Points for taking levodopa drugs for patients with Parkinson’s disease

Drug therapy is currently the most important treatment for Parkinson’s disease. Levodopa preparations are still the most effective drug. Surgical treatment is an effective supplement to drug therapy. Rehabilitation, psychotherapy and good nursing care can also be used to a certain extent. Improve symptoms. Although the currently applied treatment methods can only improve symptoms, cannot prevent the progression of the disease, and cannot cure the disease, effective treatment can significantly improve the quality of life of patients.  Parkinson’s disease drug treatment  The main treatment drug for Parkinson’s disease is levodopa, which has obvious effects, but has relatively large long-term side effects. For this reason, for patients before the age of 65, drugs that are not obvious for symptom relief but can protect neurons and alleviate the course of the disease to a certain extent, while patients after the age of 65 can choose levodopa. Drug treatment should follow the following principles:    (1) Start with a small dose, increase slowly, and try to use a smaller dose to achieve satisfactory results;    (2) Individualized treatment plan;    (3) Do not add drugs blindly, do not stop the drug suddenly, you need Take the medicine for life;    (4) The single-drug treatment effect is not satisfactory, and appropriate combination of drugs should be used.  Tips for taking levodopa  (1) It is suitable for taking on an empty stomach. If this medicine is taken with protein, the effect will be greatly reduced, so it is recommended to take it one hour before or one and a half hours after a meal.   (2) It is not recommended to drink milk or eat other protein-containing foods during the medication. Many elderly people have the habit of drinking milk for breakfast, but the protein in milk will also affect the efficacy of the medicine. If you experience the following during the treatment of levodopa: fluctuating symptoms (including three forms of reduced efficacy, switching phenomenon, and freezing phenomenon), dyskinesias (also known as dyskinesia, often manifested as choreo-like-athletesis Spontaneous movement or monotonous, rigid and involuntary movements, etc.), mental symptoms, etc., considering the possible side effects of levodopa, please consult a doctor or contact your attending doctor to adjust the dosage of levodopa. Other commonly used drugs for Parkinson’s disease include anticholinergic drugs (Antan), amantadine, dopamine receptor agonists, monoamine oxidase B inhibitors, catechol-oxygen-methyltransferase inhibitors, etc., which require specialists The doctor will choose the medicine for you personally.   When the drug treatment fails, intolerance or dyskinesia, patients are younger, whose symptoms are mainly tremor, rigidity and are on one side, surgery can be considered. Medications are still needed after surgery. The most commonly used surgical method is deep brain stimulation (DBS), also known as brain pacemaker therapy and minimally invasive brain pacemaker implantation. The therapy is to implant a high-frequency microelectrode stimulation device into the surgical target of a Parkinson’s patient. The voltage and frequency generated by high-frequency electrical stimulation are higher than the voltage and frequency generated by the diseased neuron, thereby inhibiting it. Its advantages are accurate positioning, small damage range, high safety and long-lasting efficacy, but its cost is expensive. However, at present, our hospital can reimburse the cost of brain pacemaker materials in the province’s combined therapy. This is undoubtedly good news for Parkinson’s disease patients. For specific reimbursement expenses, you also need to consult the local reimbursement policy.

Common complications of gastrointestinal function in patients with Parkinson’s disease

