Parkinson Disease

Parkinson Disease (continued) ry other up by > Contraindicated with use of nonselective MAOIs, in narrow-angle glaucoma > Caution if history of melanoma, of psychoses, or of cardiac, pulmonary, renal, hepatic, or endocrine disease > Abrupt dose reduction or discontinuation may cause neuroleptic malignant syndrome ry other > If transferring from levodopa alone, discontinue levodopa 12-24 h before starting carbidopa/levodopa (25% of previous levodopa dosage) > Contraindicated in patients with melanoma e s 4-8 h above > Intended to replace immediate release carbidopa/levidopa (without entacapone) therapy if patient experiences end-of-dose "wearing off" with total daily dose of <_ 600 mg levodopa without dyskinesia OR to switch patients on entacapone and carbidopa/levodopa as separate drugs onto one drug > See comments above for carbidopa/levodopa and entacapone > Cannot be used with entacapone nor can more than one tablet be taken at one time > Contraindicated in patients with melanoma e to max > Use only as adjunct to carbidopa/levodopa therapy for "wearing off" episodes > Avoid concomitant use with non-selective MAOIs, but may be taken with selective MAO-B inhibitor > Caution if hepatic impairment > Orthostatic hypotension, syncope, diarrhea, hallucinations, dyskinesia nd 12 > Use only as adjunct to carbidopa/levodopa therapy if symptom fluctuations and unsatisfactory response to or inappropriate candidate for other adjunctive therapies > Should not be used by patients without a complete discussion of risks and patient has provided written acknowledgement that the risks have been explained > Because of the risk of liver injury, withdraw from therapy if no substantial clinical benefit is seen within 3 weeks > Avoid concomitant use with non-selective MAOIs, but may be taken with selective MAO-B inhibitor > Orthostatic hypotension, syncope, diarrhea, hallucinations, dyskinesia Î See product labeling for complete prescribing information. Î Medications are symptomatic and not considered neuroprotective. Î Medications to reduce off time in patients with motor fluctuations:** Recommendations for medications that reduce off time for patients with motor fluctuations: Î Offer: > Entacapone > Rasagiline Î Consider: > Pergolide (use with caution; requires monitoring for valvular fibrosis) > Pramipexole > Ropinirole > Tolcapone (use with caution; requires monitoring for hepatoxicity) > Zelapar Adapted from: American Academy of Neurology (AAN) Summary of Evidence-based Guideline for Clinicians > Test with serum ALT/AST before starting therapy, every 2–4 wk as clinically indicated for 6 mo, and thereafter as clinically indicated

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