C H A P T E R 2 4
Antiparkinsonism agents
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BOX 24.1
Drug therapy across the lifespan
Antiparkinsonism agents
CHILDREN
The safety and effectiveness of most of these drugs has
not been established in children.The incidence of Parkin
son’s disease in children is very small. Children do,
however, experience parkinsonian symptoms as a result
of drug effects.
ADULTS
The eventual dependence and lack of control that
accompany Parkinson’s disease are devastating to
all people and their families but may be particularly
overwhelming to individuals in their prime of life who
value high degrees of autonomy, self-determination and
independence. Although these characteristics are not
associated with any particular ethnic group, they are
valued more highly among certain cultures than others.
It is important for the healthcare professional to assess
all families with sensitivity to determine what convictions
they hold and plan care accordingly.
Adults diagnosed with Parkinson’s disease require
extensive teaching, support and help coping with the
disease as well as with the effects of the drugs.
With the increasing interest in herbal and alternative
therapies, it is important to stress the need to inform the
healthcare provider about any other treatment being used.
Vitamin B
6
can pose a serious problem for people who are
taking some of these drugs.
PREGNANCY AND BREASTFEEDING
Women of childbearing age should be advised to
use contraception when they are on these drugs. If a
pregnancy does occur, or is desired, they need counselling
about the potential for adverse effects. Women who are
breastfeeding should be encouraged to find another
method of feeding the baby because of the potential for
adverse drug effects on the baby.
OLDER ADULTS
Although Parkinson’s disease may affect individuals of any
age, gender or nationality, the frequency of the disease
increases with age.This debilitating condition, which
affects more men than women, may be one of many
chronic problems associated with ageing.
The drugs that are used to manage Parkinson’s disease
are associated with more adverse effects in older people
with long-term problems. Both anticholinergic and
dopaminergic drugs aggravate glaucoma, benign prostatic
hypertrophy, constipation, cardiac problems and chronic
obstructive pulmonary diseases. Special precautions and
frequent follow-up visits are necessary for older people
with Parkinson’s disease, and their drug dosages may
need to be adjusted frequently to avoid serious problems.
In many cases, other agents are given to counteract the
effects of these drugs, and people then have complicated
drug regimens with many associated adverse effects and
problems. Consequently, it is essential for these people to
have extensive written drug-teaching protocols.
TABLE 24.1
DRUGS IN FOCUS Dopaminergic agents
Drug name
Dosage/route
Usual indications
amantadine (Symmetrel)
100 mg PO b.d.; up to 400 mg/day has been
used
Antiviral; treatment of idiopathic and drug-
induced parkinsonism in adults
apomorphine (Apomine)
2–6 mg SC t.d.s.
Intermittent treatment of hypomobility “off”
episodes of advanced Parkinson’s disease
bromocriptine (Parlodel)
1.25 mg PO b.d.; titrate up to 10–40 mg/day
Treatment of idiopathic Parkinson’s disease;
may be beneficial in later stages when
response to levodopa decreases
cabergoline (Bergoline)
2–3 mg/day PO as adjunct to levodopa
Treatment of Parkinson’s disease
carbidopa–levodopa
(Sinemet)
100 mg levodopa with 25 mg carbidopa PO
t.d.s.
Treatment of idiopathic Parkinson’s disease
levodopa-benserazide
(Madopar)
125 mg PO t.d.s. increased to
500–1000 mg/day t.d.s. or q.i.d.
Treatment of idiopathic Parkinson’s disease
levodopa-carbidopa-
entacapone (Stalevo)
Individualised up to maximum levodopa
1500 mg/day
Treatment of idiopathic Parkinson’s disease
with fluctuating motor status
pergolide (Permax)
Initially, 50 mcg PO/day for 2 days; titrated by
100–150 mcg/day every third day for 12 days;
increased by 250 mcg/day every third day as
needed until optimal dose reached
Adjunct treatment of Parkinson’s disease
pramipexole (Sifrol)
0.125 mg PO t.d.s., titrate up to 1.5 mg PO
t.d.s.
Treatment of idiopathic Parkinson’s disease
ropinirole (Appese,
Repreve)
0.25 mg PO t.d.s.; titrate up to maximum dose
of 24 mg/day
Treatment of idiopathic Parkinson’s disease
in early stages and in later stages when
combined with levodopa; treatment of
restless legs syndrome
rotigotine (Neupro)
Patch applied once daily
Treatment of idiopathic Parkinson’s disease
