Demystifying Parkinson's Medications: Your Complete Guide

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
Hello and welcome to Live Parkinson's live an
exceptional life.
I'm your host, chrisKustenbotter, and I've been
living an exceptional life withParkinson's for the past 15
years.
The mission of this podcast isto help as many people as
possible living with Parkinson'sto lead a great quality of life
.
Today's topic is Parkinson'sMedications Explained your
Comprehensive Guide.
Are you feeling lost in themaze of Parkinson's treatments?

(00:34):
You're definitely not alone.
Imagine understanding what eachpill does, how it works in your
body and, finally, feeling incontrol of your treatment.
This episode breaks down thecomplexities, empowering you to
have informed conversations withyour doctor and take charge of
your Parkinson's care.
I remember, when I was firstdiagnosed with Parkinson's 15

(00:55):
years ago, being so confusedabout all the medications and
treatment options for treatingParkinson's Between doctor
visits and doing research andhearing and reading about
dopamine, sinemet, dopamineagonists, mao inhibitors, comt
inhibitors.
To say I was confused and myhead was spinning was an

(01:15):
understatement.
15 years later, I can say Istill get confused with the
current medications, let alonethe new medications being
approved.
Then I thought to myself well,if I'm confused, maybe there are
a lot of other people out therehaving the same struggles as I
am.
So I decided to put on myresearch hat and lean on my time
spent in R&D doing clinicalresearch, and dive into all the

(01:36):
Parkinson's medications andlearn more about what they are
and what they do in the body,what symptoms they treat and why
and when they are used.
So in this episode, I want toshare with you what I've learned
to help give you a betterunderstanding of Parkinson's
medication landscape and equipyou with the knowledge to have a
better communication with yourhealthcare professional to get

(01:59):
the best possible care.
Now, as you know, I always liketo provide a roadmap of what
we'll be discussing, because itallows you to determine what's
important to you, but also howthe topics are related and tied
together.
So let's take a peek into whatwe'll be covering in this
podcast.
We'll start with a quickoverview of Parkinson's and its

(02:20):
impact on the brain.
We'll talk about the role ofdopamine and how Parkinson's
medications aim to addressdopamine deficiencies.
Then we'll dive into thegeneral categories of
Parkinson's medications levodopa, dopamine agonists, mao-b
inhibitors and COMT inhibitors.

(02:40):
We explore each category indetail so you understand their
roles as treatment options, andthen we'll discuss medication
management and optimization.
Then we'll transition tocommunicating with your
healthcare provider and finallygive you some tips and
strategies to help with yourmedications.
Then we'll tie it all togetherand hopefully you can walk away.

(03:02):
Then we'll tie it all togetherand hopefully you can walk away
with the knowledge of what themedications that you're taking,
or you've read about, do in thebody.
Now, before we get into thedetails, I wanted to share this
disclaimer that the informationbeing provided is for
informational purposes only.
It's based on my research andthese medications and the

(03:23):
therapies and it's not intendedas medical advice.
It's crucial that you discussall treatment options with your
healthcare professional.
They'll develop a treatmentplan for you based on your
specific needs and symptoms.
All right, so if you're readyto join me on this journey,
let's quit standing around andget going, and let's lead it off
with a brief overview ofParkinson's and how it affects

(03:45):
the brain and causes thesymptoms that impact our daily
living.
Now, this will help usunderstand the need for
medications that we're going tobe discussing a little bit later
on.
Now, as you know, parkinson's isa progressive neurodegenerative
disorder, meaning that it getsworse over time.
It primarily affects ourmovement, but also leads to a

(04:07):
wide range of non-motor symptoms.
So exactly how does it impactthe brain?
Well, the core issue inParkinson's is the gradual loss
of nerve cells, or neurons, inthe part of the brain called the
substantia nigra.
These neurons are responsiblefor producing dopamine, which is
a neurotransmitter that plays acrucial role in controlling our

(04:29):
movement.
So as the neurons die, thedopamine levels decrease, which
then disrupts the brain'sability to regulate our movement
.
Now another key feature ofParkinson's is the accumulation
of abnormal protein clumps,called Lewy bodies, within the
brain cells.
Now the Lewy bodies contain aprotein called alpha-synuclein,

(04:52):
and their presence is believedto contribute to damage and
death of the neurons.
Now the spread of Lewy bodiesto other areas of the brain is
thought to be related tonon-boner symptoms.
Parkinson's also affects otherneurotransmitter systems,
including norepinephrine, whichcontributes to non-motor
symptoms like blood pressurefluctuations and fatigue.