  Parkinson’s disease (PD) is one of the most common progressive neurodegenerative diseases. Common symptoms are tremor and slow and stiff movement. However, in the early stages of PD, these symptoms may be subtle at first and usually develop slowly over a few years. Especially in patients with rigid Parkinson’s disease, many complications gradually appear as the disease progresses, and gastrointestinal function will also be affected.  Gastric emptying disorder  PD patients may have drug-induced nausea, but it may also be due to impaired gastric emptying capacity (ie, gastroparesis). In addition to nausea, gastroparesis may also cause vomiting, early fullness, bloating after meals, and upper abdominal pain. The specific epidemiological data of gastroparesis in PD patients are not clear, and it may appear in the entire course of PD.   Since levodopa is absorbed in the small intestine, gastroparesis can delay its absorption, thereby changing the pharmacokinetics of levodopa. The non-retention of levodopa in the stomach not only leads to a delay in its onset time, but also the aromatic amino acid decarboxylase in the gastric mucus layer can also convert the retained levodopa into dopamine, which in turn makes the drug ineffective.   Dopamine antagonist metoclopramide is the standard treatment for gastroplegia, but it is contraindicated in PD patients, because metoclopramide can pass through the blood-brain barrier to antagonize dopaminergic transmitters in the brain. Domperidone (Domperidone) is a dopamine antagonist that cannot pass the blood-brain barrier and is effective in treating gastroparesis in PD patients. However, its potential cardiotoxicity has recently been discovered and it has not been approved for use by the US FDA.   Annotating botulinum toxin to the pyloric sphincter has been shown to be safe and effective in improving gastric emptying disorders in PD patients, but further research and verification are needed. There are also a series of drug and non-drug methods that may be effective in the treatment of gastroparesis, and may also be used for PD patients in the future.  Intestinal peristalsis frequency reduction   Intestinal peristalsis frequency reduction is more obvious in 20-77% of PD patients. It is not clear whether it is caused by enteric nervous system disorders or central nervous system disorders or a common mechanism. Constipation is an important manifestation and an important non-exercise feature of PD. In addition, intestinal volvulus is also a serious complication that is easily overlooked.   The treatment of constipation in PD patients is roughly the same as that of idiopathic constipation. Increasing dietary fiber and fluid intake is the first step, and stool lubricants can be used in conjunction. Osmotic laxatives such as polyethylene glycol, lactulose and sorbitol can be used in the second step. New drugs that promote gastrointestinal motility can also be used, such as lubiprostone.  Non-drug therapy can also treat PD-related constipation. Functional magnetic stimulation can reduce colonic transit time in PD patients, and abdominal massage may also be effective. Special diet ratio can also reduce constipation in PD patients. When other methods are ineffective, enema treatment can be used, and surgical intervention is rarely considered. “Defecation disorders” Two-thirds of PD patients have experienced defecation disorders, and late PD is more common. Mainly from the incoordination of the anorectal muscles and pelvic floor muscles. Such patients can use stool lubricants to make bowel movements easier, but laxatives are usually ineffective. Levodopa may improve anorectal function. Pelvic floor muscle training, physiological reflex training, daily behavior training, and sacral nerve stimulation are possible non-drug methods, but there is no definite research to confirm in PD.

[Medication Guide] “Don’t panic” when there are side effects in Parkinson’s disease drug treatment

   Speaking of the side effects of Parkinson’s disease drugs, I am often at a loss. I seem to be afraid that the side effects will outweigh the positive effects. Parkinson’s patients often ask that the side effects of dry mouth, dizziness and even hallucinations after taking these medicines are more uncomfortable than their own symptoms. In fact, it is not a big deal if you have a right attitude, face the side effects of drugs, and cooperate with doctors in scientific treatment.   Because for Parkinson’s patients, drugs generally need to be taken for life, so today we briefly summarize the side effects of some classic drugs for Parkinson’s disease.   The possible side effects of most Parkinson’s disease drugs: psychiatric symptoms, sleep disorders, gastrointestinal reactions, orthostatic hypotension, edema.  What are the common side effects of Parkinson’s disease drug treatment?  1, psychiatric symptoms  In the early treatment of levodopa, the incidence of hallucinations is only 3%, but with the increase of age and medication time, the incidence of hallucinations is also getting higher and higher.   hallucinations also often appear in patients treated with dopamine receptor agonists, including pramipexole hydrochloride and ropinirole. Generally speaking, in elderly patients and patients with cognitive impairment, Parkinson’s disease drugs may cause confusion. Moreover, anticholinergic drugs can also cause memory loss and cognitive impairment.  2, sleep disturbance  Parkinson’s disease itself has a very close relationship with sleep disturbance. Therefore, in general Parkinson’s disease patients have sleep disturbance, it is judged whether it is caused by the progress of Parkinson’s disease itself or the side effect of anti-Pad drugs. It is mainly related to the patient’s age and drug dosage.  Selegiline is the first cause of sleep disorders caused by anti-pascal drugs. It is generally recommended to take selegiline before noon or before two in the afternoon.   Secondly, amantadine can cause sleep disturbance, and it is not recommended to take it at night.   Daytime sleepiness is also a very common condition. About 16% of Parkinson’s patients have this condition, which is generally considered to be related to disease progression.  3, gastrointestinal reactions    common gastrointestinal side effects caused by anti-pascal drugs are nausea and nausea and vomiting. About half of the patients will develop nausea and abdominal distension when taking levodopa in the initial stage.   Selegiline and Kedan are also anti-pax drugs that cause nausea.  4. Orthostatic hypotension    Orthostatic hypotension is generally called orthostatic hypotension, which usually refers to a decrease in systolic blood pressure by at least 20mmHg or a decrease in diastolic blood pressure by at least 10mmHg when turning from a lying position to an upright position. Orthostatic hypotension is often considered to be the manifestation of autonomic dysfunction in PD, and the occurrence rate is 8.7% to 58.2%. But it may be the characteristics of the disease itself, or it may be the side effect of some anti-Parkinson drugs. Levodopa and dopamine receptor agonists can often cause orthostatic hypotension. In addition, this reaction will appear at the first application. Therefore, dopamine receptor agonists should be started in small doses and added if necessary. Treat sildopa to improve.  5, edema    Parkinson’s patients often have edema in the lower limbs and ankle joints. Relevant data show that ropinirole hydrochloride can cause edema in about 30% of patients, and the probability of Tesuda to cause edema is the lowest 5%.   As the disease progresses, patients with mid- to late-stage Parkinson’s disease will have symptoms of gradual decline in drug resistance due to long-term use of drugs, such as “dose end phenomenon”, “switching phenomenon”, and “dyskinesia”. The appearance of these symptoms can be relieved by adjusting the medication first, but many patients often have poor results and are very painful.   “End-of-dose phenomenon”, the effect of the drug is maintained for shorter and shorter periods of time, and the symptoms of Parkinson’s disease worsen at the end of each medication. Treatment: Increase the number of administrations of levodopa, and use Perkinning controlled-release tablets, dopamine receptor agonists, slan, COMT inhibitors to improve symptoms.   “switching phenomenon” the phenomenon of fluctuations in drug efficacy after long-term use of levodopa drugs in Parkinson’s disease patients. As the basic drugs in the treatment of Parkinson’s disease, levodopa drugs have a good effect in early clinical application. However, after taking levodopa drugs for 3 to 5 years, the limitations of the drug will appear, and the switching phenomenon will appear in the later stage of taking the drug. That is to say, during a day, the patient’s symptoms fluctuate between sudden relief (open period) and aggravated (closed period), which can be repeated and rapidly alternated many times. This kind of change is very fast and unpredictable, just like a power switch. Clinically called

