2023-07-11 19:43:27
drug science
foreword
This is the start of a new series of articles on Parkinson’s drugs.
In the first episode we start with a simple overview of the drugs and how they work, and in the next few chapters we will go into more detail regarding the individual drug groups and types.
Many say or think: My previous medicines are no longer effective – they have been used up – the body has become too used to them. This assessment is almost always wrong. The effect of the medication does not wear off. But Parkinson’s is getting worse. And he needs a higher dose, a more precise regimen or additional medication.
Many of these drugs are also marketed under their active ingredient name (generic name). For others, extra artificial names are created. I hope that the list below also contains all of these artificial names, although I may not have included all of the sales names that are common in Austria and Switzerland.
This is what my daily box looks like:
A wild mix? When you see that, you might feel downright poisoned.
But no, this colorful box is extremely organized and the combination makes a lot of sense.
Perhaps the following comparison will help: The food you eat in one day can be varied and well combined. Nobody does “monotherapy” with just potatoes.
Overview of all Parkinson’s medications:
Levo-Dopa
Levo-Dopa pure and pure and alone does not exist. With good reason: An endogenous enzyme, the so-called dopa decarboxylase (DDC) would destroy 99% of the levo-dopa in the body. So we would have to swallow several grams of pure Levo-Dopa to get the effect of today’s tablet
available with 50 or 100 mg. All L-Dopa preparations today contain a DDS inhibitor: benserazide or carbidopa in a 4:1 ratio. Both are equally good.
Levo-Dopa + Benserazid
normal – Madopar®
Depot – Madopar Depot®
quickly soluble – MadoparLT®
Levodopa + Carbidopa
normal – Nacom®
Depot – Nacomretard®
for pump therapy – Duodopa®
Mikrotabletten – MyFID®
IPX066 = Rytary™ – Numient®
Levo-dopa in triple combination
Levo-Dopa + Carbidopa + Entacapon – Stalevo®
2. DOPAMINE GONISTS = DOPAMINERGIC SUBSTANCES:
Dopamine agonists act like dopamine, so they have the same effects as dopamine, but are chemically different. They might also be called dopamine substitutes.
Apomorphine Apomorphine Injection Solution® – Dacepton®
Pramipexol – Sifrol retard®
Oprymea® – Mirapexin®, Glepark®
Ropinirol – ReQuip®, Adratel®
Rotigotine Neupro® – Reader®
PiribedilClarium® – Pronoran®, Trivastal
3. MAO Inhibitor:
Monoamine oxidase (MAO) is an enzyme that breaks down dopamine in the synapse. If you slow down this enzyme, then the dopamine acts longer – your own as well as that which you ingest via Levo-Dopa.
Selegel
Rasagilin – Azilect®, Rasagea®
4. Anticholinergika:
The term “anticholinergics” is difficult to explain, so I won’t try it right now. There is a reason for this: the drugs from this group have largely lost their importance.
Biperiden – Akineton®
methixen
Bornaprin u.a. – Sormodren®
5. NMDA Antagonists – Glutamat Antagonists
We don’t need to remember the word “N-methyl-D-aspartase” NMDA or glutamate agonists, because there is only one drug from this group that is good: amantadine. The other – Budipin – plays almost no role anymore.
Amantadin – PK-Merz®, Tregor®
Budipin – Parkinson’s®
6. Safinamid – Xadago®
Safinamide is an active ingredient similar to MAOIs with smaller additional benefits.
7. COMT-Inhibitor
Catechol-O-methyl-transferase is an enzyme that breaks down Levo-Dopa prematurely at the wrong place. So, these drugs contribute to the longer effect of Levo-Dopa. Levo-Dopa’s effect decreases later, the overall effect of Levo-Dopa is more even.
Tolcapon – Tasmar®
Entacapon – Comtess®
Opicapon – Ongentys®
fixed combination of Levo-Dopa + Carbidopa + Entacapone
The table is not complete and will be expanded as new drugs become available.
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