Demystifying Parkinson's Medications: Your Complete Guide

Feeling overwhelmed by your Parkinson's medications? In this comprehensive episode of the Live Parkinson's: Live an Exceptional Life podcast, we break down everything you need to know about navigating your Parkinson's treatment. From understanding the basics of dopamine to in-depth explanations of Levodopa, Dopamine Agonists, MAO-B Inhibitors, and COMT Inhibitors, we provide clear, accessible information to empower you on your journey.

In this episode, we cover:

• The crucial role of dopamine in Parkinson's disease and how medications aim to address its deficiency.
• Levodopa in detail: Mechanism of action, different formulations, and strategies for managing "on-off" fluctuations and potential side effects.
• Dopamine Agonists explained: How they work, their benefits, and potential side effects to be aware of.
• MAO-B Inhibitors: Understanding their role in preserving dopamine and their potential benefits.
• COMT Inhibitors: How they enhance the effectiveness of Levodopa and improve symptom control.
• Key factors influencing medication effectiveness and practical tips for managing side effects.
• The importance of regular medication reviews with your neurologist and utilizing symptom trackers.

Ready to take control of your Parkinson's medication journey?

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#ParkinsonsDisease #ParkinsonsMedication #Levodopa #DopamineAgonists #MAOBInhibitors #COMTInhibitors #MedicationManagement #ParkinsonsCare #Neurology 

References:

Levodopa - Parkinsons Foundation

Aromatic L-Am

Chapters

• 0:10 Introduction to Parkinson's Medications
• 3:56 Understanding Parkinson's and Dopamine's Role
• 8:12 Levodopa: The Gold Standard Treatment
• 16:10 Dopamine Agonists and Their Benefits
• 23:22 MAO-B and COMT Inhibitors Explained
• 32:13 Medication Management and Communication Strategies
• 36:36 Key Takeaways and Resources

Transcript

Speaker 1: 0:10

Hello and welcome to Live Parkinson's live an exceptional life. I'm your host, chris Kustenbotter, and I've been living an exceptional life with Parkinson's for the past 15 years. The mission of this podcast is to help as many people as possible living with Parkinson's to lead a great quality of life. Today's topic is Parkinson's Medications Explained your Comprehensive Guide. Are you feeling lost in the maze of Parkinson's treatments? You're definitely not alone. Imagine understanding what each pill does, how it works in your body and, finally, feeling in control of your treatment. This episode breaks down the complexities, empowering you to have informed conversations with your doctor and take charge of your Parkinson's care.

Speaker 1: 0:52

I remember, when I was first diagnosed with Parkinson's 15 years ago, being so confused about all the medications and treatment options for treating Parkinson's Between doctor visits and doing research and hearing and reading about dopamine, sinemet, dopamine agonists, mao inhibitors, comt inhibitors. To say I was confused and my head was spinning was an understatement. 15 years later, I can say I still get confused with the current medications, let alone the new medications being approved. Then I thought to myself well, if I'm confused, maybe there are a lot of other people out there having the same struggles as I am. So I decided to put on my research hat and lean on my time spent in R&D doing clinical research, and dive into all the Parkinson's medications and learn 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 to share with you what I've learned to help give you a better understanding of Parkinson's medication landscape and equip you with the knowledge to have a better communication with your healthcare professional to get the best possible care. Now, as you know, I always like to provide a roadmap of what we'll be discussing, because it allows you to determine what's important to you, but also how the topics are related and tied together.

Speaker 1: 2:13

So let's take a peek into what we'll be covering in this podcast. We'll start with a quick overview of Parkinson's and its impact on the brain. We'll talk about the role of dopamine and how Parkinson's medications aim to address dopamine deficiencies. Then we'll dive into the general categories of Parkinson's medications levodopa, dopamine agonists, mao-b inhibitors and COMT inhibitors. We explore each category in detail so you understand their roles as treatment options, and then we'll discuss medication management and optimization. Then we'll transition to communicating with your healthcare provider and finally give you some tips and strategies to help with your medications. Then we'll tie it all together and hopefully you can walk away. Then we'll tie it all together and hopefully you can walk away with the knowledge of what the medications that you're taking, or you've read about, do in the body.

