Parkinson's Disease Drug Review

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The management of Parkinsonism has evolved tremendously since first described by Dr. James Parkinson in the 19th century as "paralysis agitans" or "shaking palsy". Previously there were no treatment modalities, and life expectancy was significantly reduced. Primary causes of mortality were aspirational pneumonia and arteriosclerotic heart disease. However, since the utilization of Levodopa as the mainstay in the treatment of Parkinsonism, quality of life and life expectancy for those with Parkinsonism has increased dramatically.

In recent years, although levodopa has made an enormous positive impact on the lives of those with Parkinsonism, there has been much research pointing to newer theories of causation and management, as well as newer therapies which have altered the way in which physicians manage this condition. We now view age upon diagnosis as a significant determinant as to which therapy to initiate. The logic is that by delaying the initiation of Levodopa therapy in those under 70 years of age there may be a "neuroprotective" effect on the remaining neurons needed to process Levodopa into Dopamine, the neurotransmitter which is responsible for the symptoms of Parkinsonism when in low supply. Thus, utilizing other agents early on will reserve other options down the road which will lead to a better quality of life and perhaps even a greater life expectancy.

Click here for an overview on the pharmacologic management approach to Parkinsonism. Includes names and links to national Parkinson's Disease organizations.

Parkinson's Disease Drug Review

Acceptable Anticholinergic Agents

Acceptable Agents	Cost	Manufacturer	Generic	Cost
Cogentin	$$$	brand	Benztropine	$
Artane	$$$	brand	Trihexyphenidyl	$$

Non-preferred Anticholinergic Agents

Non-preferred Agents	Cost	Manufacturer	Generic	Cost
Kemadrin Tabs (Procyclidine)	$$$	brand	no	na
Benadryl	$$	brand	Diphenhydramine	$

Preferred Levodopa Agents

Preferred Agents	Cost	Manufacturer	Generic	Cost
Sinemet	$$$	brand	Carbidopa/Levodopa	$$

Acceptable Levodopa Agents

Acceptable Agents	Cost	Manufacturer	Generic	Cost
Sinemet CR	$$$$	brand	no	na

Preferred Dopamine Agonists Agents

Preferred Agents	Cost	Manufacturer	Generic	Cost
Parlodel	$$$$	brand	Bromocriptine	$$
Permax	$$$$	brand	Peroglide	$$

Acceptable Dopamine Agonists Agents

Acceptable Agents	Cost	Manufacturer	Generic	Cost
Mirapex	$$$$$	brand	no	na
Requip	$$$$$	brand	no	na

Acceptable Neuroprotective Agents

Acceptable Agents	Cost	Manufacturer	Generic	Cost
Eldepryl	$$$$	brand	Selegiline	$$

Preferred Miscellaneous Agents

Preferred Agents	Cost	Manufacturer	Generic	Cost
Symmetrel	$$$	brand	Amantadine	$

Acceptable Miscellaneous Agents

Acceptable Agents	Cost	Manufacturer	Generic	Cost
Tasmar (Tolcapone)*	$$$$$	brand	no	na

*NOTE: Tasmar should be reserved for severe cases unaided by other therapies. As of 11/98, there are three (3) reported deaths from severe liver damage that may be attributed to Tasmar. For more information check out the Tasmar Watchful Eye

Disclaimer

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