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SELEGILINE
(brand names: Carbex, Jumex, Eldepryl) |
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Eldepryl is prescribed along with Carbidopa)
for people with Parkinson's disease. It is used when
Sinemet no longer seems to be working well. Eldepryl
has no effect when taken by itself; it works only
in combination with Larodopa (levodopa) or Sinemet.
Parkinson's disease, which causes muscle rigidity
and difficulty with walking and talking, involves
the progressive degeneration of a particular type
of nerve cell. Early on, Larodopa or Sinemet alone
may alleviate the symptoms of the disease. In time,
however, these medications work less well; their effectiveness
seems to switch on and off at random, and the individual
may begin to experience side effects such as involuntary
movements and "freezing" in mid-motion.
Eldepryl may be prescribed at this stage of the disease
to help restore the effectiveness of Larodopa or Sinemet.
When you begin to take Eldepryl, you may need a reduced
dosage of the other medication.
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Caution! Before starting to
take this medicine, it is vital that you should consult
your doctor! Do not use it on your own initiative,
without medical advice.
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Sinemet CR is a controlled-release tablet that may
be given to help relieve the muscle stiffness, tremor,
and weakness caused by Parkinson's disease. It may
also be given to relieve Parkinson-like symptoms caused
by encephalitis (brain fever), carbon monoxide poisoning,
or manganese poisoning. Sinemet CR contains two drugs,
Carbidopa and levodopa. The drug that actually produces
the anti-Parkinson's effect is levodopa. Carbidopa
prevents vitamin B6 from destroying levodopa, thus
allowing levodopa to work more efficiently. Parkinson's
drugs such as Sinemet CR relieve the symptoms of the
disease, but are not a permanent cure.
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MIRAPEX
(MIRAPEXIN) (brand name: Mirapex) |
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Although it is not a cure, Mirapex eases the symptoms
of Parkinson's disease - a progressive disorder marked
by muscle rigidity, weakness, shaking, tremor, and
eventually difficulty with walking and talking. Parkinson's
disease results from a shortage of the chemical messenger
dopamine in certain areas of the brain. Mirapex is
believed to work by boosting the action of whatever
dopamine is available. The drug can be used with other
Parkinson's medications such as Eldepryl, Sinemet,
and Larodopa.
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Servicio de Farmacologia
Clinica, Hospital Universitario Vall d'Hebron, Barcelona,
Espana.
INTRODUCTION. In recent years new
anti Parkinson drugs have been marketed and there
has been controversy over the safety of some drugs.
OBJECTIVE. To analyze the evolution of the consumption
of anti Parkinson drugs and the effect of the newer
drugs. PATIENTS AND METHODS. A study of the consumption
of anti Parkinson drugs (1989 1998). Data were obtained
from the ECOM database of the Ministry of Health and
TEMPUS of the National Statistics Institute. The drugs
were classified using the Anatomo Therapeutic Clinical
Classification (ATC). Consumption was expressed in
defined daily dosage (DDD) and the costs in euros.
The drugs marketed since 1990 were classified as new
drugs and the others as classical drugs. RESULTS.
The total consumption of drugs increased from 1.92
DDD/1,000 inhabitants/day in 1989 to 3.64 DDD/1,000
inhabitants/day in 1998. The drugs showing the greatest
increase were selegiline, pergolide and levodopa.
The total pharmaceutical expenses tripled. There was
a smaller increase in the consumption of new drugs
(1.2% of the total in 1991 and 6.6% in 1998) than
in their costs (6.7% of the total in 1991 and 38.8%
in 1998). The cost per DDD of the new drugs increased
five times (1989: 2.55 euros and 1998: 13.59 euros)
and that of the classical drugs was similar (1989:
0.54 euros and 1998: 0.62 euros). CONCLUSIONS. The
total consumption of anti Parkinson drugs has progressively
increased. The consumption of selegiline has also
increased in spite of controversy over its safety.
The new drugs have a major economic effect.
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Laboratoire Chropi, Paris.
