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)

Parkinson's disease responds rather dramatically to levodopa therapy during the first several years of treatment. With advancing disease, however, symptom control becomes more erratic, and some symptoms may become refractory to treatment. The use of selegiline hydrochloride (Eldepryl) has been proposed to slow the progression of Parkinson's disease; however, current evidence suggests that it is only partially effective at best, and there is no definite proof of a neuroprotective effect. Nonetheless, it is a reasonable treatment choice. Carbidopa-levodopa (Sinemet) remains the foundation of symptomatic treatment of Parkinson's disease. Clinical fluctuations occurring with advancing disease may be at least partially controlled by appropriate adjustments in dosage. A direct-acting dopamine agonist, bromocriptine mesylate (Parlodel) or pergolide mesylate (Permax), can be very helpful as adjunctive therapy to smooth these clinical fluctuations. Excessive intracellular oxidative stress has been proposed as a cause of Parkinson's disease; however, a recent multicenter trial investigating the use of high doses of the antioxidant vitamin E showed it to be ineffective. Whether other forms of nonspecific antioxidant therapy will prove beneficial is open to speculation.
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PMID:Treatment of Parkinson's disease. From theory to practice. 815 48

(-)Deprenyl (Selegiline, Jumex, Eldepryl, Movergan), structurally closely related to phenylethylamine (PEA), is a drug with a unique pharmacological spectrum. It is a highly potent and selective irreversible inhibitor of B-type monoamine oxidase (MAO) and interferes with the uptake of catecholamines and indirectly acting symphathomimetics. In striking contrast to PEA and its relatives, which displace the transmitter from the storage places, (-)deprenyl inhibits the releasing effect of tyramine and is up to the present the only safe MAO inhibitor which can be administered without dietary restrictions. Maintenance on (-)deprenyl enhances selectively superoxide dismutase (SOD) and catalase activities in the striatum. This effect is unrelated to the MAO and uptake inhibitory effects of the drug. Maintenance on (-)deprenyl facilitates the activity of the nigrostriatal dopaminergic neurons with remarkable selectivity and this effect too, is unrelated to either the MAO or the uptake inhibitory effects of the drug. Maintenance on (-)deprenyl prevents the characteristic age-related morphological changes in the neuromelanin granules of the neurocytes in the substantia nigra. As a consequence of its complex spectrum of activity male rats maintained on (-)deprenyl live longer, lose their capacity to ejaculate later, show improved performance in learning tests and maintain this activity for a longer period than their untreated peers. Patients with Parkinson's disease maintained on levodopa plus (-)deprenyl (10 mg daily) live significantly longer than those on levodopa alone. Freshly diagnosed patients treated with (-)deprenyl need levodopa later than their placebo-treated peers. Continuous administration of (-)deprenyl improves the performance of patients with Alzheimer's disease.
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PMID:The pharmacological basis of the beneficial effects of (-)deprenyl (selegiline) in Parkinson's and Alzheimer's diseases. 829 2

Routine methamphetamine testing identified a urine specimen with inconsistent screening and confirmation results. The methamphetamine RIA screening test (Diagnostic Products Corporation) indicated a borderline positive specimen, while the achiral confirmatory GC/MS result showed 4690 ng/mL of methamphetamine and 1895 ng/mL of amphetamine. Analysis of the specimen after derivatization with S(-)-N-trifluoroacetylprolyl chloride showed only the presence of 1-amphetamine and 1-methamphetamine. It was later learned that the individual providing the specimen had been taking Selegiline. Selegiline, (-) propynylmethamphetamine, is a monoamine oxidase inhibitor used for the treatment of Parkinson's disease. It is sold under the trade name Eldepryl. Its major metabolites are 1-methamphetamine, 1-amphetamine and N-desmethylselegiline. Urine specimens from other Selegiline users were obtained and analyzed. A characteristic metabolic pattern was noted, exemplified by a ratio of 1-methamphetamine to 1-amphetamine of about 2.8. This is in contrast to what is observed in the urine of individuals who ingest pure 1-methamphetamine, such as with Vicks Inhaler, where the 1-methamphetamine to 1-amphetamine ratio in the urine is usually greater than 8. Caution is advised when interpreting methamphetamine results without using a chiral identification technique.
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PMID:Methamphetamine and amphetamine derived from the metabolism of selegiline. 852 18

