Classification of anti-Parkinson's drugs

Parkinson's disease is a serious disease that poses a great threat to human health. Generally, people with Parkinson's disease are unable to take care of themselves, and their muscles will gradually atrophy. Many people get particularly scared when they hear about Parkinson's. Now that we have anti-Parkinson's drugs, we can take preventive measures in advance. So. What are the categories of anti-Parkinson's drugs? There are mainly the following six categories.

There are currently six common types of drugs for treating Parkinson's disease:

1. Anticholine drugs: Currently, trihexyphenidyl is mainly used in China, which is mainly suitable for patients with tremor, but is not recommended for patients without tremor. Long-term use of this type of drug may lead to a decline in cognitive function. It is best not to use it for patients aged ≥ 60 years. It is contraindicated for patients with narrow-angle glaucoma and prostatic hypertrophy.

2. Amantadine: This drug is effective for rigidity, tremor and decreased movement. Amantadine has a synergistic effect when used in combination with anticholeretic drugs or levodopa. And it helps to improve dyskinesia. It should be used with caution in patients with renal insufficiency, epilepsy, severe gastric ulcer, and liver disease, and is prohibited for use in lactating women. Long-term use of the drug may cause livedo reticularis on the skin of the lower limbs and edema of the ankles and calves.

3. Dopamine: (Medopar, Sinemet, and Dapoxetine) It improves symptoms by supplementing the deficiency of dopamine and restoring the balance between acetylcholine and dopamine systems.

(1) Levodopa: Its use alone can significantly improve movement disorders, but it is less effective for tremors. In addition, it can only alleviate symptoms of Parkinson's disease but cannot prevent the progression of the disease. Too high a dose can easily cause nausea, vomiting, tachycardia, arrhythmia, hypotension, and mental symptoms (restlessness, hallucinations, delusions). In addition, during use, symptoms worsen 1 to 2 hours before the next dose, and the worsened symptoms disappear or fluctuate when taking the next dose, and there are involuntary movements of the head and face, twisting of the trunk, and chorea-like or athetoid hyperactivity of the limbs 2 to 3 hours after taking the medication.

(2) Compound levodopa (benserazide levodopa, carbidopa levodopa): The dosage is gradually increased according to the condition of the patient until the therapeutic effect is fully achieved. It has a relatively long maintenance time, but a slow onset of action and low bioavailability. Caution should be exercised when using it, especially when switching between two different dosage forms. It should be used with caution in patients with active gastrointestinal ulcers and is contraindicated in patients with narrow-angle glaucoma or mental illness.

(3) Catechol-O-methyltransferase inhibitors: These drugs include tolcapone and entecapone. When used in combination with compound levodopa, an appropriate dose can be maintained without causing side effects. The compound levodopa regular-release preparation has the characteristics of rapid onset of action, while the controlled-release preparation can improve PD motor symptoms and reduce the daily levodopa requirement. PD patients have good tolerance to levodopa, and only a few patients have the following adverse reactions: movement disorders, dry mouth, insomnia and diarrhea.

4. DR agonists: (Tasuda, Senforo) Currently, most people recommend non-ergot DR agonists (Bedil sustained-release tablets (Tasuda sustained-release tablets)) as the first choice drugs, especially for patients with early-onset Parkinson's disease in the early stages of the disease. Because, prevent or reduce the occurrence of sports complications. Start with a small dose and gradually increase the dose until satisfactory therapeutic effect is achieved without side effects. The side effects of DR agonists are similar to those of combined levodopa, except that the incidence of symptom fluctuations and dyskinesia is low, while the incidence of orthostatic hypotension, ankle edema and mental abnormalities (hallucinations, hyperphagia, hypersexuality, etc.) is higher.

5. Monoamine oxidase-B inhibitors (midopyril, sinocycline): Take in the morning or at noon. Do not use in the evening or at night to avoid insomnia. Or use with vitamin E 2000U. Use with caution in patients with gastric ulcers. Do not use with serotonin reuptake inhibitors (SSRIs).

6. COMT inhibitors: In the early stage of the disease, the first choice is a combination of levodopa + COMT inhibitors such as entacapone dopa tablets (a combination of entacapone/levodopa/carbidopa, with side effects such as diarrhea, headache, sweating, dry mouth, elevated transaminase, abdominal pain, yellow urine, etc. Tolcapone may cause liver damage, and liver function needs to be closely monitored, especially in the first 3 months after taking the drug.