(05:14):
Now, the motor symptoms thatcan arise from the loss of
dopamine are tremors,bradykinesia, or slowness of
movement, rigidity and posturalinstability.
Kinesia, or slowness ofmovement, rigidity and postural
instability.
Non-motor symptoms can occur,which impact our quality of life
and include cognitive changes,mood disorders like anxiety and
depression, sleep disturbances,loss of smell many of you have

(05:37):
probably experienced that painconstipation, bladder problems
and blood pressure changesconstipation, bladder problems
and blood pressure changes.
So, in short, parkinson's is acomplex disorder affecting
multiple brain systems whichleads to a wide range of motor
and non-motor symptoms.
Okay, now that we know whatParkinson's is related to the

(05:58):
decrease of dopamine-producingneurons in the brain.
But exactly what does dopaminedo?
As we mentioned, dopamine is aneurotransmitter, which is a
chemical messenger that's goingto transmit signals between
nerve cells in the brain.
So dopamine is important forhelping to control our movement,
our coordination and ourbalance.

(06:20):
Dopamine also has an impact onour mood, motivation and reward
and recognition.
Now this is where theParkinson's medications come
into play.
They aim to compensate for thedopamine deficiency and loss in
several ways, and let's take aquick look at the four
categories of medications andtheir function in helping with

(06:44):
the dopamine loss.
Now, this is just going to be aquick overview of each category
.
We'll discuss more in detail alittle bit later on.
And the first up is levodopa.
And levodopa is a precursor todopamine and it's converted into
dopamine in the brain to helpreplenish the loss of dopamine
from the dying nerve cells inthe substantia nigra.

(07:07):
All right.
Next up is dopamine agonists.
Now, these medications mimicthe action of dopamine,
essentially stimulating dopaminereceptors in the brain, and
they act like dopamine.
Now the next category is MAO-Binhibitors, and these drugs
inhibit the enzyme calledmonoamine oxidase B hence the

(07:28):
term MAO-B inhibitor whichbreaks down dopamine.
By blocking the enzyme, theyhelp preserve existing dopamine
levels.
And then, finally, comtinhibitors they inhibit the
coenzyme which breaks downlevodopa by blocking the enzyme.
This helps to levodopa to worklonger.

(07:50):
So, essentially, the categoriesof Parkinson's medications
either replace lost dopaminethey mimic dopamine effects or
they slow down the breakdown ofdopamine or levodopa to
alleviate motor symptoms so thatyou can live a better quality
of life.
All right, now let's look ateach category in detail, and
we'll start it off with levodopa.

(08:12):
Levodopa is considered the goldstandard or the cornerstone
medication of Parkinson's.
Now, according to theParkinson's Foundation article,
levodopa levodopa is the mostpotent medication for
Parkinson's disease.
The article states that itsdevelopment in the late 1960s
represents one of the mostimportant breakthroughs in the

(08:32):
history of medicine.
Levodopa, when taken by itself,can produce nausea and vomiting
.
That's why it's always combinedwith carbidopa, because this
helps to significantly lessen orget rid of some of those side
effects.
Now the combined medication iscalled carbidopa levodopa and

(08:54):
the brand name formulation isSinemet Carbidopa levodopa is
available in many differentforms, including immediate
release, controlled release ortime-release pills or capsules.
It's also available in anintestinal gel called Duopa, and

(09:15):
an inhaler with inhaleddopamine called Ambrosia.
Now let's look at some of thecommon brand names for Levodopa
so that you're more familiarwith some of the generic names
as well.
So you'll see Sinemet andSinemet-CR, which stands for
controlled release, rytary,crexent, which is one of the

(09:38):
newest newly approved forms ofcarbidopa, levodopa that's
designed to extend your on times, and then Imbresia, which is an
inhaled form of levodopa tohelp prevent off periods before
your next dosing schedule.
Now it is important to keep inmind that levodopa is usually
combined with carbidopa tolessen the potential for nausea

(09:59):
and vomiting.
Now there's a number ofdifferent doses for each
particular medication, dependingon which one your doctor puts
you on and based on yourspecific needs.
So when you see theprescription, you may notice it
written.
For example, if it was aSinemet-CR prescription, you may
see it written as 50milligrams-200 milligrams.

