Progress and Prospects in Parkinson's Research/Symptoms

Rasagiline

Rasagiline is an irreversible inhibitor of monoamine oxidase^[1] used as a monotherapy in early Parkinson's disease or as an adjunct therapy in more advanced cases.^[2] It is selective for MAO type B over type A by a factor of fourteen.^[3]

Mannitol

Colloidal anhydrous silica

Maize starch

Stearic acid

Talc

Very common (Affecting more tham 1 user im 10)

Dyskinesia

Headache

Common (Affecting 1 to 10 users in 100}

abdominal pain

falls

allergy

fever

flu (influenza)

general feeling of being unwell (malaise)

neeck pain

chest pain (angina pectoris)

orthostatic hypotension

decreased appetite

constipation

dry mouth

nausea and vomiting

flatulence

leucopenia(abnormal blood tests)

arthralgia (joint pain)

musculoskeletal pain

joint inflammation (arthritis)

carpal tunnel syndrome (weakness or numbness of the hands)

decreased weight

abnormal dreams

postural instability

depression

dizziness

dystonia (muscle contractions)

rhinitis (runny nose)

dermatitis (skin irritation)

conjunctivitis (eye irritation)

urinary urgency

{Affects 1 to 10 users in 1,000)

stroke (cerebrovascular accident)

heart attack (myocardial infarction)

blistering rash (vesiculobullous rash)

AZILECT should not be taken concurrently with:-

monamine oxidase (MAO) inhibitors

pethidine

St. John's Wort

1. ↑ Oldfield V, Keating GM, Perry CM (2007). "Rasagiline: a review of its use in the management of Parkinson's disease". Drugs 67 (12): 1725–47. PMID 17683172. 
2. ↑ Gallagher DA, Schrag A (2008). "Impact of newer pharmacological treatments on quality of life in patients with Parkinson's disease". CNS Drugs 22 (7): 563–86. doi:10.2165/00023210-200822070-00003. PMID 18547126. 
3. ↑ Binda C, Hubálek F, Li M et al. (2005). "Binding of Rasagiline-related Inhibitors to Human Monoamine Oxidases: A Kinetic and Crystallographic Analysis". Journal of Medical Chemistry 48 (26): 8148–54. doi:10.1021/jm0506266. PMID 16366596. PMC 2519603. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2519603/. 

Levodopa, an aromatic amino acid, is a white, crystalline compound, slightly soluble in water, with a molecular weight of 197.2. It is designated chemically as (—)-L-α-amino-β-(3,4-dihydroxybenzene) propanoic acid. Its empirical formula is C₉H₁₁NO₄.

Decarboxylase benzeraside

Allergies (rash, itch,irregular heartbeat, blood in stools)

Reduced white blood cells (infections of mouth, gums, lungs or throat)

Reduced red blood cells (fatigue, bruise easily, prone to infections)

Reduced platelets in blood (bruising, nose bleeds)

Digestive system

Loss of appetite

Nausea

Diarrhoea

Heart and circulatory system

Dizziness

Blood

Anaemia (Palpitations, Pale skin, Fatigue, Heart flutters, Shortness of breath).

Mental Problems

Excitement, Anxiety, Agitation, Agressin, Depression, Disorientation.

Hallucinations, Out of touch with reality.

Narcolepsy, Insomnia.

Excessive urge to gamble.

Excessive sex drive.

Miscellaneous

Dyskinesia.

Loss of taste, Taste abnormalities.

Redness of face or neck.

Abnormal sweating.

Propranolol hydrochloride

Contents

Lactose

Manesium stearate

Maize starch

Stearic acid

Hypromellose (E464)

Coating

Polysorbate

Carmoisine (E122)

Titanium dioxide {E171)

Iron oxide - red {E172}

Hypromelose {E464}

Less than 1 in 10 users

Tiredness, fatique

Cold extremities

Sleep disturbance

Slow or irregullar heartbeat

Raynaud's syndrome

Nightmares

Uncommon (Less than 1 in 100 users)

Nausea, Vomiting

Diarrhoea

Rare (Less tha 1 in 1000 users)

Blood cell changes (Nosebleeds, Bruising, Sore throats, Infections)

Worsening of heart failure (Low blood pressure, Fainting on standing, Dizziness, Intermittent claudication)

Dermatological problems (Skin rash,soriasis, Hair loss, Dry flaky skin, red/itchy skin)

Neuroses (Hallucinations, Mood changes, Pinsand needles, Psychoses, Memory loss)

Difficulty in breathing

Dry eyes, Visual disturbances

Not known (cannot be estimated from availble data)

Hyperthyroidism

Changes in blood fats

Changes in kidney function

Changes in blood sugar levels

Fits (seizures)

Worsening of Angina, Headache, Depression, Confusion

Consti[ation

Dy mouth

Conjunctivitis

Changes in sex drive or potency

Joint pain

Verapamil or Diltiazem to treat heart disease}

Disopyramide or Quinidine or Amiodarone (to treat irregular heartbeat - arrhythmia)

Ergotamine< derivates (to treat migraine}

Adenaline {epinephrine used to treat anaphylactic shock)

Insulin and other medicines for the treatment of diabetes.