Motor fluctuations and dyskinesia often develop in patients with Parkinson's disease after 3 to 5 years of levodopa therapy. Dosage adjustments, addition of a second medication to the drug regimen, and dietary modifications may help maximize response to symptomatic therapy. Given the dramatic variability of symptoms and response to treatment, drug regimens must be individualized according to the patient's needs. In newly diagnosed cases of Parkinson's disease, administration of selegiline hydrochloride (Eldepryl) may slow symptom development and delay the need for levodopa therapy. Many physicians prescribe selegiline initially for its symptomatic and potential neuroprotective benefits.
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PMID:Moderate Parkinson's disease. Strategies for maximizing treatment. 853 10

The manufacturer of deprenyl (selegeline; Eldepryl) (Somerset Pharmaceuticals, Tampa, FL) recently advised physicians to avoid prescribing the drug in combination with an antidepressant because of potentially serious CNS toxicity that may represent the serotonin syndrome. Manifestations of the serotonin syndrome vary but may include changes in mental status and motor and autonomic function. To better estimate the frequency of the serotonin syndrome in patients with Parkinson's disease (PD) treated with deprenyl and an antidepressant, we surveyed all investigators in the Parkinson Study Group. Based on estimates provided by the 47 investigators (75%) who responded, 4,568 patients were treated with the combination of deprenyl and an antidepressant medication. Eleven patients (0.24%) were reported to have experienced symptoms possibly consistent with the serotonin syndrome. Only two patients (0.04%) experienced symptoms considered to be serious. No deaths were reported. We also reviewed all published case reports and adverse experiences reported to the U.S. Food and Drug Administration and the manufacturer of Eldepryl. Available information indicates that serious adverse experiences resulting from the combined use of deprenyl and an antidepressant medication in patients with PD are quite rare and that the frequency of the true "serotonin syndrome" is even rarer.
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PMID:Serotonin syndrome and the combined use of deprenyl and an antidepressant in Parkinson's disease. Parkinson Study Group. 910 2

Selegiline is a selective, irreversible inhibitor of MAO-B, used in the treatment of Parkinson's disease, either alone or as an adjunct to L-DOPA. The sole recommended dosing regimen is 5 mg given in the morning and at noon with breakfast and lunch. A pulsatile oral dosage form was developed to mimic the conventional tablet release from two oral administrations separated by 4 h, to permit once-daily dosing and increase compliance. The pharmacokinetics of the pulsatile delivery system was studied in six healthy male volunteers. The plasma concentration-time profile from the pulsatile system of selegiline and metabolites is dissimilar to that obtained from the 5 mg bid administration of the conventional tablet and cannot be considered to be bioequivalent. The initial pulse of the delivery system is rapidly absorbed but to a lesser extent than the conventional regimen; the second pulse exhibits absorption which is delayed and prolonged. The decrease in the selegiline concentration may be due to the less absorptive surface of the lower GI tract which is available to the second pulse. Another reason could be the disparity between the in vitro and in vivo release profiles from the second pulse. Compartmental analysis indicates that the ratio of formation-absorption rate constant for the selegiline to N-desmethylselegiline pathway decreases from 1.57 +/- 1.04 for the first pulse to 0.61 +/- 0.54 for the second pulse of the pulsatile delivery system, suggesting that the upper portion of the GI tract has a greater capacity to convert selegiline to N-desmethylselegiline than the lower GI tract. The lack of in vivo and in vitro correlation is most likely due to site specific absorption/metabolism. Regimen has been previously shown to be a significant factor in estimating the extent of selegiline and metabolite exposure following oral administration. The inequivalence of dosing regimens of the same total daily dose may ultimately be linked to the saturability of gut wall metabolism. This phenomenon may preclude the development of novel delivery systems designed to mimic the recommended dosing regimen of the conventional Eldepryl tablet.
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PMID:Pharmacokinetic evaluation of a selegiline pulsatile oral delivery system. 937 24

Selegiline (Deprenyl, Jumex, Movergan etc.) is primarily used in the therapy of Parkinson's disease due to its neuroprotective, antidepressive and oxidative stress-preventing activities. Its prime effect is based upon the inhibition of the monoamine oxidase enzyme (MAO-B). The cofactor of this flavoenzyme is riboflavin (vitamin B2). Riboflavin, on the other hand, is an effective photosensitizer, with the capacity to promote the photodegradation of molecules (drugs, biological systems) which are otherwise stable against daylight. It has been studied whether this property of riboflavin is expressed against selegiline as well. This experiments proved that in the presence of riboflavin, both daylight and the light of daylight-lamps are sufficient to significantly decompose selegiline. The major decomposition product is methamphetamine.
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PMID:[In vitro interaction of selegiline, riboflavin and light. Sensitized photodegradation of drugs. I]. 1040 Nov 52

