How many options?

Someone else made a comment: “We take meds to make the symptoms bearable. If your symptoms dont require meds yet dont take them, but if they do why deprive yourself? You should not feel guilty or be made to feel guilty and its not giving in.”

Kelly Crumrin wrote the following in an article in the My Parkinsons Team community. She has given pretty thorough details about the numerous options. “People with Parkinson’s can improve their symptoms and quality of life with effective treatment options.”

“Symptoms and severity can vary widely between individuals with parkinsonism. There is no standard treatment for Parkinson’s. Guidelines for Parkinson’s treatments are based on what symptoms a person has, the severity of the symptoms, how long they have had Parkinson’s, which type and stage of Parkinson’s they have, tolerance of side effects, the age of the person, and any other health conditions they have or medications they use. Some treatments are highly effective for one type of Parkinson’s, but ineffective for others. In most people, medications gradually lose their effectiveness as the disease progresses.”

Medications for Parkinson’s

“In Parkinson’s, the brain cells that produce a neurotransmitter — a chemical that helps nerves communicate — called dopamine begin to shrink and die. With too little dopamine, the brain cannot facilitate movement as well. Researchers believe parkinsonian symptoms begin when the level of dopamine falls to about half of normal levels. Levels of other neurotransmitters rise, trying to compensate for the lack of dopamine, and this results in more dysfunction.”

“Many medications for parkinsonism are aimed at improving motor symptoms by raising levels of dopamine, replicating the effects of dopamine, or controlling levels of other neurotransmitters. Other medications are taken to treat side effects of Parksinson’s treatments, psychotic symptoms, or low blood pressure that leads to falls soon after standing.”

“Most Parkinson’s medications need to be carefully timed on a daily schedule around meals, bedtime, and waking. Correctly timing medications ensures the most effectiveness, avoids “off” times when symptoms worsen, and avoids dangerous interactions with food or other medications. There are many mobile applications available to track medication timing.”

“Many Parkinson’s medications can cause serious withdrawal symptoms if stopped suddenly. Other drugs must be out of your system for weeks before you start another type of medication. If you want to stop or change medications, always discuss a plan with your doctor for tapering off.”

Dopaminergic Medications

“The first drugs offered to many people with Parkinson’s are dopaminergic drugs — drugs that work by influencing dopamine levels. Dopaminergic drugs include the combination medication Levodopa/Carbidopa (sold under the brand names Sinemet, Parcopa, and Rytary). Levodopa/Carbidopa is usually taken orally. If Levodopa/Carbidopa is working, but the person still has “off” hours when symptoms are more pronounced, the doctor may recommend Duopa, a system that infuses Levodopa/Carbidopa directly into the small intestine via a small, battery-powered pump.”

“These drugs eventually become less effective and wear off sooner, resulting in “off” time. When Levodopa/Carbidopa begins to lose effectiveness, some people switch to Stalevo (Levodopa/Carbidopa/Entacapone), which adds a third drug to the combination. Entacapone, sold separately under the brand Comtan, is a catechol-O-methyltransferase (COMT) inhibitor. Entacapone is believed to work by increasing the amount of Levodopa that reaches the brain, making Levodopa effective at significantly lower doses. Tasmar (Tolcapone) is another COMT inhibitor. COMT inhibitors can cause liver damage and worsen side effects of Levodopa.”

“Over the long term, Levodopa therapy causes many people to develop dyskinesia — involuntary swaying, writhing, or head-bobbing movements — as a side effect. Amantadine, sold under the brand names Symmetrel and Gocovri, may be prescribed to treat dyskinesia. Amantadine is classified as an antiviral and anti-Parkinsonian drug. It is believed that Amantadine works by increasing the amount of dopamine available in the brain.”

“Some people also develop impulsive or compulsive behaviors — gambling, shopping, or sexual activities — abnormal to their usual habits and personality. Side effects become more likely and worsen with higher dosages. Due to these serious side effects, people with Parkinson’s may choose to delay starting Levodopa until motor symptoms begin to disrupt their daily activities.”

“Dopamine agonists may be given alone or in combination with Levodopa/Carbidopa. Dopamine agonists are believed to work by making brain cells more receptive to dopamine. The dopamine agonist class includes oral drugs Apokyn (Apomorphine), Mirapex and Mirapex ER (Pramipexole), and Requip (Ropinirole). Neupro (Rotigotine) is administered as a skin patch.”

“Serious side effects of dopamine agonists can include dizziness, fainting, and increased risk for heart problems.”

“When dopamine levels drop, levels of another neurotransmitter called acetylcholine rise and cause additional symptoms. Anticholinergics such as Artane (Trihexyphenidyl) and Cogentin (Benztropine mesylate) are believed to work by regulating levels of acetylcholine in the brain. Anticholinergics can cause or worsen memory problems and constipation.”

“Early in the course of Parkinson’s, some people take medications from a class of antidepressant drugs called monoamine oxidase inhibitors (MAOIs). MAOIs are believed to work by preventing the breakdown of dopamine in the brain, thereby increasing the amount of dopamine available. MAOIs are somewhat effective at treating Parkinson’s symptoms, and some may help protect the brain and slow the progress of Parkinson’s disease. MAOIs include Azilect (Rasagiline), Xadago (Safinamide), and Selegiline, sold under the brand names Eldepryl and Zelapar. MAOIs can worsen side effects caused by Levodopa.”

Symptom Management Medications

“Exelon (Rivastigmine) is an acetylcholinesterase inhibitor. Exelon is believed to work by increasing the amount of a neurotransmitter called acetylcholine in the brain.”

“Northera (Droxidopa) treats orthostatic hypotension (dizziness upon standing up) in people with Parkinson’s disease.”

“Psychotic symptoms such as hallucinations, delusions, and paranoia may be caused by Parkinson’s or medications used to treat it. Antipsychotics such as Seroquel (Quetiapine) and Nuplazid (Pimavanserin) may be prescribed to reduce psychotic symptoms. Antipsychotics are believed to work by interfering with serotonin receptors in the brain. Unfortunately, some antipsychotics can worsen Parkinson’s symptoms.”

“Some people with Parkinson’s use medical marijuana to treat symptoms including pain, mood problems, and sleep disorders. Depending on your symptoms, one strain of medical cannabis may provide more benefit than another.”

“Depression and anxiety are common in Parkinson’s, as in all chronic conditions. Some people take antidepressants to improve their mood and outlook. Work with your doctor to choose an antidepressant that will not interact with Parkinson’s medications or other drugs you take.”