Speaker 1: 3:11

Now, before we get into the details, I wanted to share this disclaimer that the information being provided is for informational purposes only. It's based on my research and these medications and the therapies and it's not intended as medical advice. It's crucial that you discuss all treatment options with your healthcare professional. They'll develop a treatment plan for you based on your specific needs and symptoms. All right, so if you're ready to join me on this journey, let's quit standing around and get going, and let's lead it off with a brief overview of Parkinson's and how it affects the brain and causes the symptoms that impact our daily living. Now, this will help us understand the need for medications that we're going to be discussing a little bit later on.

Speaker 1: 3:56

Now, as you know, parkinson's is a progressive neurodegenerative disorder, meaning that it gets worse over time. It primarily affects our movement, but also leads to a wide range of non-motor symptoms. So exactly how does it impact the brain? Well, the core issue in Parkinson's is the gradual loss of nerve cells, or neurons, in the part of the brain called the substantia nigra. These neurons are responsible for producing dopamine, which is a neurotransmitter that plays a crucial role in controlling our movement. So as the neurons die, the dopamine levels decrease, which then disrupts the brain's ability to regulate our movement. Now another key feature of Parkinson's is the accumulation of abnormal protein clumps, called Lewy bodies, within the brain cells. Now the Lewy bodies contain a protein called alpha-synuclein, and their presence is believed to contribute to damage and death of the neurons. Now the spread of Lewy bodies to other areas of the brain is thought to be related to non-boner symptoms.

Speaker 1: 5:03

Parkinson's also affects other neurotransmitter systems, including norepinephrine, which contributes to non-motor symptoms like blood pressure fluctuations and fatigue. Now, the motor symptoms that can arise from the loss of dopamine are tremors, bradykinesia, or slowness of movement, rigidity and postural instability. Kinesia, or slowness of movement, 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 probably experienced that pain constipation, bladder problems and blood pressure changes constipation, bladder problems and blood pressure changes. So, in short, parkinson's is a complex disorder affecting multiple brain systems which leads to a wide range of motor and non-motor symptoms.

Speaker 1: 5:55

Okay, now that we know what Parkinson's is related to the decrease of dopamine-producing neurons in the brain. But exactly what does dopamine do? As we mentioned, dopamine is a neurotransmitter, which is a chemical messenger that's going to transmit signals between nerve cells in the brain. So dopamine is important for helping to control our movement, our coordination and our balance. Dopamine also has an impact on our mood, motivation and reward and recognition.

Speaker 1: 6:29

Now this is where the Parkinson's medications come into play. They aim to compensate for the dopamine deficiency and loss in several ways, and let's take a quick look at the four categories of medications and their function in helping with the dopamine loss. Now, this is just going to be a quick overview of each category. We'll discuss more in detail a little bit later on. And the first up is levodopa. And levodopa is a precursor to dopamine and it's converted into dopamine in the brain to help replenish the loss of dopamine from the dying nerve cells in the substantia nigra. All right. Next up is dopamine agonists. Now, these medications mimic the action of dopamine, essentially stimulating dopamine receptors in the brain, and they act like dopamine. Now the next category is MAO-B inhibitors, and these drugs inhibit the enzyme called monoamine oxidase B hence the term MAO-B inhibitor which breaks down dopamine. By blocking the enzyme, they help preserve existing dopamine levels. And then, finally, comt inhibitors they inhibit the coenzyme which breaks down levodopa by blocking the enzyme. This helps to levodopa to work longer. So, essentially, the categories of Parkinson's medications either replace lost dopamine they mimic dopamine effects or they slow down the breakdown of dopamine or levodopa to alleviate motor symptoms so that you can live a better quality of life. All right, now let's look at each category in detail, and we'll start it off with levodopa.