Coping with abnormal movement in patients with Parkinson’s disease

Dyskinesia in patients with Parkinson’s disease is generally a manifestation of overdose of metopa drugs, and its disability rate is very high. It is often manifested as choreography, dystonia, stereotypes and akathisia during attacks. Or a mixture of many.   LID can be divided into peak dyskinesia, bidirectional dystonia and dystonia. Dose peak dysfunction is the most common type, accounting for about 80%, followed by “off phase” dystonia, accounting for about 30%, and bipolar dysfunction accounting for 20%. The typical manifestations of    abnormal movement are involuntary movements of the head and neck, dance-like movements of the torso, and gross tremors of the limbs, which are easily confused with static tremor. Levodopa-related dystonia usually occurs when the blood concentration of levodopa rises or falls, and can be manifested as toe flexion or foot reversal when walking. Dystonia usually also occurs when the blood concentration of levodopa increases or decreases. The most common type is dystonia when the efficacy is reduced. It occurs at night, early in the morning, or at the stage of decreased efficacy after a dose, and can be manifested as Painful muscle cramps of the feet and calves.   Sometimes we see that the patient’s body will experience Parkinson’s symptoms for a while, a momentary movement, or the two appear alternately, with almost no time interval in between. This is paroxysmal dyskinesia, which is called a “yo-yo” reaction. The occurrence of dyskinesia is related to the age of onset, the severity of the disease, the course of the disease, and the length of time of levodopa treatment. The risk of dyskinesia is inversely related to the age of onset of PD, and the risk of dyskinesia with tremor is relatively low. Lower body weight and weight loss during the course of the disease also increase the risk of LID. These influencing factors are also important considerations in the setting of programming parameters and drug adjustments after DBS.   Once a patient develops dyskinesia, it means that the efficacy of the drug will decrease, and the adjustment of the drug will become very difficult. PD treatment guidelines recommend: reduce the dose of compound levodopa to increase the number of times; reduce the dose of compound levodopa, increase the DR agonist; reduce the dose of compound levodopa, increase the COMT inhibitor; add amantadine, add atypical nerves Stabilizer. The direction of new drug research is mainly to improve the continuous stimulation of dopamine receptors and reduce the fluctuation of levodopa.   Although drugs can reduce the duration and intensity of dysmotility to a certain extent, there can be no qualitative changes. The symptoms of dysmotility still exist and continue to increase. However, the improvement of dysmotility by DBS surgery is obvious.

What should I do if there is a “switching phenomenon” in the drug treatment of Parkinson’s disease patients?

The    switch phenomenon is a phenomenon of fluctuations in the efficacy of Parkinson’s disease patients after long-term use of levodopa drugs. As the basic drugs in the treatment of Parkinson’s disease, levodopa drugs have good early clinical application effects. However, after taking levodopa drugs for 3 to 5 years, the limitations of the drug will appear, and the switching phenomenon will appear in the later stage of taking the drug. That is to say, during a day, the patient’s symptoms fluctuate between sudden relief (open period) and aggravation (closed period), which can be repeated and rapidly alternated many times. This kind of change is very fast and unpredictable, just like a power switch. Clinically, this physiological phenomenon is called the switching phenomenon. The switching phenomenon is unpredictable, and the patient is afraid to go out all day long.   “Switching phenomenon” treatment principles and methods?   treatment can increase the number of dopa preparations administered, add dopamine receptor agonists (such as bromocriptine, Xieliangxing, cripple, etc.), COMT inhibitors (gangtan), etc.  What is “dose phenomenon”?   “End-of-dose phenomenon”, also known as reduced efficacy or worsening of end-of-dose, refers to the shortening of the effective action time of each medication and the regular fluctuation of symptoms with blood drug concentration.  Why is it difficult to evaluate the “dose phenomenon”?   Transient and changeable, difficult to be recognized by patients, doctors cannot observe directly, and rely on the subject’s understanding and feelings.   The cause of the “dose end phenomenon”?   The level of levodopa in patients decreased; dopaminergic cells decreased; buffer capacity decreased; post-receptor mechanism.   The treatment of “dose end phenomenon”?   Regulate positive levodopa medication; use levodopa sustained-release agent; add dopamine receptor agonist; add monoamine oxidase-B inhibitor; add COMT inhibitor; surgical treatment.