Lidocaine or Propafenine or Flecanide (used to treat irregular heartbeat or as a local anaesthetic}

Indometacin (A Non-Steroidal Anti-inflammatory Drug- NSAID)

Digitalis glycosdes (such as digoxin, use to treat heart disease}

Chlorpromazine (for mental illness)

Cimetidine (for stomach ulcers)

Alpha blockersor Clonidine or Moxonidine or Methyldopa or Hydralaxine {for high blood pressure)

Monamine oxidase inhibitors or Imipramine or <Fluvoxamine (for depression)

Warfarin (to prevent clotting)

Rizatriptan (for migraine)

Rifampicin (to treat infection)

arbiturates (to combat severe insomnia)

Theophylline (for treating asthma and reversible airways obstruction)

Diuretics (to clear excess water from the body)

Ropinirole hydrochloride

Nausea

Vomiting

Stomach ache

Drowsiness

Swelling of arms and legs

Burning sensation in stomach if taken with alcohol

Lowered blood pressure {leading to Slow pulse; Falls; Orthostatic hyotension; Fainting; Unsteadiness; Dizzines}

Somnolence (Extreme sleepiness)

Sudden sleep episodes {Narcolepsy}

Compulsive behaviour (e.g Sexual or gambling adiction}

If taken with levodopa

Dystonia (Jerky movements))

Hallucination

Confusion

Position statement by the European Medicines Agency http://www.ema.europa.eu/docs/en_GB/document_library/Position_statement/2009/12/WC500017653.pdf

Carbidopa, is an inhibitor of aromatic amino acid decarboxylation, and is a white, crystalline compound, slightly soluble in water, with a molecular weight of 244.3. It is designated chemically as (—)-L-α-hydrazino-α-methyl-β-(3,4-dihydroxybenzene) propanoic acid monohydrate. Its empirical formula is C₁₀H₁₄N_2O4•H_2O.

Levodopa, an aromatic amino acid, is a white, crystalline compound, slightly soluble in water, with a molecular weight of 197.2. It is designated chemically as (—)-L-α-amino-β-(3,4-dihydroxybenzene) propanoic acid. Its empirical formula is C₉H₁₁NO₄.

Hydroxypropyl cellulose

Pregelatinized starch

Crospovidone

Microcrystalline cellulose

Magnesium stearate

SINEMET 10-100 and 25-250 Tablets also contain:-

FD&C Blue #2/lndigo Carmine AL.

SINEMET 25-100 Tablets also contain:-

D&C Yellow #10 Lake.

Dyskinesia

Nausea

Body as a Whole

Chest pain, asthenia.

Cardiovascular

Cardiac irregularities, hypotension, orthostatic effects including orthostatic hypotension, hypertension, syncope, phlebitis, palpitation.

Gastrointestinal

Dark saliva, gastrointestinal bleeding, development of duodenal ulcer, anorexia, vomiting, diarrheoa, constipation, dyspepsia , dry mouth, taste alterations.

Hematologic

Agranulocytosis, hemolytic and non-hemolytic anemia, thrombocytopenia, leukopenia.

Hypersensitivity

Angioedema, urticaria, pruritus, Henoch-Schonlein purpura, bullous lesions (including pemphigus-like reactions).

Musculoskeletal

Back pain, shoulder pain, muscle cramps.

Nervous System/Psychiatric

Psychotic episodes including delusions, hallucinations, and paranoid ideation, neuroleptic malignant syndrome, bradykinetic episodes ("on-off" phenomenon), confusion, agitation, dizziness, somnolence, dream abnormalities including nightmares, insomnia, paresthesia, headache, depression with or without development of suicidal tendencies, dementia, pathological gambling, increased libido including hypersexuality, impulse control symptoms.

Respiratory

Dyspnea, upper respiratory infection.

Skin

Rash, increased sweating, alopecia, dark sweat.

Urogenital

Urinary tract infection, urinary frequency, dark urine.

Symptomatic postural hypotension has occurred when SINEMET was added to the treatment of a patient receiving antihypertensive drugs.

Severe orthostatic hypertenson can occur for patients receiving MAO inhibitors (Type A or B).

There have been rare reports of adverse reactions, including hypertension and dyskinesia, resulting from the concomitant use of tricyclic antidepressants and SINEMET.

Dopamine D2 receptor antagonists (e.g. phenothiazines, butyrophenones, risperidone) and isoniazid may reduce the therapeutic effects of levodopa. In addition, the beneficial effects of levodopa in Parkinson's disease have been reported to be reversed by phenytoin and papaverine.