Speaker 1: 8:12

Levodopa is considered the gold standard or the cornerstone medication of Parkinson's. Now, according to the Parkinson's Foundation article, levodopa levodopa is the most potent medication for Parkinson's disease. The article states that its development in the late 1960s represents one of the most important breakthroughs in the history of medicine. Levodopa, when taken by itself, can produce nausea and vomiting. That's why it's always combined with carbidopa, because this helps to significantly lessen or get rid of some of those side effects. Now the combined medication is called carbidopa levodopa and the brand name formulation is Sinemet Carbidopa levodopa is available in many different forms, including immediate release, controlled release or time-release pills or capsules. It's also available in an intestinal gel called Duopa, and an inhaler with inhaled dopamine called Ambrosia. Now let's look at some of the common brand names for Levodopa so that you're more familiar with some of the generic names as well. So you'll see Sinemet and Sinemet-CR, which stands for controlled release, rytary, crexent, which is one of the newest newly approved forms of carbidopa, levodopa that's designed to extend your on times, and then Imbresia, which is an inhaled form of levodopa to help prevent off periods before your next dosing schedule.

Speaker 1: 9:53

Now it is important to keep in mind that levodopa is usually combined with carbidopa to lessen the potential for nausea and vomiting. Now there's a number of different doses for each particular medication, depending on which one your doctor puts you on and based on your specific needs. So when you see the prescription, you may notice it written. For example, if it was a Sinemet-CR prescription, you may see it written as 50 milligrams-200 milligrams. Or for Riteri, 36.25-145 milligrams, 36.25 slash 145 milligrams. So in both these examples Sinemet-CR, 50 milligram, 200 milligram 50 milligrams is the carbidopa and 200 milligrams is the levodopa. And for the Riteri, 36.25 slash 145 milligrams 36.25 milligrams is the carbidopa and 145 is the amount of levodopa. Now, these are common names you may see for carbidopa, levodopa and dosing examples written by your doctor. So typically you're going to see if it's carbidopa, levodopa, two dosages.

Speaker 1: 11:04

Now let's look at the mechanism of action and how it works in the body to help manage our Parkinson's motor symptoms. Mechanism of action and how it works in the body to help manage our Parkinson's motor symptoms. Now, remember, levodopa was first used in the 1960s to treat Parkinson's and still remains the gold standard today for treating Parkinson's motor symptoms because it replenishes the dopamine levels in the brain. And here's how it works Now. First, it's important to note that levodopa the brain. And here's how it works Now. First, it's important to note that levodopa, also called L-dopa, is a naturally occurring amino acid that serves as a precursor to dopamine. This is crucial to note because dopamine itself cannot readily cross the blood-brain barrier, which is a protective shield that restricts the passage of substances from the bloodstream into the brain. Levodopa, however, can cross the blood-brain barrier and, once inside the brain, can be converted into dopamine through an enzymatic process. And let's look at that step-by-step process for how it works. So, step one entry into the brain. Levodopa is going to be transported across the blood-brain barrier by an active transport system.

Speaker 1: 12:14

Step two is conversion to dopamine Inside the brain, particularly in the remaining dopamine-producing neurons of the substantia nigra. Remember, that's the area of the brain that starts to die off and the dopamine levels decrease, which causes Parkinson's symptoms to be noticeable. The levodopa is converted to dopamine by an enzyme called aromatic L-amino acid decarboxylase. Now, that's a tongue twister, that's just in case you want to impress your friends with your medical knowledge. Now, according to the clinical study aromatic L--Aminoacid Decarboxylase Deficiency published in Gene Reviews, the authors note that the aromatic L-Aminoacid decarboxylase catalyzes the last step in the biosynthesis of the monoamine transmitters, dopamine and serotonin. They note that dopamine itself is a precursor for the synthesis of epinephrine and norepinephrine. So when there's a deficiency in this enzyme, it can cause a deficiency in dopamine, serotonin and epinephrine and norepinephrine, which can cause motor symptoms. And then step three is dopamine's effect. And then step three is dopamine's effect Now. The newly formed dopamine, then, is going to bind to the dopamine receptors on other neurons, restoring the signal that was lost due to the degeneration of dopamine-producing cells. Now the enhanced dopamine signaling is going to help alleviate the motor symptoms of Parkinson's, such as tremor rigidity and bradykinesia Now, so hopefully that wasn't too complicated.

