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Dementia with Lewy Body and Parkinson's Disease PatientsPatient, Family, and Clinician Working Together for Better Outcomes$
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J. Eric Ahlskog

Print publication date: 2013

Print ISBN-13: 9780199977567

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199977567.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 20 June 2021

Parkinsonism Treatment for Those Already on Medications

Parkinsonism Treatment for Those Already on Medications

Chapter:
(p.81) 7 Parkinsonism Treatment for Those Already on Medications
Source:
Dementia with Lewy Body and Parkinson's Disease Patients
Author(s):

J. Eric Ahlskog

Publisher:
Oxford University Press
DOI:10.1093/oso/9780199977567.003.0013

The previous chapter provided instructions for starting and adjusting carbidopa/levodopa, but specifically pertained to those individuals on no other drugs for parkinsonism or those on only a low carbidopa/levodopa dosage. In this chapter, we focus on people who are taking other drugs for parkinsonism either with or without carbidopa/levodopa. As mentioned earlier, people with DLB or PDD are prone to hallucinations and delusions, which can be exacerbated by drugs for parkinsonism. Carbidopa/levodopa is the least likely to worsen or provoke these problems; however, this is true only if it is used alone (i.e., without other parkinsonism drugs). Carbidopa/levodopa is also the most efficacious drug for parkinsonism. Thus it is reasonable to take the approach that carbidopa/levodopa should be the sole treatment for parkinsonism in DLB or PDD. Whereas using carbidopa/levodopa by itself is often tolerated, adding it to other parkinsonian medications may provoke problems, especially hallucinations or delusions. Hence, before starting carbidopa/levodopa, it is wise to scrutinize the medication list and eliminate other parkinsonism drugs, one by one. There are two general rules of thumb regarding these medications: 1 It is not necessary to change drugs if things are going well and are expected to continue. 2 Change only one medication at a time (but if there are severe drug side effects, the physician may take more aggressive action). Some drugs are worse offenders than others and will be prioritized with that in mind. Note that a variety of schemes may be employed to taper off a drug. The drug-elimination schedules provided below are somewhat arbitrary and other similar schedules may work as well. The most important factor is the total time to reduce the dosage down to zero. The longer a person has been on a medication and the higher the dosage, the more prolonged the taper. The clinician needs to work closely with the patient as this is being done. Parkinsonism may transiently worsen when these drugs are eliminated; however, this typically can subsequently be reversed with carbidopa/levodopa adjustments.

Keywords:   Comtan (entacapone), Neupro patch (rotigotine), benztropine (Cogentin), catechol-O-methyl-transferase (COMT) inhibitors, gambling behaviors, from dopamine agonists, restless legs syndrome (RLS), spending behaviors, from dopamine agonists, tolcapone (COMT inhibitor), treatment options for those already on medications, trihexyphenidyl (Artane)

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