(10:22):
Or for Riteri, 36.25-145milligrams, 36.25 slash 145
milligrams.
So in both these examplesSinemet-CR, 50 milligram, 200
milligram 50 milligrams is thecarbidopa and 200 milligrams is

(10:44):
the levodopa.
And for the Riteri, 36.25 slash145 milligrams 36.25 milligrams
is the carbidopa and 145 is theamount of levodopa.
Now, these are common names youmay see for carbidopa, levodopa
and dosing examples written byyour doctor.
So typically you're going tosee if it's carbidopa, levodopa,
two dosages.

(11:04):
Now let's look at the mechanismof action and how it works in
the body to help manage ourParkinson's motor symptoms.
Mechanism of action and how itworks in the body to help manage
our Parkinson's motor symptoms.
Now, remember, levodopa wasfirst used in the 1960s to treat
Parkinson's and still remainsthe gold standard today for
treating Parkinson's motorsymptoms because it replenishes
the dopamine levels in the brain.

(11:25):
And here's how it works Now.
First, it's important to notethat levodopa the brain.
And here's how it works Now.
First, it's important to notethat levodopa, also called
L-dopa, is a naturally occurringamino acid that serves as a
precursor to dopamine.
This is crucial to note becausedopamine itself cannot readily
cross the blood-brain barrier,which is a protective shield

(11:46):
that restricts the passage ofsubstances from the bloodstream
into the brain.
Levodopa, however, can crossthe blood-brain barrier and,
once inside the brain, can beconverted into dopamine through
an enzymatic process.
And let's look at thatstep-by-step process for how it
works.
So, step one entry into thebrain.

(12:07):
Levodopa is going to betransported across the
blood-brain barrier by an activetransport system.
Step two is conversion todopamine Inside the brain,
particularly in the remainingdopamine-producing neurons of
the substantia nigra.
Remember, that's the area ofthe brain that starts to die off
and the dopamine levelsdecrease, which causes

(12:30):
Parkinson's symptoms to benoticeable.
The levodopa is converted todopamine by an enzyme called
aromatic L-amino aciddecarboxylase.
Now, that's a tongue twister,that's just in case you want to
impress your friends with yourmedical knowledge.
Now, according to the clinicalstudy aromatic L--Aminoacid
Decarboxylase Deficiencypublished in Gene Reviews, the

(12:54):
authors note that the aromaticL-Aminoacid decarboxylase
catalyzes the last step in thebiosynthesis of the monoamine
transmitters, dopamine andserotonin.
They note that dopamine itselfis a precursor for the synthesis
of epinephrine andnorepinephrine.
So when there's a deficiency inthis enzyme, it can cause a

(13:16):
deficiency in dopamine,serotonin and epinephrine and
norepinephrine, which can causemotor symptoms.
And then step three isdopamine's effect.
And then step three isdopamine's effect Now.
The newly formed dopamine, then, is going to bind to the
dopamine receptors on otherneurons, restoring the signal

(13:37):
that was lost due to thedegeneration of
dopamine-producing cells.
Now the enhanced dopaminesignaling is going to help
alleviate the motor symptoms ofParkinson's, such as tremor
rigidity and bradykinesia Now,so hopefully that wasn't too
complicated.
Now, one of the big benefits oflevodopa use is the amount of
clinical research supporting itsuse in patients.

(13:58):
Levodopa's efficacy in treatingParkinson's has been
extensively studied in clinicaltrials and have shown
significant improvements inmotor function in patients
receiving levodopa therapy.
Now there's some key things tounderstand that your doctor may
discuss with you whenprescribing levodopa therapy.
These could include on-offphenomenon.

(14:20):
Over time, many patientsexperience fluctuations in their
response to levodopa, which youoften have referred to as off
and on periods, which you oftenhave referred to as off and on
periods.
This means you have periods ofgood symptom control or on
period People say I'm on rightnow and that can alternate with
periods of worsening symptoms,called off periods.