Speaker 1: 13:53

Now, one of the big benefits of levodopa use is the amount of clinical research supporting its use in patients. Levodopa's efficacy in treating Parkinson's has been extensively studied in clinical trials and have shown significant improvements in motor function in patients receiving levodopa therapy. Now there's some key things to understand that your doctor may discuss with you when prescribing levodopa therapy. These could include on-off phenomenon. Over time, many patients experience fluctuations in their response to levodopa, which you often have referred to as off and on periods, which you often have referred to as off and on periods. This means you have periods of good symptom control or on period People say I'm on right now and that can alternate with periods of worsening symptoms, called off periods. Now, according to the Parkinson's Foundation managing off time fact sheet, they indicate that to help off time, use a multiple approach, which includes tracking your symptoms and potential causes that you can share with your doctor, and if you visit liveparkinsonscom, you can get a free copy of the Parkinson's symptom tracker to help you do that. That way you can go into your doctor and say these are the major symptoms that I'm having and you've tracked how serious they are mild, moderate or severe, how much they impact your daily living and the time of day, and that's going to help the doctor be able to make medicine changes or dosage changes. And then balancing your protein is another important piece, because high protein meals can lessen levodopa's effectiveness, and then, finally, your doctor may make medication changes to help with your off periods. Now, another consideration with levodopa is dyskinesias, which are involuntary, abnormal movements, often caused by long-term levodopa use. So, to summarize, levodopa works in the body. It plays a pivotal role in Parkinson's by effectively replenishing dopamine levels in the brain, which in turn improve your motor function. Now, as with any drug, there are potential side effects, which your physician will help you manage. And then, finally, it's important that you take levodopa, as prescribed by your doctor, at consistent times to help you manage your off periods. All right, that's an overview of levodopa, still the gold standard treatment.

Speaker 1: 16:15

And now let's look at the second class of Parkinson's medications dopamine agonists. All right, so what are dopamine agonists? Well, it's a type of medication that mimics the action of dopamine, and then these drugs bond to dopamine receptors and stimulate them to help compensate for the loss of the dopamine that was lost from the dying neurons. Now let's look at the commonly used dopamine agonists used to treat Parkinson's. You have Mirapax and Mirapax extended release. The chemical name is primipexol. There's Requip the common name is ropinerol. Apexol. There's Requip, the common name is Ropinrol. Neuropro, which is Rhodogine, and then you have Apokin, which is Apomorphine, and then, finally, you have Parloril, which is Bromocryptine.

Speaker 1: 17:05

Now one question that often comes up is why use these dopamine agonists if levodopa is the gold standard? Well, the answer to this question is really twofold. First, dopamine agonists are often used in the early stages of Parkinson's because they can delay the use of levodopa, which has the potential to cause the long-term dyskinesias and off periods. Dopamine agonists are generally associated with a lower risk of developing dyskinesias, especially in the early stages of treatment for Parkinson's. Dopamine agonists are used because they have a longer duration of action than levodopa, which can produce more stable symptom control. Second, dopamine agonists can be used in conjunction or in combination as an adjunctive therapy with levodopa, especially in the later stages of the disease, to help extend the on time and allow for lower doses of levodopa to help minimize the side effects. Now it's crucial to note that the choice of medication is highly individualized and depends on factors such as the patient's age and depends on factors such as the patient's age, their disease stage and overall health. Your movement disorder specialist or your neurologist will determine the most appropriate treatment plan for you All.

