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DRUGS USED FOR

TREATMENT
PARKINSON DISEASE

MEDICAL FACULTY
UNIVERSITY OF LAMPUNG

PARKINS
ON
DISEASE
TREMOR
RIGIDITY
KINESIA
A
P
OSTURAL
INSTABILITY

Groups
Dopamine Agonist
Levodopa (L-dopa)
Carbidopa
Bromoriptine

Indirect Dopamine
Agonist (Dopaminoantikolinergik)

Example
Levodopa, Benserazide
(Madopar)
Bromocriptine mesylate
(Parlodel)

Selegilline (Jumex)

Deprenyl
Amantadine

Antimuscarinic
Agent

Benzhexol HCl (Artane)

Benztropine
Biperidene
Orphenadrine
Trihexyphenidyl

Trihexyphenidyl, Neostigmine
metylsulfate, Prostigmine

Levodopa Karbidopa
Intermediate compounds of
cathecolamine synthesis
Trough Blood Brain Barrier and changed
by L- decarboxylate aromatic amino acid
(dopa-decarboxylate) into dopamin
T 1-3 hour
> 90% metabolized by peripherydepo
decarboxylate (CNS outside) into
dopamine
The levels to the brain <2%
More effective to reduce rigidity and
bradichynesia than reduce tremors

Pyridoxin increase metabolism


levodopa
Reserfn (decrease dopamine depo)
and neuroleptic (blocking dopamine
reseptor) exacerbate parkinsonism
Anticholinergic, tryciclic
antidepresan, phenytoin and
benzodyazepin decrease effect of
levodopa

CNS : Dyskinesia, behavioral


changes
GIT : Nausea dan Vomitus
Liver Function Test : slightly
increased
Cardiovascular : arythmia, postural
hypotensi, hypertensi (high dose)

Drugs
Interacti
on
Advers
Effect

Bromocriptine
Ergote alkaloids derivate
Agonist of dopamine reseptor
T 8-12 hour
Treatment effect prolonged
for several month
Indication : Parkinsonism &
Hyperprolactinemia

Toxicity

Contraindicati
on

Involuntary movement,
behavioral changes
Nausea and vomite
Arytmia and postural
hypotensi
Livedo retikularis

Myocardium infarction
Mental disorders

Deprenile
Mono Amin Oxidase Inhibitor (MAOI)
Amantadine
Antiviral drugs
Work by releasing cathecolamine from
place of storage

Work by releasing dopamine from presinaptic


vesicle
Urine excretion with intact form warning for
patient with renal failure
Indication : Parkinson disease, type A infuenza
infection
Advers effect / toxicity
Behavioral changes
Livedo retikularis
Congestive hearth failure

Indirect
dopaminer
gic agent
Amantadin
e

Inhibiting competitively muscarinic


reseptor in the brain
Effective for reducing tremor but less
effective for bradikinesia
Indication
Mild Parkinsonism single dose
Parkinsonism severe relatively
combination with dopaminergic
agent
Most effective for tremor
Adverse effect same with atropine :
confusion, hallucinations, dry mouth,
constipation, urine retention

Benztropine
and
trihexilphenid
ine