Parkinson's Disease

Getting the Most out of Parkinson’s Disease Medications

To get the most out of the medications:

  • You should never compare your treatment schedule with those of other people suffering with Parkinson’s Disease. You are all different. Take the medication as prescribed by your doctor. While this advice sounds obvious, it is important since the medication has been individually adjusted for your symptoms. Remember that your doctor probably has more clinical experience in treating people with Parkinson’s disease than anyone else who is likely to give you advice.
  • Make sure you understand the expected benefit and potential early side effects of a drug before you leave the physician’s office.
  • Side effects of anti-Parkinson drugs are reversible by lowering the dosage or discontinuing the treatment.
  • Do not increase or abruptly stop any of your drugs without consulting your physician.
  • Taking medications on an empty stomach often leads to increased side effects.

Need To Know:

Is it safe to take other drugs while on PD medication?

Most drugs are safe to take with antiparkinson drugs. However,

  • One group known as dopamine antagonists (for example haloperidol (HaldolTM), rispiridone (RisperdalTM), olanzapine (ZyprexaTM), chlorpromazine ( LargactylTMand metoclopromide ( MaxeranTM, prochlorperazine ( StemetilTM), should be avoided because they can worsen the symptoms of PD by blocking the action of dopamine in the brain. They are generally prescribed for psychiatric conditions or nausea . Check with your doctor or pharmacist if you are not sure whether you have been prescribed one of these.
  • Demerol, frequently used to control postoperative pain, can cause confusion and hallucinations in people with PD and should be avoided.
  • Discuss any concerns about drug interactions with your doctor.

Two of the major side effects of anti-parkinson medication can be managed.

  • Nausea is much less common with controlled-release SinemetTM, which is absorbed more slowly than the regular SinemetTM. Dopamine agonists can cause nausea even in people who did not experience it with either kind of SinemetTM. Building up your dose very slowly can help, even though you may be impatient to feel the improvement in your Parkinson’s symptoms. In Canada and other parts of the world there is a drug called domperidone (MotiliumTM, which is used to prevent the nausea caused by anti-parkinson drugs.
  • Dizziness is due to the fact that the drugs can lower your blood pressure. It may occur in the early stages of treatment, but it usually resolves over time. If it does not, consult your doctor, particularly if you are already taking a medication for high blood pressure. .

PRACTICAL INFORMATION

The following suggestions may help to raise blood pressure without the addition of medications (Non Medical Management of Low Blood Pressure (Orthostatic Hypotension)

Orthostatic hypotension is defined as a fall in systolic blood pressure of at least 20 mm Hg and/or diastolic blood pressure of at least 10 mm Hg within 3 minutes of standing and may or may not cause symptoms of dizziness or fainting.

Parkinson’s Disease patients with a combination of postural hypotension and impairment of postural reflexes are candidates for dizziness, fainting and falls leading to fractures. Fractures have serious consequences for the long term health of patients with Parkinson’s long term health. A safety assessment from a rehabilitation specialist is strongly recommended.Lying and standing blood pressure recordings are essential as diagnostic measures.

These are the triggers that may cause dizziness and fainting:

  1. The addition of anti-Parkinson drugs if you are already taking tablets to lower your blood pressure, or drugs known to lower blood pressure (e.g. tricyclic anti-depressants- amitriptyline, nortryptiline, doxepine )
  2. Increasing the dose of anti-Parkinson drugs too quickly -particularly dopamine agonists bromocriptine, pergolide, ropinerole or pramipexole.
  3. Taking anti-Parkinson drugs on an empty stomach
  4. The hour following medications, or a meal
  5. Urinating standing up (men)
  6. A bowel movement
  7. Lying flat for too long
  8. Getting up too quickly from a bed, or chair, or after a bowel movement
  9. Warm weather, dehydration and hot baths

Prevention strategies include:

  1. Increase intake of fluids and salt.
  2. Have a 6-8-oz glass of orange juice before you get out of bed each morning. Sit on the side of the bed for a couple of minutes, get up, and walk about.
  3. Have 1-2 cups strong real coffee for breakfast. It will help to increase your blood pressure.
  4. Increase your clear fluids until about 4 p.m. (To limit trips to the bathroom during the night)
  5. Remain seated after a meal for about 20 minutes. Blood is drawn to the gastrointestinal tract to aid digestion, which is why we feel sleepy after a big meal. If you stand up quickly after a meal there will not be enough blood volume to supply sufficient to the brain.
  6. Sit down to towel off after a shower or a bath and then get up and walk about.
  7. Be careful standing up too quickly after a bowel movement or urinating. Men with low blood pressure should urinate sitting down.
  8. Stay out of hot sun; avoid hot tubs, saunas, and steam rooms.
  9. Never stand still (particularly after exercise) as blood pools in the legs.
  10. Always sit down after any exercise even walking about the house.

If postural hypotension persists despite these measures, a physician may suggest reducing, stopping or replacing drugs known to be lowering your blood pressure. If this isn’t possible the physician may recommend an anti-hypotensive such as fludrocortisone or midodrine, which will artificially raise your blood pressure.

If you have very low blood pressure you may be at risk for recumbent hypertension. This means that your blood pressure may go up too much when you lie down. We recommend that when you are in bed or lying on a couch, your head be 30 degrees higher than your feet. This can be done with lots of pillows or by raising the head of the bed by putting the feet on bricks/blocks or books.

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