(14:41):
Now, according to theParkinson's Foundation managing
off time fact sheet, theyindicate that to help off time,
use a multiple approach, whichincludes tracking your symptoms
and potential causes that youcan share with your doctor, and
if you visit liveparkinsonscom,you can get a free copy of the
Parkinson's symptom tracker tohelp you do that.

(15:03):
That way you can go into yourdoctor and say these are the
major symptoms that I'm havingand you've tracked how serious
they are mild, moderate orsevere, how much they impact
your daily living and the timeof day, and that's going to help
the doctor be able to makemedicine changes or dosage
changes.
And then balancing your proteinis another important piece,

(15:24):
because high protein meals canlessen levodopa's effectiveness,
and then, finally, your doctormay make medication changes to
help with your off periods.
Now, another consideration withlevodopa is dyskinesias, which
are involuntary, abnormalmovements, often caused by
long-term levodopa use.

(15:44):
So, to summarize, levodopaworks in the body.
It plays a pivotal role inParkinson's by effectively
replenishing dopamine levels inthe brain, which in turn improve
your motor function.
Now, as with any drug, thereare potential side effects,
which your physician will helpyou manage.
And then, finally, it'simportant that you take levodopa

(16:05):
, as prescribed by your doctor,at consistent times to help you
manage your off periods.
All right, that's an overviewof levodopa, still the gold
standard treatment.
And now let's look at the secondclass of Parkinson's
medications dopamine agonists.
All right, so what are dopamineagonists?
Well, it's a type of medicationthat mimics the action of

(16:26):
dopamine, and then these drugsbond to dopamine receptors and
stimulate them to helpcompensate for the loss of the
dopamine that was lost from thedying neurons.
Now let's look at the commonlyused dopamine agonists used to
treat Parkinson's.
You have Mirapax and Mirapaxextended release.
The chemical name is primipexol.

(16:46):
There's Requip the common nameis ropinerol.
Apexol.
There's Requip, the common nameis Ropinrol.
Neuropro, which is Rhodogine,and then you have Apokin, which
is Apomorphine, and then,finally, you have Parloril,
which is Bromocryptine.
Now one question that oftencomes up is why use these

(17:08):
dopamine agonists if levodopa isthe gold standard?
Well, the answer to thisquestion is really twofold.
First, dopamine agonists areoften used in the early stages
of Parkinson's because they candelay the use of levodopa, which
has the potential to cause thelong-term dyskinesias and off
periods.
Dopamine agonists are generallyassociated with a lower risk of

(17:31):
developing dyskinesias,especially in the early stages
of treatment for Parkinson's.
Dopamine agonists are usedbecause they have a longer
duration of action than levodopa, which can produce more stable
symptom control.
Second, dopamine agonists canbe used in conjunction or in
combination as an adjunctivetherapy with levodopa,

(17:52):
especially in the later stagesof the disease, to help extend
the on time and allow for lowerdoses of levodopa to help
minimize the side effects.
Now it's crucial to note thatthe choice of medication is
highly individualized anddepends on factors such as the
patient's age and depends onfactors such as the patient's
age, their disease stage andoverall health.

(18:12):
Your movement disorderspecialist or your neurologist
will determine the mostappropriate treatment plan for
you All.
Right now let's take a look athow dopamine agonists work in
the body, also known as theirmechanism of action, and then
we'll also talk a little bitabout the benefits that they
provide.
Now, dopamine agonists directlystimulate dopamine receptors.

(18:33):
So, unlike levodopa, which isconverted into dopamine by an
enzymatic process, dopamineagonists bind directly to
dopamine receptors, mimickingthe effects of dopamine.
Now, dopamine agonists activatethese receptors, triggering the
same signaling pathways thatdopamine normally activates, and
there are different types ofdopamine receptors, for example,

(18:56):
d1, d2, d3, etc.
Dopamine agonists can havevarying degrees of selectivity
on different receptors, meaning,for example, one may be more
selective of the D3 receptorversus the 1 and 2.
So this selectivity caninfluence their effectiveness
and their side effect profile.

