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PARKINSON
DOPAMINERGIC
CO-CARELDOPA
Levodopa +
carbidopa
MECHANISM OF ACTIONS
Levodopa is converted to dopamine via DOPA
decarboxylase. This occurs both in the peripheral
circulation and in the central nervous system after
levodopa has crossed the blood brain barrier.
Activation of peripheral dopamine receptors
causes nausea and vomiting.
For this reason levodopa is usually administered in
combination with a DOPA decarboxylase inhibitor
(DDCI), in this case carbidopa. It cannot cross the
blood brain barrier and diminished peripheral
conversion of levodopa to dopamine hence,
reduces the unwanted peripheral side effects of
levodopa.
Use of carbidopa also increases availability of
levodopa to the CNS
Bromocriptine
Selegiline
Entacapone
INDICATIONS
Parkinson
Effective in pt exhibiting
fluctuations in their response to
levodopa.
Less risk of developing dyskinesia
and motor fluctuations as initial
therapy compared to levodopa
Little potential to cause hypertensive
crisis.
ADVERSE EFFECTS
Peripheral effects
- Anorexia, nausea and vomiting
- Tachycardia and ventricular extrasystoles
- Hypotension
- Saliva and urine are a brownish color
(melanin pigment produced from
catecholamine oxidation)
CNS effects
- Visual and auditory hallucinations
- Dyskinesia
- Mood changes, depression, psychosis,
anxiety
A.MUSCA
RINIC
Procyclidine
Anti-muscarinic agent
Adjuvant therapy