Investigation of the Pharmaceutical Care in One Elderly Parkinson’s Disease Patient with Psychotic Symptoms

Abstract

A 66-year-old male patient with a 10-year course of Parkinson’s disease (PD) was admitted for hallucination lasting a half a month. After treatment with levodopa/carbidopa, selegiline, and piribedil, the patient’s motor symptoms were improved while no significant effects were observed on psychotic symptoms. A clinical pharmacist analyzed the pharmacologic and pharmacokinetic characteristics of selegiline and piribedil, summarized the scheme of PD with psychotic symptoms in the literature, and discovered that selegiline might potentiate psychotic side effects of piribedil, while the use of levodopa/carbidopa cannot be ruled out either. Finally, the clinical pharmacist proposed to reduce the dosage of levodopa/carbidopa, increase the dosage of selegiline and quetiapine, and discontinue piribedil. The clinician accepted this suggestion. After the adjustment of medication, the patient’s motor symptoms were absolutely improved and the psychotic symptoms were notably improved. This case study suggests that long-term treatment with levodopa/carbidopa and piribedil, along with the progression of the disease itself, could contribute to the emergence of psychotic symptoms in PD. Additionally, selegiline could potentiate psychotic side effects of piribedil. Neurology clinical pharmacists should work alongside neurology clinicians at the bedside to optimize pharmacotherapy, improve patient safety, and contribute to scholarly efforts.

Characterization and expression of phenylalanine hydroxylase in rabbits under different feeding conditions of faba bean (Vicia faba L.)

“…The deficiency of PAH enzyme leads to the accumulation of phenylalanine (Phe) amino acid in the blood, causing phenylketonuria (PKU), a disease that causes mental retardation in infants and children [11][12][13][14][15][16][17][18][19][20][21]. Moreover, phenylalanine deficiency in the blood leads to low dopamine levels in the body, which is the only reason for Parkinson's disease and L-dihydroxyphenylalanine (L-DOPA)-induced dyskinesia (LID) [7,22,23]. Therefore, to sustain normal health, the PAH enzyme must be found in its active form and normal ratio in humans, animals, and plants.…”

In Silico Protein-Ligand Interaction Study of Selected Phytochemicals Against Monoamine Oxidase-B

“…Contrary to their competitors, MAO-B inhibitors may furthermore provide a chance for disease modification, which so far remains the main unmet need in the treatment of PD and essentially makes them the right drug candidates for the early management of PD (Löhle and Reichmann 2011). Selegiline and rasagiline have been reported to have various side effects like hallucinations and confusion (Gu et al 2018;Tan et al 2022), light-headedness, nausea, mild headaches, and joint or neck pain (Baweja et al 2023). In effect, there is an urgent need to search for novel drug candidates with no side effects that can be used in the treatment of PD.…”