(19:17):
Now let's look at some of thebenefits that dopamine agonists
provide for Parkinson's.
First is symptom relief.
Dopamine agonists caneffectively alleviate motor
symptoms like tremors, rigidityand bradykinesia.
Second, they can delay levodopause.
They're often used to delay theneed for levodopa because,
while levodopa is highlyeffective, it does carry the

(19:40):
risk of long-term complicationslike dyskinesias.
Dopamine agonists are generallyassociated with a lower risk of
developing dyskinesias comparedto levodopa.
Third, longer duration ofaction.
Some dopamine agonists have alonger duration of action than
levodopa, providing more stablesymptom control and reducing the

(20:05):
off periods.
Fourth, they can be used as acombination therapy with
levodopa in the later stages ofthe disease to extend on times
and reduce off times, and alsothey can allow for lower doses
of levodopa, which can minimizethe side effects.
Now, while dopamine agonistshave a number of benefits for
managing Parkinson's, sometimestheir use can be limited by a
range of potential side effects.
Some of the common side effectsof dopamine agonists include

(20:27):
nausea and vomiting, and this isone of the most common side
effects, especially whenstarting or increasing the dose.
Now, according to the researcharticle Dopamine Agonists
published on StatPearls as acontinuing education paper, the
authors note that, in additionto nausea and vomiting,
orthostatic hypertension orlightheadedness upon standing,

(20:49):
headache, dizziness and cardiacarrhythmias are the most common
side effects of dopamineagonists.
They note these adverse effectsmay also be dose-dependent.
Other potential side effectsinclude sleep disturbances,
including insomnia, daytimesleepiness and vivid dreams.
All three of those are possibleNow.

(21:10):
I took a dopamine agonistduring my Parkinson's journey,
and excessive daytime sleepinesswas one of the big side effects
that I noticed, especially atthe higher doses.
I'd sit there trying to read inthe afternoon and I would nod
off, and so it became veryfrustrating.
So I eventually started to weanoff of the dopamine agonist I
was taking for a long time.

(21:30):
Others include visual andauditory hallucinations, which
can occur especially in olderpatients or at higher doses.
Also, edema swelling in thelegs and ankle can develop.
All right now dopamine agonistscan have some more serious side
effects that can limit theiruse in treating Parkinson's, and
these include impulse controldisorders.

(21:51):
Now, this is a significantconcern, and the physician may
ask the patient or a familymember if they notice any
warning signs of these followingpotential side effects,
including pathological gambling,hypersexuality, compulsive
shopping and binge eating.
Patients have been documentedto spend their life savings on
gambling, for example.

(22:11):
So impulse control disorderscan have a significant impact on
patients and their families.
For instance, every time I goto see the movement disorder
specialist, they ask me or mywife if they've noticed that
I've made any big purchaseswithout their consent when I was
on the dopamine agonist,because they're concerned about
impulse control disorders Now.

(22:32):
Another serious side effect isexcessive daytime sleepiness and
sleep attacks.
These can cause sudden andunexpected episodes of falling
asleep, which can really bedangerous while you're driving.
Now, in my case, excessivedaytime sleepiness is one of the
reasons I stopped taking adopamine agonist, because it was
having a significant impact onmy daily life and it made it

(22:53):
difficult to complete some ofthe things that I really enjoy
doing.
All right, so those are thebenefits and potential side
effects of dopamine agonist, andyour physician will help you
determine if dopamine agonistsare appropriate as part of your
treatment plan.
And then, as with anyParkinson's medication, it's
important to inform your doctorof any side effects you may be
experiencing, especially thathas an effect on the quality of

(23:15):
your life.
All right, now let's move on tothe third class of Parkinson's
medications MAO-B inhibitors.
Now you may be thinking what inthe world are MAO-B inhibitors?
Well, they're medications thatblock the enzyme monoamine
oxidase B, which breaks downdopamine in the brain.
So by inhibiting this enzyme,the drugs help increase the

(23:40):
dopamine levels.
So, according to the articleMAO-B Inhibitors by the
Parkinson's Foundation, theynote that MAO-B inhibitors may
be useful as early monotherapy,a medication that she's alone,
or as an add-on to othermedications, including levodopa.
When used with other medications, mao-b inhibitors may reduce