Speaker 1: 18:22

Right now let's take a look at how dopamine agonists work in the body, also known as their mechanism of action, and then we'll also talk a little bit about the benefits that they provide. Now, dopamine agonists directly stimulate dopamine receptors. So, unlike levodopa, which is converted into dopamine by an enzymatic process, dopamine agonists bind directly to dopamine receptors, mimicking the effects of dopamine. Now, dopamine agonists activate these receptors, triggering the same signaling pathways that dopamine normally activates, and there are different types of dopamine receptors, for example, d1, d2, d3, etc. Dopamine agonists can have varying degrees of selectivity on different receptors, meaning, for example, one may be more selective of the D3 receptor versus the 1 and 2. So this selectivity can influence their effectiveness and their side effect profile.

Speaker 1: 19:17

Now let's look at some of the benefits that dopamine agonists provide for Parkinson's. First is symptom relief. Dopamine agonists can effectively alleviate motor symptoms like tremors, rigidity and bradykinesia. Second, they can delay levodopa use. They're often used to delay the need for levodopa because, while levodopa is highly effective, it does carry the risk of long-term complications like dyskinesias. Dopamine agonists are generally associated with a lower risk of developing dyskinesias compared to levodopa. Third, longer duration of action. Some dopamine agonists have a longer duration of action than levodopa, providing more stable symptom control and reducing the off periods. Fourth, they can be used as a combination therapy with levodopa in the later stages of the disease to extend on times and reduce off times, and also they can allow for lower doses of levodopa, which can minimize the side effects.

Speaker 1: 20:16

Now, while dopamine agonists have a number of benefits for managing Parkinson's, sometimes their use can be limited by a range of potential side effects. Some of the common side effects of dopamine agonists include nausea and vomiting, and this is one of the most common side effects, especially when starting or increasing the dose. Now, according to the research article Dopamine Agonists published on StatPearls as a continuing education paper, the authors note that, in addition to nausea and vomiting, orthostatic hypertension or lightheadedness upon standing, headache, dizziness and cardiac arrhythmias are the most common side effects of dopamine agonists. They note these adverse effects may also be dose-dependent. Other potential side effects include sleep disturbances, including insomnia, daytime sleepiness and vivid dreams. All three of those are possible Now. I took a dopamine agonist during my Parkinson's journey, and excessive daytime sleepiness was one of the big side effects that I noticed, especially at the higher doses. I'd sit there trying to read in the afternoon and I would nod off, and so it became very frustrating. So I eventually started to wean off of the dopamine agonist I was taking for a long time. Others include visual and auditory hallucinations, which can occur especially in older patients or at higher doses. Also, edema swelling in the legs and ankle can develop. All right now dopamine agonists can have some more serious side effects that can limit their use in treating Parkinson's, and these include impulse control disorders.

Speaker 1: 21:51

Now, this is a significant concern, and the physician may ask the patient or a family member if they notice any warning signs of these following potential side effects, including pathological gambling, hypersexuality, compulsive shopping and binge eating. Patients have been documented to spend their life savings on gambling, for example. So impulse control disorders can have a significant impact on patients and their families. For instance, every time I go to see the movement disorder specialist, they ask me or my wife if they've noticed that I've made any big purchases without their consent when I was on the dopamine agonist, because they're concerned about impulse control disorders Now. Another serious side effect is excessive daytime sleepiness and sleep attacks. These can cause sudden and unexpected episodes of falling asleep, which can really be dangerous while you're driving. Now, in my case, excessive daytime sleepiness is one of the reasons I stopped taking a dopamine agonist, because it was having a significant impact on my daily life and it made it difficult to complete some of the things that I really enjoy doing. All right, so those are the benefits and potential side effects of dopamine agonist, and your physician will help you determine if dopamine agonists are appropriate as part of your treatment plan. And then, as with any Parkinson's medication, it's important to inform your doctor of any side effects you may be experiencing, especially that has an effect on the quality of your life.