[Disease Science] Vigilance: Young patients with Parkinson’s disease are increasing

At present, Parkinson’s disease is no longer a “senile disease”, and the population is gradually younger. Due to the lack of understanding of the disease, the non-motor symptoms of early patients lead to misdiagnosis and mistreatment. There are about 2 million to 2.5 million Parkinson’s disease patients in China. People, but there are only 500,000 patients in our country who are receiving treatment, and many people do not realize that they are sick. Therefore, the situation of Parkinson’s disease prevention and treatment in my country is severe, and timely detection and systematic treatment are particularly important.  Experts remind: Hand tremor is not necessarily Parkinson’s.  Many people recognize Parkinson’s disease as hand tremor. Experts emphasize that one of the manifestations of Parkinson’s disease is tremor, which is what everyone calls shaking hands and feet, but not all tremors are Parkinson’s disease. Tremors can be divided into many types, the common ones are physiological tremor, essential tremor and Parkinson’s disease tremor.   Primary tremor is mostly manifested as tremor during activity and rarely occurs at rest. The tremor of Parkinson’s disease is often an involuntary rhythmic tremor when stationary, usually a unilateral hand rubbing movement, and then it will develop to the ipsilateral lower limb and the contralateral limb. In addition, patients may also experience slow motion, high muscle tone, abnormal posture and gait, etc., such as walking only small and broken steps, “mask face”-the patient has a dull expression like wearing a mask.  Vigilance: The number of young patients with Parkinson’s disease is increasing.   Parkinson’s disease has always been called “the disease of the elderly”, and it mostly occurs in the elderly over 50. At present, the specific causes of Parkinson’s disease are unknown, but aging, genetic genes and environmental toxin exposure are considered to be the most important related factors. However, related reports show that young people may also suffer from Parkinson’s disease due to environmental pollution, brain trauma, drug abuse and other factors. Clinically, the number of Parkinson’s disease patients under 50 years old is increasing, and it is not uncommon for young patients in their 30s, even teenagers. Statistics show that “juvenile Parkinson’s disease” patients account for 10% of the total number of patients with the disease. Therefore, it is very important to detect disease signals from the body in time.   People are getting older and their movements are not as flexible as before. Many people think that this is a normal manifestation of body decline in old age, but if the movement is very slow and there is a trend of gradual aggravation, then you must be alert to the possibility of Parkinson’s disease. One of the main symptoms of Parkinson’s disease is slow movement. It only takes a few seconds for a normal person to raise his hand and make a fist, but it may take 1-3 minutes for a person with Parkinson’s disease, which is very slow and clumsy, especially in fine detail. Slower in action. Experts remind that at home, you can simply test whether there is a sign of Parkinson’s disease through a handwriting experiment, that is, copy three or four lines of text continuously. If the font becomes smaller and smaller, the more difficult it is to recognize, you should pay attention to it. Distinctive characteristics of Parkinson’s writing.  Early treatment is very important  Early treatment is divided into non-drug treatment and drug treatment. Non-drug treatment includes understanding and understanding the disease, supplementing nutrition, strengthening exercise, strengthening the confidence to overcome the disease, as well as the understanding, care and support of the society and family. In the early stage of Parkinson’s disease, the goal of drug therapy should be to improve motor symptoms and prevent motor complications. It is recommended to use dopamine receptor agonists and monoamine oxidase inhibitors alone. Those with poor symptom improvement or those with higher social work requirements can be combined Dose levodopa, combined with optimized small doses of multiple drugs, strive to achieve the best therapeutic effect, longer maintenance time, and reduce the incidence of dyskinesia complications. Deliberately delaying the use of levodopa has no significant meaning in preventing the occurrence of sports complications. In terms of age of onset, for early-onset patients, dopamine receptor agonists (pramipexole, cabergoline, ropinirole) or monoamine oxidase-B inhibitors (selegiline, rasagiline) are generally used first , Dopamine receptor agonists or monoamine oxidase-B inhibitors can delay the application of levodopa. Compound levodopa is the first choice for patients with late onset. Levodopa should start with a small dose, adhere to the principle of “dose titration”, and gradually increase the dose slowly, and strive to “as small as possible to achieve satisfactory clinical effects”.

