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More: American Pharmacists Association 2008 Annual Meeting

Selection from: Highlights of the American Pharmacists Association 2008 Annual Meeting

Treatment Modalities for Parkinson's Disease CME/CE

Jack J. Chen, PharmD, BCPS, CGP, FCPhA
Disclosures
http://www.medscape.com/viewarticle/575587

EXcerpt:
Treatments for Early Parkinson's Disease

At present, there is no cure for PD. The goal of therapy is to relieve symptoms to provide maximal function and comfort and to improve quality of life while minimizing acute and long-term side effects.

The combination product carbidopa/levodopa remains the cornerstone of symptomatic therapy. However, in patients with early stage PD, symptoms can be adequately managed with non-levodopa medications such as dopamine agonists or monoamine oxidase type B (MAO-B) inhibitors. Eventually, as a result of disease progression and the worsening of motor impairment, it becomes necessary to add carbidopa/levodopa to the treatment regimen.

In early disease, dopamine agonists (pramipexole, ropinirole) are very effective and associated with a reduced risk of dyskinesias.[7-9] These agents are initiated at a low, subtherapeutic dose and slowly titrated to a therapeutic dosage. The slow dosage titration minimizes the development of side effects. Common side effects include nausea, somnolence, orthostatic hypotension, confusion, and hallucinations. Impulse control disorders occur with dopamine agonists and are not uncommon.[10] These impulse control disorders manifest as overindulgence or excessive preoccupation with a range of behaviors such as gambling, sex, or shopping. Clinicians should be vigilant for impulse control disorders because patients and caregivers may not attribute these behaviors to the dopamine agonist.

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