Speaker 1: 23:17

All right, now let's move on to the third class of Parkinson's medications MAO-B inhibitors. Now you may be thinking what in the world are MAO-B inhibitors? Well, they're medications that block the enzyme monoamine oxidase B, which breaks down dopamine in the brain. So by inhibiting this enzyme, the drugs help increase the dopamine levels. So, according to the article MAO-B Inhibitors by the Parkinson's Foundation, they note that MAO-B inhibitors may be useful as early monotherapy, a medication that she's alone, or as an add-on to other medications, including levodopa.

Speaker 1: 23:58

When used with other medications, mao-b inhibitors may reduce motor fluctuations. Now, common forms of MAO-B inhibitors include selegoline, which is L-dipril, and this is indicated as a monotherapy for slowness, stiffness and tremor and as an adjunct therapy for motor fluctuations. There's also a segaline HCC orally disintegrating tablet called Xelopar, which is indicated for use as an adjunctive therapy for motor fluctuations, plus the need to dissolve the medication in the mouth, especially if swelling issues are impaired. Next up is risagaline or azelect. It's indicated as a monotherapy for slowness, stiffness, tremor and as an adjunct therapy for motor fluctuations. And then, finally, cefenamide or zhodago is indicated as an adjunct therapy for carbidopa levodopa to help with off periods.

Speaker 1: 24:58

Now let's look at some of the potential benefits MAO-B inhibitors may provide. First is symptom relief. Mao-b inhibitors can alleviate motor symptoms such as tremor, rigidity and bradykinesia. Second, it can be used as an early stage treatment or as a monotherapy in the early stages of Parkinson's. Third, they can be used as adjunctive therapy, meaning they can be combined with other drugs in combination, and they help to reduce the off-time and allow for lower doses of levodopa. Some potential side effects with MAO-B inhibitors, while generally are well-tolerated, can include mild side effects like nausea, dizziness and insomnia. Now it's important to be aware of drug interactions, especially with certain antidepressants and other drugs. According to the article MAOB Inhibitors Rasagiline, selegiline and Sifinamide by the Parkinson's UKorg, they note that if you're taking some types of antidepressants, you might not be able to take MAOB inhibitors because these drugs can interact with each other and raise blood pressure to dangerous levels. Decongestants or cold medicines can affect some MAOB inhibitors, so if you need to use them, check with your physician or doctor and pharmacist to ensure they're safe and are appropriate for you as part of your treatment plan.

Speaker 1: 26:19

Let's take a look at the final class of Parkinson's medications COMT inhibitors. Okay, so what are COMT inhibitors and how do they work? Comt inhibitors are a class of medication used to treat Parkinson's by primarily enhancing the effectiveness of levodopa, and let's look at how they work. First, let's look at the role COMT plays, and that's catechol-O-methyltransferase, and it's an enzyme that breaks down levodopa in the bloodstream before it can reach the brain. Now the breakdown reduces the amount of levodopa available to be converted to dopamine in the brain. Now the mechanism of action for COMT inhibitors works like this COMT inhibitors work by blocking the activity of the COMT coenzyme. By inhibiting COMT. These medications reduce the breakdown of levodopa in the periphery, outside the brain, and then, by inhibiting the breakdown of levodopa, this allows more levodopa to reach the brain, where it can be converted to dopamine. So, essentially, comt inhibitors help to prolong the effect of levodopa, and this results in a more stable dopamine levels in the brain, leading to smoother and more consistent symptom control.

Speaker 1: 27:38

All right, let's take a look at some of the COMT inhibitors that may be prescribed for Parkinson's, starting off with enticapone, also known as Comtan, and it's typically used four to eight times a day with each levodopa dose. Its indicated use is as a combination therapy with levodopa for motor control fluctuations, not used without levodopa, though. Next is tolcopone, also known as TASMAR. Now, the treatment regimen is usually 100 milligrams up to three times per day, to a maximum of 200 milligrams three times a day. Now, this drug has a risk of liver damage. It needs regular blood tests to check liver function. Its indicated uses are as a combination therapy with levodopa for motor fluctuations, and it is not used without levodopa. Now, typically, it should only be used after all Parkinson's medications have been tried and should be discontinued if there's no benefit seen in the first three weeks.