What are the main points to follow in the early treatment of Parkinson’s disease?

   Early treatment is divided into non-drug treatment and drug treatment. Non-drug treatment includes understanding and understanding the disease, supplementing patients’ nutrition, strengthening rehabilitation exercises, and strengthening the confidence to overcome the disease. It also requires the understanding, care and support of the society and family. In the early stage of Parkinson’s disease, the goal of drug treatment should take into account the improvement of motor symptoms and prevention of motor complications. Those with higher requirements for social work can use small doses of levodopa, and use optimized small doses of multiple drugs in combination to achieve therapeutic effects The best, longer maintenance time, the treatment goal of reducing the incidence of dyskinesia complications. Deliberately delaying the use of levodopa has no significant meaning in preventing the occurrence of sports complications. In terms of age of onset, for early-onset patients, dopamine receptor agonists (pramipexole, cabergoline, ropinirole) or monoamine oxidase-B inhibitors (selegiline, rasagiline) are generally used first , Dopamine receptor agonists or monoamine oxidase-B inhibitors can delay the application of levodopa. Compound levodopa is preferred for late-onset patients. Levodopa should start with a small dose, adhere to the principle of “dose titration”, and gradually increase the dose slowly, and strive to “as small as possible to achieve satisfactory clinical effects”. Key points for the treatment of Parkinson’s disease in advanced stage Parkinson’s disease is in advanced stage. The daily life and activity ability and quality of life of patients are severely impaired due to sports complications. The treatment strategy should adopt drug treatment, and even surgical treatment to relieve symptoms and improve sports complications. Reduce the dosage of medications, reduce the rate of sickness, and improve the quality of life of patients. Parkinson’s disease is often accompanied by dyskinesia complications, including symptom fluctuations, dyskinesias, “switching phenomenon” and “freezing phenomenon”. Different types of motor complication have different mechanisms and treatment strategies. It is clear that the type is reasonable treatment The premise.   At present, both domestic and foreign countries have formulated corresponding treatment strategies according to different types of sports complications. It is recommended to fully consider the patient’s condition in specific applications and emphasize individualized drug treatment to minimize sports complications. The following measures can be taken:   1, find the intersection point, which can achieve better curative effect without causing abnormalities;   2, increase the number of medications, reduce the dose of each medication, and the daily dose of the drug will remain unchanged;   3, switch to a controlled release dosage form Increase the dosage appropriately;   4. Add other drugs with a relatively long half-life, such as dopamine receptor agonists, to provide relatively continuous dopaminergic stimulation and reduce the dosage of levodopa. After the “honeymoon period” of Parkinson’s disease drug treatment, if the course of the diagnosed primary PD reaches more than 5 years or the efficacy of the drug has decreased significantly, surgical treatment may be considered. At this time, brain pacemaker implantation is a good choice. Especially for patients with sports complications to improve the quality of life.   However, the timing of the brain pacemaker implantation operation is very important, and the effect will not be good if it is too early or too late. The “Expert Consensus on Deep Brain Electrical Stimulation Therapy for Parkinson’s Disease in China” released not long ago believes that patients with primary PD who have taken levodopa drugs have had a good effect, and the effect has been significantly reduced or severe motor fluctuations or dyskinetics have appeared. Consider surgery when considering the quality of life. The course of the patient’s disease is usually more than 5 years, and the age in principle is not more than 75 years old, but it can also be moderately relaxed according to the evaluation results and the patient’s wishes.

Application of sustained-release preparations in the treatment of Parkinson’s disease