Patient-reported data can be a valuable, adjunctive tool in helping physicians assess the quality-of-life and functional changes in patients with Parkinson's disease (PD). We analyzed and evaluated the largest PD patient-reported database (PROPATHtrade mark) relative to prescribing habits and changes in reported outcomes by therapy. Our analysis included 1436 patients, followed for 1 yr, who completed a series of questionnaires assessing medication therapy, daily activity scores adapted from the Unified Parkinson's Disease Rating Scale (UPDRS), global disease visual analogue scale, and health resources consumption. Our results indicated that physicians are prescribing Eldepryl(R) with increased frequency in patients with early and mild PD. Patients receiving Eldepryl alone or in combination with Sinemet(R) reported better outcomes than those receiving Sinemet monotherapy. There was a great deal of variability in the reported utilization of healthcare resources by patients in the PROPATH program and, thus, no statistical differences were noted for patients treated with different regimens. We conclude that the adjunctive use of longitudinal patient self-reported data programs such as PROPATH can help assess and improve overall patient outcomes. Future controlled studies should be conducted to further evaluate the roles of alternative therapies and patient-reported data in improving quality-of-life and outcomes for PD patients.
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PMID:Does patient self-reported data have a role in the longitudinal study of Parkinson's disease? An analysis of the PROPATHtrade mark database. 1859 Oct 61

Parkinson's disease is a complicated disease state that affects patients' quality of life. The first monoamine oxidase (MAO-B) inhibitor for PD, selegiline (Eldepryl), was approved by the Food and Drug Administration (FDA) in 1996, and rasagiline (Azilect) received FDA approval in 2006. At first, pharmacists may assume that rasagiline is just another me-too drug. There are three areas in which the two medications differ from each other: MAO type A inhibitors are found in high concentrations in the intestines, and MAO type B inhibitors are found mostly in the brain. If MAO-A inhibition occurs, the body cannot protect itself from exogenous amines such as tyramine. The absorbed tyramine can cause hypertensive crisis, also known as the cheese reaction. Selegiline's capsule product labeling includes a bolded warning that it "should not be used at daily doses exceeding 10 mg per day because of the risks associated with non-selective inhibition of MAO." It also says, "the selectivity of selegiline for MAO B may not be absolute, even at the recommended daily dose." The fact that rasagiline has the same effect has been challenged by two main-stream studies. Selegiline is a propargyl amphetamine derivative that undergoes extensive first-pass metabolism to L-methamphetamine and L-amphetamine. Rasagiline's major metabolite is amioindan, which has no amphetaminelike properties. Selegiline has been reviewed looking for neuroprotection, but studies have been unable to come to a definite positive neuroprotection conclusion. Proponents of rasagiline's neuroprotective effects also point to clinical studies in humans that demonstrate delayed and reduced need for future use of levodopa. In summary, selegiline and rasagiline look more and more like distant cousins instead of twins.
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PMID:Selegiline and rasagiline: twins or distant cousins? 2122 99

Age-related increase in monoamine oxidase B (MAO-B) may contribute to CNS neurodegenerative diseases. Moreover, MAO-B inhibitors are used in the treatment of idiopathic Parkinson disease as preliminary monotherapy or adjunct therapy with L-dopa. To date, meager natural sources of MAO-B inhibitors have been identified, and the relative strength, potency and rank of many plants relative to standard drugs such as Selegiline (L-deprenyl,Eldepryl) are not known. In this work, we developed and utilized a high throughput enzyme microarray format to screen and evaluate 905 natural product extracts (0.025-.7 mg/ml) to inhibit human MAO-B derived from BTI-TN-5B1-4 cells infected with recombinant baculovirus. The protein sequence of purified enzyme was confirmed using 1D gel electrophoresis-matrix assisted laser desorption ionization -time-of-flight-tandem mass spectroscopy, and enzyme activity was confirmed by [1] substrate conversion (3-mM benzylamine) to H202 and [2] benzaldehyde. Of the 905 natural extracts tested, the lowest IC50s [<0.07 mg/ml] were obtained with extracts of Amur Corktree (Phellodendron amurense), Bakuchi Seed(Cyamopsis psoralioides), Licorice Root (Glycyrrhiza glabra/uralensis), Babchi (Psoralea corylifolia seed). The data also show, albeit to a lesser extent, inhibitory properties of herbs originating from the mint family (Lamiaceae) and Turmeric, Comfrey, Bringraj, Skullcap, Kava-kava, Wild Indigo, Gentian and Green Tea. In conclusion, the data reflect relative potency information by rank of commonly used herbs and plants that contain human MAO-B inhibitory properties in their natural form.
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PMID:High throughput screening to identify natural human monoamine oxidase B inhibitors. 2288 93


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