Speaker 1: 28:42

All right. Next up is Opicapone or Angentis, which is available in 25 and 50 milligram capsules. The typical treatment regimen is 50 milligrams by mouth once daily at bedtime. Typical treatment regimen is 50 milligrams by mouth once daily at bedtime. And opacopone is indicated as a combination therapy with levodopa for off periods and it's not pharmacologically active by itself, so you need to have it work with levodopa. And then, finally, one that I took myself is carbidopa-levodopa-entacopone tablets, which is called Stilivo. Now, this combination drug, which includes Entocopone and Carbidopa levodopa, is one pill. It's more convenient compared with Carbidopa, levodopa and Entocopone taken separately. The typical treatment regimen is 150 to 1600 milligrams of Levodopa, total daily dose and, depending on the daily need, with a maximum of eight tablets daily. So it's indicated uses as a replacement for carbidopa, levodopa for motor fluctuations, with the benefit of enticapone, which extends the life of the levodopa.

Speaker 1: 29:51

Now the information on COMT inhibitors comes from the article COMT Inhibitors by the Parkinson's Foundation. All right, now that we know what COMT inhibitors are and how they work, and the commercially available COMT inhibitors, let's look at their benefits and why they're used. First, is they prolong the effects of levodopa? Comt inhibitors are primarily used to extend the on-time and reduce the off-time associated with levodopa therapy. Second is improving symptom control. They help smooth out fluctuations in motor symptoms, providing more consistent relief. Third is reducing levodopa usage. So in some cases, comt inhibitors allow for a reduction in levodopa, which can help or minimize levodopa-related side effects like dyskinesia. And finally, they help with wearing off periods.

Speaker 1: 30:46

Now let's look at the common side effects. Since we discussed the benefits, we need to talk about what some of the common side effects are. Well, according to the Parkinson's Foundation, common side effects may include they may exaggerate some levodopa-related side effects, especially dyskinesias, hallucinations, discoloration of the urine, making it reddish-brown or rust-colored, and diarrhea. Now, as we wrap up our COMT inhibitors, some key considerations are they're always used with levodopa. They're not effective on their own and, as with any other drug, there may be a possible drug interaction. So, in summary, comt inhibitors enhance the effectiveness of levodopa, which leads to a more stable symptom control, which, in turn, provides a better quality of life. So those are the four classification categories of Parkinson's medication Levodopa, dopamine agonists, maob inhibitors and COMT inhibitors.

Speaker 1: 31:46

Now my 15-year journey with Parkinson's. I've taken Levodopa, a dopamine agonist, and a combination with the Stolivo. Now it's important to share your symptoms with your doctor and which ones are going to be the most bothersome, and which ones happen and when do they occur and they can help you develop a personalized treatment plan to help you manage when your symptoms are the worst. Now let's turn our attention to medication management and optimization. Effective medication management is crucial for Parkinson's because individual responses to drugs can vary significantly. Optimizing your medications involves tailing your medications to maximize symptom control and, at the same time, minimizing side effects. So it's important to work with your doctor and share your symptoms to get the best quality care possible.

Speaker 1: 32:38

Now let's look at some of the factors that can influence the effectiveness of your medication. Disease stage the progression of Parkinson's influences medication needs. Individual metabolism how quickly a person processes the drug varies. Dietary factors Certain foods can interact with medications. Other medications Drug interactions can affect your Parkinson's medications effectiveness, and then comorbidities. Other health conditions can influence medication changes and dosages. Stress and activity levels Physical and emotional stress can affect symptom severity and medication response.

Speaker 1: 33:18

Timing of doses Consistent timing is crucial for stable drug levels. Finally, the formulation of medications immediate versus extended release. Those are going to have a different action in the body. All right, now let's look at some of the strategies for managing side effects, starting with dosage adjustments Lowering or adjusting the dose can reduce side effects. Timing adjustments changing the times can also help to reduce some of the side effects. So, for instance, with protein, if you're taking levodopa, you don't want to eat it within an hour or two of a high-protein meal.