(24:01):
motor fluctuations.
Now, common forms of MAO-Binhibitors include selegoline,
which is L-dipril, and this isindicated as a monotherapy for
slowness, stiffness and tremorand as an adjunct therapy for
motor fluctuations.
There's also a segaline HCCorally disintegrating tablet

(24:23):
called Xelopar, which isindicated for use as an
adjunctive therapy for motorfluctuations, plus the need to
dissolve the medication in themouth, especially if swelling
issues are impaired.
Next up is risagaline orazelect.
It's indicated as a monotherapyfor slowness, stiffness, tremor

(24:44):
and as an adjunct therapy formotor fluctuations.
And then, finally, cefenamideor zhodago is indicated as an
adjunct therapy for carbidopalevodopa to help with off
periods.
Now let's look at some of thepotential benefits MAO-B
inhibitors may provide.
First is symptom relief.
Mao-b inhibitors can alleviatemotor symptoms such as tremor,

(25:08):
rigidity and bradykinesia.
Second, it can be used as anearly stage treatment or as a
monotherapy in the early stagesof Parkinson's.
Third, they can be used asadjunctive therapy, meaning they
can be combined with otherdrugs in combination, and they
help to reduce the off-time andallow for lower doses of
levodopa.

(25:29):
Some potential side effectswith MAO-B inhibitors, while
generally are well-tolerated,can include mild side effects
like nausea, dizziness andinsomnia.
Now it's important to be awareof drug interactions, especially
with certain antidepressantsand other drugs.
According to the article MAOBInhibitors Rasagiline,

(25:51):
selegiline and Sifinamide by theParkinson's UKorg, they note
that if you're taking some typesof antidepressants, you might
not be able to take MAOBinhibitors because these drugs
can interact with each other andraise blood pressure to
dangerous levels.
Decongestants or cold medicinescan affect some MAOB inhibitors

(26:12):
, so if you need to use them,check with your physician or
doctor and pharmacist to ensurethey're safe and are appropriate
for you as part of yourtreatment plan.
Let's take a look at the finalclass of Parkinson's medications
COMT inhibitors.
Okay, so what are COMTinhibitors and how do they work?
Comt inhibitors are a class ofmedication used to treat

(26:32):
Parkinson's by primarilyenhancing the effectiveness of
levodopa, and let's look at howthey work.
First, let's look at the roleCOMT plays, and that's
catechol-O-methyltransferase,and it's an enzyme that breaks
down levodopa in the bloodstreambefore it can reach the brain.
Now the breakdown reduces theamount of levodopa available to

(26:54):
be converted to dopamine in thebrain.
Now the mechanism of action forCOMT inhibitors works like this
COMT inhibitors work byblocking the activity of the
COMT coenzyme.
By inhibiting COMT.
These medications reduce thebreakdown of levodopa in the
periphery, outside the brain,and then, by inhibiting the

(27:17):
breakdown of levodopa, thisallows more levodopa to reach
the brain, where it can beconverted to dopamine.
So, essentially, comtinhibitors help to prolong the
effect of levodopa, and thisresults in a more stable
dopamine levels in the brain,leading to smoother and more
consistent symptom control.

(27:38):
All right, let's take a look atsome of the COMT inhibitors that
may be prescribed forParkinson's, starting off with
enticapone, also known as Comtan, and it's typically used four
to eight times a day with eachlevodopa dose.
Its indicated use is as acombination therapy with
levodopa for motor controlfluctuations, not used without

(28:00):
levodopa, though.
Next is tolcopone, also knownas TASMAR.
Now, the treatment regimen isusually 100 milligrams up to
three times per day, to amaximum of 200 milligrams three
times a day.
Now, this drug has a risk ofliver damage.
It needs regular blood tests tocheck liver function.

(28:21):
Its indicated uses are as acombination therapy with
levodopa for motor fluctuations,and it is not used without
levodopa.
Now, typically, it should onlybe used after all Parkinson's
medications have been tried andshould be discontinued if
there's no benefit seen in thefirst three weeks.