The most profound feeling of Parkinson’s disease patients during treatment is that they are really meticulous about taking medications, and they don’t dare to neglect them, because a little later, their ability to take care of themselves will be threatened. On the good side, Parkinson’s patients take medications with particularly good compliance. From a negative point of view, patients with Parkinson’s disease are still deeply troubled by drugs. Many times a day, before and after meals, they sometimes get confused. Parkinson’s disease is a degenerative disease of the central nervous system that is common in middle-aged and elderly people with progressive vertebral extracorporeal dysfunction. The currently recognized pathogenesis “dopamine theory” believes that the denaturation of dopaminergic neurons in the dense substantia nigra leads to substantia nigra The dopamine neurotransmitter in the striatum pathway is significantly reduced, leading to Parkinson’s disease.  L-dopa has become the first choice for the treatment of Parkinson’s disease, but it cannot effectively prevent and delay the course of the disease. Long-term use will also cause serious adverse reactions such as hyperactivity, symptom fluctuations and mental symptoms. In response to the deficiency of levodopa, dopamine receptor agonists have brought new hope for the treatment of patients with Parkinson’s disease. Dopamine receptor agonists are different from levodopa in that they are absorbed more completely and are not affected by other factors such as food. After entering the brain, its half-life in the striatum is relatively long, producing a longer-lasting receptor stimulating effect than levodopa, which is beneficial to overcome the adverse effects of levodopa symptoms fluctuations. Second, dopamine receptor agonists can directly stimulate dopamine receptors, without relying on the presence of endogenous dopamine and changes in its metabolism and synthetic storage. L-dopa therapy in the late stage of Parkinson’s disease, due to the depletion of dopamine decarboxylase activity in the substantia nigra striatum, so that exogenous levodopa cannot be decarboxylated into dopamine, even if the dose is increased, it is not effective for the treatment of Parkinson’s disease. Dopamine receptor agonists are still effective even in the later stages of Parkinson’s disease. Therefore, more and more neurologists now advocate dopamine receptor agonists as the preferred treatment for Parkinson’s disease to reduce or replace the use of levodopa.   Then the question is coming again! Under normal physiological conditions, the activity of normal nigra dopaminergic neurons is stable, and the striatum dopamine content is also maintained at a relatively stable level. However, the stimulation of dopamine receptors on the dopamine receptors by the regular preparations of dopamine receptors taken several times a day is intermittent and discontinuous, which is not consistent with its physiological state. As a result, scientists have developed a sustained-release preparation, which is given once a day to continuously excite dopamine receptors.  The main purpose of changing the dosage form is to meet the needs of clinical treatment. There are many types of clinical diseases, and there are symptoms and emergencies. The appropriate route of administration and corresponding dosage form should be determined according to the type and characteristics of the disease. For example, for the treatment of acute diseases such as angina pectoris and acute bronchial asthma, injections are generally preferred; while for the treatment of some chronic diseases, such as hypertension, Parkinson’s disease, epilepsy, depression, etc., slow-release preparations are suitable dosage forms. The release preparation can maintain a stable blood drug concentration, reduce the frequency of taking medicine, facilitate the patient to take medicine, and improve the patient’s compliance with taking medicine. With the continuous deepening of the understanding of the pharmacological characteristics of drugs, the research direction of sustained and controlled release preparations in recent years has been a more high-tech time-release drug system, which releases effective therapeutic doses of drugs at regular intervals according to physiological needs. To ensure a stable blood drug concentration and achieve the best therapeutic effect, I believe that more promising research results will emerge in the field of Parkinson’s disease treatment in the future.  Xining and Medopa are levodopa drugs, and their principle of action is to compensate for the deficiency of the patient’s own dopamine content and adjust the corresponding damage to brain function caused by the reduction of dopamine. The difference is that Xining is a complex of carbidopa and levodopa in a ratio of 1:4. It is a controlled-release tablet that can be slowly decomposed in the stomach and released for a long time, generally 4-6 Effective ingredients are released within hours, with slow onset and long duration of drug effects.

Parkinson’s age “high incidence”

 Parkinson’s disease is a middle-aged and elderly disease that is common around 65 years old. There are currently about 2 million patients with Parkinson’s disease in my country. The analysis pointed out that 25 years later, our country’s Parkinson’s disease patients are expected to reach 5 million.  This is the number that the reporter learned at the media meeting of “Parkinson’s Disease Treatment Status and Challenges” a few days ago. Parkinson’s disease is a common neurological dysfunction. Its symptoms are involuntary tremors in the hands, head, or mouth when it is at rest, muscle rigidity, and slow movements, which cause patients to be unable to take care of themselves.  Introduction: Levodopa is a drug used by patients with Parkinson’s disease sooner or later. Although these drugs can control tremor and other motor symptoms, but after 3 to 5 years of use, about 50% of patients will experience “end-of-agent phenomenon” “switch phenomenon” and other sports complications. Therefore, the current international and domestic guidelines for the treatment of Parkinson’s disease recommend dopamine agonists such as sinophorus as the first choice for early treatment of Parkinson’s disease, and then add levodopa to the middle stage.   “Postponing the use of levodopa drugs also delays the occurrence of motor complications.” However, in my country, the proportion of receptor agonist recommended in the diagnosis and treatment guidelines is only 30%.   “The index of choice of treatment for Parkinson’s patients in my country is not the efficacy, but mainly the price.” At present, some drugs with good efficacy are not included in the scope of medical insurance reimbursement, which results in a lower proportion of drug use to some extent. To this end, the government is called upon to “open the door” for the treatment of new drugs for Parkinson’s disease, to improve social security for Parkinson’s disease, and to include all or part of the drugs with excellent efficacy in the coverage of Parkinson’s patients. The price allows more Parkinson’s patients to improve their quality of life.   “Drug end phenomenon” means that the duration of drug effect is getting shorter and shorter, and the symptoms of Parkinson’s disease worsen in the late stage of each medication. The “switch” phenomenon is manifested as a sudden stiffness and inability to move, such as a sudden failure to walk when walking. “Abnormality” refers to the patient’s uncontrollable hand-dancing symptoms after taking the medicine.

