Drug interactions in the treatment of Parkinson's disease

Abstract

In recent years, the antiparkinsonian drug regime has become increasingly complicated. A wide range of antiparkinson agents is meanwhile available. Combination therapies may unfortunately induce interactions up to the point of life-threatening events. The potential of drug-drug interactions must be taken into account before starting a patient on combination treatment. Moreover, the frequent multimorbidity of patients with Parkinson's disease necessitates the application of additional drugs. A general overview is difficult to maintain because of the countless number of possible interactions. Cautious proceeding is certainly indicated in particular cases. The most common interactions will be discussed below. We should bear in mind that many of the interactions related to drug combinations are unknown yet.

What are the considerations for anti-hypertensive treatment in patients with Parkinson’s disease?

“…Adjusting for blood pressure must take both aspects into consideration. Medications that can induce OH (such as alpha-blockers, molsidomine, nitroglycerin or naftidrofuryl) should only be given with special attention and with the appropriate controls for blood pressure [14,18]. Use of beta-blockers as anti-hypertensives should principally be given critical review due to the fact that the preexisting adrenergic deficit is reinforced [3,14].…”

“…In the treatment of AH in PD antihypertensives containing moxonidine, alpha-methyldopa or reserpine [2,18,23] are contraindicated. Verapamil, diltiazem, amlodipine and nifedipine should not be combined with levodopa.…”

“…Amlodipine was reported to induce Parkinson symptoms [24], not confirmed in several studies [25,26]. On the other hand some molecules used as antihypertensives are discussed as disease-modifying drugs [25,26] Negative influence on the PD results from preparations containing reserpine [2,18]. Combinations of guanethidine with dopaminergic agents often results in arrhythmias [18].…”

“…On the other hand some molecules used as antihypertensives are discussed as disease-modifying drugs [25,26] Negative influence on the PD results from preparations containing reserpine [2,18]. Combinations of guanethidine with dopaminergic agents often results in arrhythmias [18]. The effect of molsidomine is reinforced in combination with levodopa [18,23].…”

Neurodegenerative Disorders: The Role of Genetic Factors in Their Origin and the Efficiency of Treatment

“…Drugs with a broader range of applications, which can be used in all NDs, are based on the common model of ND pathogenesis and cell apoptosis [119][120][121][122]. Possible drug interactions, which are also influenced by individual genetic features, should be considered in combined therapy of NDs and associated disorders such as seborrhea, hyperhydrosis, orthostatic hypotension, hypersalivation, bladder dysfunction, and neuropsychological syndromes (depression, sleep disorders, psychoses, and dementia) [123][124][125][126]. For instance, polymorphism of the CYP2D6 gene for a cytochrome P-450 isoform determines slow or rapid metabolism of many drugs and, eventually, promotes the development of adverse reactions and NDs, including PD [127,128].…”