(28:42):
All right.
Next up is Opicapone orAngentis, which is available in
25 and 50 milligram capsules.
The typical treatment regimenis 50 milligrams by mouth once
daily at bedtime.
Typical treatment regimen is 50milligrams by mouth once daily
at bedtime.
And opacopone is indicated as acombination therapy with

(29:02):
levodopa for off periods andit's not pharmacologically
active by itself, so you need tohave it work with levodopa.
And then, finally, one that Itook myself is
carbidopa-levodopa-entacoponetablets, which is called Stilivo
.
Now, this combination drug,which includes Entocopone and
Carbidopa levodopa, is one pill.
It's more convenient comparedwith Carbidopa, levodopa and

(29:25):
Entocopone taken separately.
The typical treatment regimenis 150 to 1600 milligrams of
Levodopa, total daily dose and,depending on the daily need,
with a maximum of eight tabletsdaily.
So it's indicated uses as areplacement for carbidopa,
levodopa for motor fluctuations,with the benefit of enticapone,

(29:47):
which extends the life of thelevodopa.
Now the information on COMTinhibitors comes from the
article COMT Inhibitors by theParkinson's Foundation.
All right, now that we knowwhat COMT inhibitors are and how
they work, and the commerciallyavailable COMT inhibitors,

(30:08):
let's look at their benefits andwhy they're used.
First, is they prolong theeffects of levodopa?
Comt inhibitors are primarilyused to extend the on-time and
reduce the off-time associatedwith levodopa therapy.
Second is improving symptomcontrol.
They help smooth outfluctuations in motor symptoms,
providing more consistent relief.

(30:28):
Third is reducing levodopausage.
So in some cases, comtinhibitors allow for a reduction
in levodopa, which can help orminimize levodopa-related side
effects like dyskinesia.
And finally, they help withwearing off periods.
Now let's look at the commonside effects.
Since we discussed the benefits, we need to talk about what

(30:51):
some of the common side effectsare.
Well, according to theParkinson's Foundation, common
side effects may include theymay exaggerate some
levodopa-related side effects,especially dyskinesias,
hallucinations, discoloration ofthe urine, making it
reddish-brown or rust-colored,and diarrhea.
Now, as we wrap up our COMTinhibitors, some key

(31:13):
considerations are they'realways used with levodopa.
They're not effective on theirown and, as with any other drug,
there may be a possible druginteraction.
So, in summary, comt inhibitorsenhance the effectiveness of
levodopa, which leads to a morestable symptom control, which,
in turn, provides a betterquality of life.

(31:34):
So those are the fourclassification categories of
Parkinson's medication Levodopa,dopamine agonists, maob
inhibitors and COMT inhibitors.
Now my 15-year journey withParkinson's.
I've taken Levodopa, a dopamineagonist, and a combination with
the Stolivo.

(31:54):
Now it's important to shareyour symptoms with your doctor
and which ones are going to bethe most bothersome, and which
ones happen and when do theyoccur and they can help you
develop a personalized treatmentplan to help you manage when
your symptoms are the worst.
Now let's turn our attention tomedication management and
optimization.
Effective medication managementis crucial for Parkinson's

(32:18):
because individual responses todrugs can vary significantly.
Optimizing your medicationsinvolves tailing your
medications to maximize symptomcontrol and, at the same time,
minimizing side effects.
So it's important to work withyour doctor and share your
symptoms to get the best qualitycare possible.

(32:38):
Now let's look at some of thefactors that can influence the
effectiveness of your medication.
Disease stage the progressionof Parkinson's influences
medication needs.
Individual metabolism howquickly a person processes the
drug varies.
Dietary factors Certain foodscan interact with medications.
Other medications Druginteractions can affect your

(33:01):
Parkinson's medicationseffectiveness, and then
comorbidities.
Other health conditions caninfluence medication changes and
dosages.
Stress and activity levelsPhysical and emotional stress
can affect symptom severity andmedication response.
Timing of doses Consistenttiming is crucial for stable

(33:22):
drug levels.
Finally, the formulation ofmedications immediate versus
extended release.
Those are going to have adifferent action in the body.
All right, now let's look atsome of the strategies for
managing side effects, startingwith dosage adjustments Lowering
or adjusting the dose canreduce side effects.
Timing adjustments changing thetimes can also help to reduce

(33:47):
some of the side effects.
So, for instance, with protein,if you're taking levodopa, you
don't want to eat it within anhour or two of a high-protein
meal.
Combination therapies addingother medications to counteract
specific side effects.
Dietary modifications adjustingyour diet to minimize nausea
and other digestive issues.
And then symptom managementtreating individual symptoms