Parkinson’s “eating and drinking” problem

  Parkinson’s disease (tremor paralysis) is a disease of the central nervous system common to the elderly after Alzheimer’s disease.  Attention should be paid to the following points when eating:    1. Do not ingest too much food before taking the medicine, so as not to hinder the absorption of the medicine and affect the curative effect. Generally, a small amount of easily digestible food can be taken before taking the medicine.   2. Avoid excessive intake of foods containing vitamin B6, because vitamin B6 can affect levodopa and other anti-tremor paralysis drugs into the brain. Such foods mainly include: beans, potatoes, buckwheat flour, sunflower seeds, bananas, peanuts, etc.   3. Limit protein in breakfast and lunch, make up for dinner. Because large neutral amino acids in protein can compete with levodopa for the blood-brain barrier and affect the entry of drugs into the brain, avoid eating protein-rich foods such as milk and eggs as much as possible for breakfast and lunch. The protein needed by the human body can be supplemented at dinner.  Attention should be paid to the following points when drinking:    1. Levodopa needs to be dissolved in an acidic environment, so if you take such drugs, you can drink acidic drinks (such as lemon juice) to facilitate absorption and improve the efficacy.   2. Drinking: Because patients with tremor paralysis have postural reflexes, a large amount of drinking affects the balance function, and it is easy to cause reversal, but a small amount of drinking generally has little effect. For patients with depressive symptoms, proper drinking can refresh and promote appetite. 3. Coffee, tea and other beverages: Caffeine and theophylline can inhibit drowsiness. Patients with Parkinson’s disease, especially elderly patients, are sleepy all day long after getting up in the morning. Using dopamine receptor agonists is more prone to drowsiness. Therefore, drinking tea and coffee is beneficial to overcome these phenomena. 

Parkinson’s dietary treatment principles

Nutrition plays a very important role in the health of patients with Parkinson’s disease. Diet therapy is one of the adjunct treatment methods for Parkinson’s disease. The purpose is to maintain better nutrition and physical condition of the patient, and to adjust the diet to make the drug treatment achieve better results. Let us understand the principles of Parkinson’s diet therapy.  Parkinson’s Diet Therapy 1: Foods are varied and pleasant to eat   Different foods in a day’s diet, including cereals, vegetables, fruits, milk or beans, meat, etc. Diverse foods can satisfy the body’s needs for various nutrients and make the diet itself fun. Eat happily in a relaxed environment and atmosphere, let the diet be a life enjoyment.  Parkinson’s Diet Therapy 2: Eat more cereal vegetables and fruits  Usually eat 300-500 grams of cereal foods such as rice, noodles, and cereals. You can get carbohydrates, protein, dietary fiber, vitamin B and other nutrients from cereals, and get the energy your body needs. Carbohydrates usually do not affect the efficacy of levodopa.  Each day eat about 300 grams of vegetables or melons, 1 or 2 medium-sized fruits. Get vitamins A, B, C, various minerals and dietary fiber from it.  Parkinson’s diet three: eat milk and beans in moderation   Milk is rich in calcium. Calcium is an important element of bones, so for elderly Parkinson’s disease patients who are prone to osteoporosis and fractures, drinking 1 cup of milk or yogurt every day is an excellent way to supplement the body’s calcium. However, because the protein content of milk may have a certain effect on the efficacy of levodopa, in order to avoid affecting the effect of medication during the day, it is recommended to drink milk and arrange it before bed at night. In addition, eating soy products such as tofu and dried tofu can also supplement calcium. According to research reports, broad beans (especially broad bean pods) contain natural levodopa. Adding broad beans to the diet of patients with Parkinson’s disease can make the patient’s levodopa and methyl dopazide compound drugs (such as Xining) &nbsp.) The release time is extended from the usual 2 hours to 5 hours. This function of broad beans may be helpful for the treatment of Parkinson’s disease, but further experimental proofs are needed.  Parkinson’s Diet Therapy IV: Limit meat consumption  Because some amino acids in food protein will affect the action of levodopa drugs into the brain, it is necessary to limit protein intake. Eat about 50 grams of meat every day, choose lean livestock, poultry or fish. One egg contains protein equivalent to 25 grams of lean meat. Meat food can be distributed in the morning, evening or lunch, and dinner, but for some patients, in order to make the daytime medicine better, you can also try to arrange protein-rich food only at dinner during the day.  Reminder: Whether it is in daily life, or before or after Parkinson’s examination or treatment, it is necessary to pay attention to Parkinson’s dietary treatment to avoid Parkinson’s occurrence. Parkinson’s diet therapy must attract the attention of patients and live a healthy life in order to make life more healthy.

