory and other
cognitive processes.  Acetylcholine is a main transmitter which exerts its
effects on autonomic functions in the periphery.  These effects include
stimulating secretions and bowel movement.  By understanding the role of
acetylcholine in neurotransmission, we can understand the side  effects of
blocking this neurotransmitter.

Artane is in a class of drugs called anticholinergics.  Anticholinergics were
the first class of drugs used to treat Parkinsonian symptoms.  Parkinson's is
a neurological degenerative condition affecting the dopaminergic neurons.
What we know with Parkinson's is that there is an imbalance between two
neurotransmitters, dopamine and acetylcholine.    As a result, there is a
decrease level of dopamine and we tend to see a higher level of
acetylcholine.  Artane works by decreasing the level of acetylcholine;
thereby, creating a balance between dopamine and acetylcholine and hopefully
alleviating Parkinsonian symptoms.

As a pharmacist for Athena Rx Home Pharmacy, we tend not to see
anticholinergics used as frequently due to the newer class of medications
available to treat Parkinsonian symptoms.  We also tend not to see them used
in patients over the age of 65 due to the risk of confusion, dryness of
mouth, blurred vision, dizziness, constipation, and dryness of the eyes.  All
side effects associated with anticholinergics.

The newer class of agents available today include the dopamine agonists.
These include Permax, Parlodel, Requip, and Mirapex.  These agents work by
"imitating" dopamine.  They act directly on the dopamine receptors and help
to alleviate Parkinsonian symptoms.  One common side effect of these agents
includes drowsiness.  However, many Parkinsonians and physicians favor Permax
because it doesn't appear to cause as much drowsiness.  Dopamine agonists are
sometimes prescribed alone, but most often prescribed in conjunction with
levodopa/carbidopa.  When prescribed in conjunction with levodopa/carbidopa
the daily dose of levodopa/carbidopa can usually be decreased.  Dopamine
agonists are especially helpful when levodopa/carbidopa begins to lose its
effectiveness.

I welcome the opportunity to answer additional questions for you.  If you
have any questions, please feel free to contact me at 1-800-537-8899 ext.
6104.

Sincerely,

Dominic Marchese, RPh.
Athena Rx Home Pharmacy
Pharmacy Service Specialist
1-800-5-ATHENA