(34:11):
like nausea, dizziness or sleepdisturbances with targeted
medications.
And then, finally, slowtitration increasing medication
doses slowly over time.
Now it's important to rememberthat you should have regular
medication reviews andadjustments with your doctor.
Since Parkinson's is aprogressive disease, they can
make adjustments to optimizeyour symptom control and

(34:32):
minimize the side effects.
So it's important to use asymptom tracker to identify the
types of symptoms, the severityof your symptoms, the timing of
your symptoms, medicationeffectiveness and any
significant side effects thatyou're experiencing.
This can provide valuableinformation for your physician
to make informed medicationadjustments by helping identify

(34:54):
patterns and potential triggers.
Now you can get a freeParkinson's symptom tracker by
visiting my website,liveparkinsonscom.
Now, finally, before we wrap up,let's provide some tips for
communicating with yourneurologist.
First, prepare a list ofquestions.
Write down any questions orconcerns you have about your
medications.
Prior to the appointment, keepa symptom tracker or journal.

(35:18):
Track your symptoms, theseverity, the timing, the side
effects, which can providevaluable information to your
neurologist.
And then you want to bespecific.
If you have specific examples,don't hesitate to talk to your
doctor.
Ask for clarification If youdon't understand something.
Ask your neurologist to explainanything that you don't

(35:38):
understand and repeat back whatthey say to ensure that you
understood correctly.
Discuss all medications.
Make sure you share allmedications that include
supplements and herbal remediesthat you're taking, because this
can help prevent druginteractions.
Advocate for yourself.
So if you feel your concernsaren't being addressed, don't

(35:59):
hesitate to speak up.
You're the best advocate.
And then, finally, be honest.
You don't have to leave out anyof the details, even if they
are embarrassing.
Now here are a few communicationtips Take notes, write down
important information andinstructions.
So it's helpful to bring acaregiver or advocate.
They can listen and take notesand capture things that you may

(36:20):
have missed during theappointment and then that way,
finally, they'll be able to pickup if there's questions or
comments that you may havemissed.
They'll be there to do that too.
So just make sure that if youhave any questions, that you get
those clarified before youleave the office.
So navigating Parkinson'smedications can feel
overwhelming, but, as we'veexplored today, understanding

(36:40):
your treatment options empowersyou to take control of your
journey.
Now we've delved into thecornerstone of Parkinson's
therapy levodopa and itsmechanism of action,
highlighting the importance ofmanaging its long-term effects.
We've also examined the role ofdopamine agonists, maob
inhibitors and COMT inhibitors,discussing their benefits and

(37:02):
potential side effects.
Now remember personalizedmedication management.
Regular reviews with yourneurologist can help you really
improve your quality of life.
It's also important to do asymptom tracker, because it's
going to also help to optimizethe care that you're getting,
because it's going to give thedoctor specific times when

(37:24):
you're in your off periods oryou're having symptom issues.
Now your journey withParkinson's doesn't have to be
one that navigating alone.
To continue your education andstay informed, I encourage you
to visit liveparkinsonscom.
There you can subscribe to themonthly newsletter, which is
packed with the latest researchand articles, practical tips and
inspiring stories.

(37:45):
You'll also find a free, a lotof free, resources and articles
to support you on every step ofyour journey.
And then, furthermore, buildinga strong Parkinson's care team
is essential to receiving thebest care possible, and to
assist you with this, you canvisit liveparkinsonscom or visit
my Ko-fi page to get a copy ofmy guide Building your

(38:08):
Parkinson's Care Team ResourcesGuide and Workbook.
The resource will help you toassemble a team of experts
dedicated to helping you liveyour best quality of life with
Parkinson's.
And then, finally, if you foundthis podcast valuable and want
to support our mission ofimproving the quality of life
for people with Parkinson's,please consider contributing to
my Ko-fi page.

(38:28):
Your support helps me continueto create informative and
empowering content.
So thank you for joining metoday, and remember you're not
alone with this fight.
You just need the rightinformation and support to help
you live a full and meaningfullife with Parkinson's.
So until next time, stayhealthy, stay strong and live
your best life with Parkinson's.

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