The data obtained during the past
decade in experimental and clinical pharmacology show
that the GABAergic drugs, with central activity, do
not ameliorate the symptoms of the Parkinson's disease
(PD), but would worsen the akineto-rigid syndrome,
the dyskinesias and the deteriorating mental status
in the later stages of the PD. On the other hand,
recent data of experimental pharmacology suggest the
possibility that glycinergic or glutamatergic derivatives,
with central activity, would have a beneficial effect
on the syndromes of the later stages of PD (declining
efficacy of L-DOPA, dyskinesias, deteriorating mental
status), which constitute, with the fluctuation of
the response to L-DOPA, ("on-off" effects),
the major problems of the PD's treatment. Some theoretical
and experimental data also suggest the possibility
of a beneficial effect of the glutamatergic drugs
in the treatment of the "on-off" effects.
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In normal elderly humans there is
progressive motor dysfunction and loss of nigrostriatal
neurons and brain dopamine similar to, although of
a milder degree than, that seen in Parkinson's disease.
Ten healthy elderly volunteers were given Carbidopa/levodopa
or placebo in a double-blind crossover study. We measured
movement velocity, reaction time, tremor, visual evoked
response (VER), and electroretinography (ERG). Significant
changes were seen only in ERG. Motor functions and
VER were unchanged. Although there appeared to be
pharmacologic activity (ie, changes in ERG), levodopa,
in adequate antiparkinson dosage, had no impact on
the mild extrapyramidal impairment of normal elderly
subjects.
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CONTEXT: Pramipexole and levodopa
both ameliorate the motor symptoms of early Parkinson
disease (PD), but no controlled studies have compared
long-term outcomes after initiating dopaminergic therapy
with pramipexole vs levodopa. OBJECTIVE: To compare
the development of dopaminergic motor complications
after initial treatment of early PD with pramipexole
vs levodopa. DESIGN: Multicenter, parallel-group,
double-blind, randomized controlled trial. SETTING:
Academic movement disorders clinics at 22 sites in
the United States and Canada. PATIENTS: Three hundred
one patients with early PD who required dopaminergic
therapy to treat emerging disability, enrolled between
October 1996 and August 1997. INTERVENTIONS: Subjects
were randomly assigned to receive pramipexole, 0.5
mg 3 times per day, with levodopa placebo (n = 151);
or Carbidopa/levodopa, 25/100 mg 3 times per day,
with pramipexole placebo (n = 150). For patients with
residual disability, the dosage was escalated during
the first 10 weeks. From week 11 to month 23.5, investigators
were permitted to add open-label levodopa to treat
continuing or emerging disability. MAIN OUTCOME MEASURES:
Time to the first occurrence of any of 3 dopaminergic
complications: wearing off, dyskinesias, or on-off
motor fluctuations; changes in scores on the Unified
Parkinson's Disease Rating Scale (UPDRS), assessed
at baseline and follow-up evaluations; and, in a subgroup
of 82 subjects evaluated at baseline and 23.5 months,
ratio of specific to nondisplaceable striatal iodine
123 2-beta-carboxymethoxy-3-beta-(4-iodophenyl)tropane
(beta-CIT) uptake on single photon emission computed
tomography imaging of the dopamine transporter. RESULTS:
Initial pramipexole treatment resulted in significantly
less development of wearing off, dyskinesias, or on-off
motor fluctuations (28%) compared with levodopa (51%)
(hazard ratio, 0.45; 95% confidence interval [CI],
0. 30-0.66; P<.001). The mean improvement in total
UPDRS score from baseline to 23.5 months was greater
in the levodopa group than in the pramipexole group
(9.2 vs 4.5 points; P<.001). Somnolence was more
common in pramipexole-treated patients than in levodopa-treated
patients (32.4% vs 17.3%; P =.003), and the difference
was seen during the escalation phase of treatment.
In the subgroup study, patients treated initially
with pramipexole (n = 39) showed a mean (SD) decline
of 20.0% (14.2%) in striatal beta-CIT uptake compared
with a 24.8% (14.4%) decline in subjects treated initially
with levodopa (n = 39; P =.15). CONCLUSIONS: Fewer
patients receiving initial treatment for PD with pramipexole
developed dopaminergic motor complications than with
levodopa therapy. Despite supplementation with open-label
levodopa in both groups, the levodopa-treated group
had a greater improvement in total UPDRS compared
with the pramipexole group.
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