Speaker 1: 33:56

Combination therapies adding other medications to counteract specific side effects. Dietary modifications adjusting your diet to minimize nausea and other digestive issues. And then symptom management treating individual symptoms like nausea, dizziness or sleep disturbances with targeted medications. And then, finally, slow titration increasing medication doses slowly over time. Now it's important to remember that you should have regular medication reviews and adjustments with your doctor. Since Parkinson's is a progressive disease, they can make adjustments to optimize your symptom control and minimize the side effects. So it's important to use a symptom tracker to identify the types of symptoms, the severity of your symptoms, the timing of your symptoms, medication effectiveness and any significant side effects that you're experiencing. This can provide valuable information for your physician to make informed medication adjustments by helping identify patterns and potential triggers. Now you can get a free Parkinson's symptom tracker by visiting my website, liveparkinsonscom.

Speaker 1: 35:03

Now, finally, before we wrap up, let's provide some tips for communicating with your neurologist. First, prepare a list of questions. Write down any questions or concerns you have about your medications. Prior to the appointment, keep a symptom tracker or journal. Track your symptoms, the severity, the timing, the side effects, which can provide valuable information to your neurologist. And then you want to be specific. If you have specific examples, don't hesitate to talk to your doctor.

Speaker 1: 35:33

Ask for clarification If you don't understand something. Ask your neurologist to explain anything that you don't understand and repeat back what they say to ensure that you understood correctly. Discuss all medications. Make sure you share all medications that include supplements and herbal remedies that you're taking, because this can help prevent drug interactions. Advocate for yourself. So if you feel your concerns aren't being addressed, don't hesitate to speak up. You're the best advocate. And then, finally, be honest. You don't have to leave out any of the details, even if they are embarrassing.

Speaker 1: 36:07

Now here are a few communication tips Take notes, write down important information and instructions. So it's helpful to bring a caregiver or advocate. They can listen and take notes and capture things that you may have missed during the appointment and then that way, finally, they'll be able to pick up if there's questions or comments that you may have missed. They'll be there to do that too. So just make sure that if you have any questions, that you get those clarified before you leave the office.

Speaker 1: 36:36

So navigating Parkinson's medications can feel overwhelming, but, as we've explored today, understanding your treatment options empowers you to take control of your journey. Now we've delved into the cornerstone of Parkinson's therapy levodopa and its mechanism of action, highlighting the importance of managing its long-term effects. We've also examined the role of dopamine agonists, maob inhibitors and COMT inhibitors, discussing their benefits and potential side effects. Now remember personalized medication management. Regular reviews with your neurologist can help you really improve your quality of life. It's also important to do a symptom tracker, because it's going to also help to optimize the care that you're getting, because it's going to give the doctor specific times when you're in your off periods or you're having symptom issues. Now your journey with Parkinson's doesn't have to be one that navigating alone.

Speaker 1: 37:31

To continue your education and stay informed, I encourage you to visit liveparkinsonscom.

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There you can subscribe to the monthly newsletter, which is packed with the latest research and articles, practical tips and inspiring stories.

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You'll also find a free, a lot of free, resources and articles to support you on every step of your journey. And then, furthermore, building a strong Parkinson's care team is essential to receiving the best care possible, and to assist you with this, you can visit liveparkinsonscom or visit my Ko-fi page to get a copy of my guide Building your Parkinson's Care Team Resources Guide and Workbook. The resource will help you to assemble a team of experts dedicated to helping you live your best quality of life with Parkinson's. And then, finally, if you found this podcast valuable and want to support our mission of improving the quality of life for people with Parkinson's, please consider contributing to my Ko-fi page. Your support helps me continue to create informative and empowering content. So thank you for joining me today, and remember you're not alone with this fight. You just need the right information and support to help you live a full and meaningful life with Parkinson's. So until next time, stay healthy, stay strong and live your best life with Parkinson's.