Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030567 (Parkinson's disease)
 63,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Apomorphine (Apokyn) is now available for rescue treatment of "off" episodes in patients with advanced Parkinson's disease. It must be injected subcutaneously. Apomorphine in a variety of formulations has been used in Europe for many years. Like other dopamine agonists it can cause nausea and vomiting, orthostatic hypotension, drowsiness, "sleep attacks" and dyskinesias. It should be taken initially with an antiemetic to avoid nausea and vomiting.
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PMID:Apomorphine (Apokyn) for advanced Parkinson's Disease. 1564 5

For 10 years, we have used intravenous and oral perphenazine as part of a multimodal antiemetic prophylaxis care plan for at least 10,000 outpatients. We have never encountered an adverse event, to our knowledge, when the intravenous dose was less than or equal to 2 mg, or when the single preoperative oral dose did not exceed 8 mg (with no repeated dosing). As a single-dose component of multimodal antiemetic prophylaxis therapy, we believe that this track record of anecdotal safety in adults who meet certain criteria (age 14-70, no less than 45 kg, no history of extrapyramidal reactions or of Parkinson disease, and no Class III antidysrhythmic coadministered for coexisting disease) constitutes a sufficient patient safety basis for formal prospective study. We believe that future perphenazine studies should include routine coadministration with prospectively established multimodal antiemetics (i.e., dexamethasone and a 5-HT3 antagonist). In settings where droperidol is still routinely used and deemed acceptable by local scientific ethics committees, we believe that oral perphenazine 8 mg should be compared head to head with droperidol 0.625-1.25 mg in patients receiving coadministered dexamethasone and 5-HT3 antagonists in order to determine differences in synergistic efficacy, if any. Similar trials should be performed, individually evaluating cyclizine, transdermal scopolamine, and aprepitant in combination with coadministered dexamethasone and a 5-HT3 antagonist. Such studies should also quantify efficacy in preventing nausea and vomiting after discharge home, and also quantify the extent to which the prophylaxis plans reduce postanesthesia care unit (PACU) requirements (i.e., increase PACU bypass), reduce the need for any nursing interventions for postoperative nausea and/or vomiting (PONV), and influence the extent to which any variable costs of postoperative nursing care are reduced.
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PMID:Routine multimodal antiemesis including low-dose perphenazine in an ambulatory surgery unit of a university hospital: a 10-year history. Supplement to: Eliminating postoperative nausea and vomiting in outpatient surgery with multimodal strategies including low doses of nonsedating, off-patent antiemetics: is "zero tolerance" achievable? 1761 79

The dual cholinesterase inhibitor rivastigmine is approved in capsule form in many countries for the symptomatic treatment of dementia associated with Alzheimer disease (AD) and Parkinson disease (PD). All orally administered cholinesterase inhibitors are associated with central cholinergic gastrointestinal side effects, particularly during the titration phase, which are believed to be caused by a rapid increase in brain acetylcholine levels after effective inhibition of the target enzymes. A recently developed rivastigmine transdermal patch may have the potential to reduce such side effects. Pharmacokinetic studies have shown that transdermal administration of rivastigmine prolongs t(max), lowers C(max), and reduces fluctuations in plasma concentration. The 10-cm(2) rivastigmine patch provides comparable exposure (area under the curve, AUC) to the highest capsule dose (6-mg BID) and may be the target maintenance dose for most patients, delivering optimal rivastigmine exposure to produce a therapeutic effect. The potential of a patch to improve the tolerability of rivastigmine (e.g., nausea and vomiting) while permitting similar exposure to the highest doses of capsules may, in turn, lead to improved efficacy and compliance.
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PMID:Pharmacokinetic rationale for the rivastigmine patch. 1764 18

Application of dopamine agonists in the therapy of Parkinson's disease constitutes significant progress. The adverse effects of dopamine agonists in the treatment of this disease are caused by various action mechanisms and depend upon the composition and pharmacological characteristics of the drug, its impact upon the dopaminergic and non-dopaminergic receptors, as well as dosage and duration of treatment. The most important ones include: nausea and vomiting, orthostatic hypotonia, psychiatric syndromes, sleep disturbances, pleuropulmonary and retroperitoneal fibrosis, vasoconstrictive properties, oedema, hormonal disturbances, as well as dyskinesias. Knowledge of such adverse effects is necessary for each physician, although in Poland dopamine agonists are used in a minority of patients due to the significant costs of the treatment.
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PMID:[Adverse effects of dopamine agonists]. 1794 57

Whether nicotine has therapeutic effects on Parkinson's disease (PD) symptoms is controversial, but high doses and chronic treatment have never been tested. We report the results of a pilot, open-label trial to assess the safety and possible efficacy of chronic high doses of nicotine. Six patients with advanced idiopathic PD received increasing daily doses of transdermal nicotine up to 105 mg/day over 17 weeks. All patients but one accepted the target dose. Nausea and vomiting were frequent but moderate, and occurred in most of the patients (four of six) who received over 90 mg/day and 14 weeks of nicotine treatment. During the plateau phase, patients improved their motor scores and dopaminergic treatment was reduced. These results confirm the feasibility of chronic high dose nicotinic treatment in PD but warrant validation of the beneficial effects by a randomized controlled trial.
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PMID:Chronic high dose transdermal nicotine in Parkinson's disease: an open trial. 1794 58