Iron salts may reduce the bioavailability of levodopa and carbidopa.

Although metoclopramide may increase the bioavailability of levodopa by increasing gastric emptying, metoclopramide may also adversely affect disease control by its dopamine receptor antagonistic properties.

(1997)

Block et al ^[1]carried out a multi-centre trial over 5 years comparing the effects of Sinemet (immediate Release) and Sinemet CR (Controlled Release) and found favourably for the latter.

1. ↑ Block, G,; Liss, C.; Reines, S.; Irr. I. and Nibbelink, D. AbstractEur. Neurol. 37 (1) 23 – 27 Comparison of Immediate-Release and Controlled Release Carbidopa/Levodopa in Parkinson’s Disease http://www.karger.com/Article/Abstract/117399

Carbidopa, is an inhibitor of aromatic amino acid decarboxylation, and is a white, crystalline compound, slightly soluble in water, with a molecular weight of 244.3. It is designated chemically as (—)-L-α-hydrazino-α-methyl-β-(3,4-dihydroxybenzene) propamic acid monohydrate. Its empirical formula is C₁₀H₁₄N_2O4•H_2O.

Entacapone is somewhat similar to carbidopa or benserazide, in that it is an inhibitor of an enzyme that converts L-DOPA into a compound that cannot cross the blood brain barrier.

Levodopa, an aromatic amino acid, is a white, crystalline compound, slightly soluble in water, with a molecular weight of 197.2. It is designated chemically as (—)-L-α-amino-β-(3,4-dihydroxybenzene) propanic acid. Its empirical formula is C₉H₁₁NO₄

croselcarmellose sodium

magnesium stearate

maize starch]

manitol (E421)

povidone K30 (E1201)

glycerol (422)

hypromellose

polysorbate 80

red iron oxide (E172)

sucrose

titanium dioxide (E171)

yellow iron oxide (E172)

Dystonia (Uncontrolled movements)

Nausea

Paranoia and psychotic symptoms

Depression (possibly with thoughts of suicide)

Amnesia and cognitive deficits

Irregular heart rate and rhythm

Light headedness or fainting due to low blood pressure

Dizziness

Drowsiness

Sudden worsening of Parkinson's symptoms

Loss of appetite

Vomiting

Bleeding in the gut

Ulcers

Abdominal pain

Dry mouth

Constipation

Diarrhoea

High blood pressure

Inflammation of the veins in the legs

Insomnia

Hallucinations

Confusion

Unpleasant dreams

Tiredness

Muscle cramps

Sweating

Falls postural instability)

Changes in blood cells

Fainting

Infections

Bleeding

Chest pain

Shortness of breath

Tingling or numbness

Convulsions

Agitation

Itching and rashes

Weight loss or gain

vision disturbances

Muscle cramps

Selective MAO-A plus MAO- inhibitors

>non-selective MAO inhibitors (e.g. Moclobemide-aka Aurorix and Manerix.}

noradrenaline re-uptake inhibitors (e.g. Desipramine- aka Desmethylimipramine; Maprotiline aka -Deprilept, Ludiomil, Psymion; Venlaxafine - aka Effexor or Efexor )

tricycline antidepressants (e.g. Amitryptiline - aka Tryptomer, Elavil, Tryptizol, Laroxyl, Saroten, Sarotex, Lentizol, Endep)

Paroxetine aka Aropax, Paxil, Pexeva, Seroxat, Sereupin

Isoprenaline aka Isoproterenol, Medihaler-Iso and Isupre

Dopamine

Dobutamine

Alpha-methyldopa

Apomorphine aka Apokyn, Ixense, Spontane, Uprima]]

rimiterole

Dopamine antagonists

Phenytoin

Papaverine

iron supplements

Adrenaline

(current)

U.S. Food and Drugs Administration report on Stalevo, http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm206513.htm

(2010)

Podcast for Healthcare Professionals:Ongoing Safety Review of Stalevo (entacapone/carbidopa/levodopa) and possible development of Prostate Cancer http://www.fda.gov/Drugs/DrugSafety/DrugSafetyPodcasts/ucm207688.htm

FDA Drug Safety Communication: Ongoing Safety Review of Stalevo and possible increased cardiovascular risk http://www.fda.gov/Drugs/DrugSafety/ucm223060.htm

FDA Drug Safety Podcast for Healthcare Professionals: Ongoing Safety Review of Stalevo and possible increased cardiovascular risk http://www.fda.gov/Drugs/DrugSafety/DrugSafetyPodcasts/ucm223620.htm

FDA Drug Safety Communication: Ongoing Safety Review of Stalevo (entacapone/carbidopa/levodopa) and possible development of Prostate Cancer http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm206363.htm

Eurpean Medicines Agency report on stalevo. http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/000511/human_med_001063.jsp&mid=WC0b01ac058001d124