Rivastigmine patch is the first transdermal treatment to be approved for Alzheimer's disease (AD) and Parkinson's disease dementia in the USA and for AD in Europe. It provides smooth, continuous drug delivery, and has the potential to maintain rivastigmine concentrations within an optimal therapeutic window while avoiding the peaks and troughs associated with oral drug delivery. The target dose, rivastigmine 9.5 mg/24 h patch (a 10 cm(2) patch), is given once daily and requires a simple one-step dose titration to the therapeutic dose. In a 24-week study in 1195 AD patients, the rivastigmine 9.5 mg/24 h patch provided similar efficacy to the highest dose range of capsules, with approximately three-times fewer reports of nausea and vomiting. Patients in the 9.5 mg/24 h patch and 12 mg/day capsule groups evidenced significant improvements versus placebo on both primary outcome measures: the Alzheimer's Disease Assessment Scale-Cognitive subscale; and Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change; in addition to the following secondary outcome measures: Alzheimer's Disease Cooperative Study-Activities of Daily Living scale; Mini-Mental State Examination; and Trail Making Test Part A for assessment of attention, visual tracking and motor processing speed. Treatment differences on the Neuropsychiatric Inventory and Ten Point Clock-drawing Test did not reach statistical significance in this study. The patch may be the optimal way to treat dementia patients with rivastigmine.
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PMID:A rivastigmine patch for the treatment of Alzheimer's disease and Parkinson's disease dementia. 1799 95

Side effects to antiparkinsonian drugs constitute an important component of the daily management of patients with Parkinson's disease. Treatment with levodopa frequently leads to motor fluctuations and dyskinesias. Hallucinosis, nausea and vomiting, drowsiness, orthostatic hypotension and peripheral edema can be managed by dose reduction, medication substitution and specific counteractive measures. Anticholinergics frequently cause cognitive or autonomic symptoms while ergot-derived dopamine agonists carry unique, albeit rare, risks of fibrotic, vasoconstrictive and dermatological side effects. Current areas of controversy include: dopamine agonist-induced sleep attacks, increased mortality with the combination of selegiline and levodopa and the association of levodopa with melanoma.
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PMID:Adverse effects in the treatment of Parkinson's disease. 1981 Oct 20

Hawai'i is home to 1000 native species of flowering plants. Mucuna gigantea is one such Hawaiian species which has been studied as affordable sustenance and as a cover crop in developing countries. Mucuna gigantea and other Mucuna species (spp.) in general, are known to contain natural levodopa and its utility in the treatment of Parkinson's Disease has also been evaluated. Levodopa is converted in the periphery into dopamine which can then act on dopamine receptors to cause nausea, vomiting, arrhythmias, and hypotension. We describe a case in which a patient presents with abdominal pain, nausea, and vomiting after legume ingestion. The bean was ultimately identified as Mucuna gigantea and the patient was diagnosed with levodopa-induced gastrointestinal toxicity from consumption of the legume. A literature review was conducted using the database search engines, Biological Abstracts and PubMed, with a broad combination of keywords of which include "mucuna, "gigantean," "levodopa," "l-dopa," "toxicity," and the association between Mucuna gigantea ingestion and levodopa toxicity is discussed. These findings expand the differential diagnosis of abdominal pain associated with nausea and vomiting in the correct clinical context.
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PMID:Case of levodopa toxicity from ingestion of Mucuna gigantea. 2379 19

An 84-year-old woman presented to her local emergency department for abdominal pain. Her medical history included hemodialysis in the treatment of chronic renal failure, Parkinson's disease, chronic atrial fibrillation, chronic constipation, appendicectomy and cholecystectomy. The patient complained of diffuse abdominal pain for 4 days, associated with nausea and vomiting in the last 24 hours. Physical examination revealed a soft and depressible abdomen, diffusely painful, without signs of peritoneal irritation. A digital rectal exam revealed large amount of stool in the rectal vault without palpable masses. Blood tests showed a creatinine level of 2.7 mg/dl due to chronic renal failure and the plain abdominal radiography revealed a dolichocolon completely contrasted. The patient denied the realization of any medical imaging-proofs with oral or rectal contrast. Reviewing home treatment, the patient was taking lanthanum carbonate (2 tablets of 750 mg per day) since 1 month ago, a drug that contrasts the digestive tract. Appreciating contrast in the colon, intestinal subocclusion was excluded and the clinical picture was attributed to her chronic constipation. In conclusion, it should be noted that lanthanum carbonate contrasts the digestive tract, with radiopaque appearance on the plain abdominal radiography and without any pathological significance.
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PMID:Lanthanum carbonate has a radiopaque appearance on the plain abdominal radiography. 2732 19

Levodopa is the most used drug to treat motor symptoms in Parkinson's disease (PD). However, dopaminergic side effects such as nausea and vomiting may occur. Several evidences indicate a major role for dopamine receptors D2 (DRD2) and D3 (DRD3) in emetic activity. The aim of this study was to investigate the relationship of DRD2 rs1799732 and DRD3 rs6280 gene polymorphisms with gastrointestinal (GI) symptoms induced by levodopa in PD patients. Two hundred and seventeen PD patients on levodopa therapy were investigated. DRD2 rs1799732 and DRD3 rs6280 polymorphisms were genotyped by PCR-based methods. Multiple Poisson regression method with robust variance estimators was performed to assess the association between polymorphisms and gastrointestinal symptoms. The analyses showed that DRD2 Ins/Ins (prevalence ratio (PR)=2.374, 95% confidence interval (CI): 1.105-5.100; P=0.027) and DRD3 Ser/Ser genotypes (PR=1.677, 95% CI 1.077-2.611; P=0.022) were independent and predictors of gastrointestinal symptoms associated with levodopa therapy. Despite all the efforts to alleviate GI symptoms, this adverse effect still occurs in PD patients. Pharmacogenetic studies of GI symptoms induced by levodopa therapy have the potential to display new ways to better understand the molecular mechanisms involved in these side effects.
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PMID:Association between DRD2 and DRD3 gene polymorphisms and gastrointestinal symptoms induced by levodopa therapy in Parkinson's disease. 2777 45


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