How to choose Parkinson’s disease drug receptor agonist and levodopa?

  Parkinson’s patients often discuss and share the experience of medication, and the outpatient department often encounters patients to ask which medicine is best. In fact, only the most suitable, from the perspective of improving the motor symptoms of Parkinson’s disease, I am afraid there is no medicine comparable to levodopa. However, due to some irresistible side effects-end-of-drug phenomenon, switching phenomenon, dyskinesia, etc., for patients with moderate disease or above, patients with high quality of life requirements, and older patients with dementia, levodopa is First choice. For early patients with mild symptoms, young patients with long life expectancy, and patients who do not require excessive quality of life, dopamine receptor agonists are a good choice.  Why use receptor agonists?   First, although the receptor agonist is not a neurotransmitter of levodopa, it can still play an anti-Parkinson’s disease similar to levodopa, so it has become an alternative to levodopa. Secondly, as mentioned earlier, levodopa has some insurmountable drug side effects in the later period of administration. Compared with it, the chance of receptor agonists producing similar side effects is significantly reduced. This is especially significant for young patients, because these people have a long course of disease and are more prone to levodopa-related symptom fluctuations and dyskinesia, which puts an end to the effective period of drug treatment. The receptor agonist can be monotherapy within a certain time range, so it can delay the use of levodopa drugs, and thus delay the occurrence of side effects of levodopa drugs, prolong the drug treatment time window of Parkinson’s disease patients. In addition, it also has the advantages of not competing with food proteins to enter the blood-brain barrier, independent of dopamine concentration in the body, and antidepressant effects.  How to choose dopamine receptor agonist?  Receptor agonist selection has the following considerations: (1) Use non-ergot type. Ergot receptor agonists have withdrawn from the rivers and lakes due to the side effects of heart valve fibrosis, but it is not ruled out that some remote areas may continue to be used, especially bromocriptine. Receptor agonists currently on the market include pramipexole and piredil, both of which are non-ergot. (2) Whether there are contraindications for liver and kidney function. If the liver function is abnormal, most drugs excreted from the kidney (such as pramipexole: sinophoro) can be considered; if there are patients with poor kidney function, receptor agonists with liver metabolic pathways (such as piredil can be considered) : Taishuda). (3) Reference half-life. (4) Consider cost performance. (5) Tolerance of side effects. (6) Consider the availability of drugs. What are the side effects of    receptor agonists?  The most common side effects are gastrointestinal reactions and drowsiness, which are also the most common reasons for patients not to be able to increase the amount smoothly or be forced to change medicines. For gastrointestinal reactions, patients can usually be advised to take the medicine after a meal or to take it with a meal. For drowsiness, it is necessary to pay attention to avoiding risky activities such as driving and working at heights when starting medication and during the dosage process. For the elderly and patients who have too much sleep during the day, the use and dosage should be especially careful. Slow dosage can reduce the risk of side effects. In addition, postural hypotension and impulse control disorders also need attention. The latter manifestations include impulsive shopping, increased sexual impulse, pathological gambling, overeating and other abnormal behaviors.  Although dopamine receptor agonists have good effects, they are not magic drugs for curing Parkinson’s disease, and they are not without drawbacks. Therefore, it is the right choice to objectively understand the long-term nature of Parkinson’s disease, understand the purpose of the doctor’s use of each drug, and communicate with the doctor in a timely manner when encountering problems. After all, there is no best medicine, only the doctor who knows the best!

What should I do if I have dyskinesia in Parkinson’s disease?

Patients with Parkinson’s disease usually use drug treatment in the early stage. However, as the disease progresses, patients with advanced Parkinson’s disease will gradually reduce the drug resistance efficacy due to long-term use of drugs, such as “end-of-agent phenomenon” and “switching phenomenon”. “, “dyskinesia” and so on. The appearance of these symptoms can first be adjusted to relieve medication, but many patients often suffer from poor results. “End-dose phenomenon” means that the duration of drug effect is getting shorter and shorter, and the symptoms of Parkinson’s disease deteriorate in the late stage of each medication. Treatment: Increase the frequency of administration of levodopa. The use of Parkinin controlled-release tablets, dopamine receptor agonists, slan, COMT inhibitors can improve symptoms. “Switching phenomenon” is the fluctuation of the drug effect that occurs in patients with Parkinson’s disease after long-term application of levodopa drugs. As a basic drug in the treatment of Parkinson’s disease, levodopa drugs have a good effect in early clinical application. However, after taking levodopa drugs for 3 to 5 years, the limitations of the drugs will appear, and the switching phenomenon will appear in the later period of taking the drugs. That is to say, during a day, the patient’s symptoms fluctuate between sudden remission (on period) and aggravation (off period), and can appear repeatedly and quickly alternately multiple times. This change is very fast and unpredictable, just like a power switch. Clinically, this physiological phenomenon is called a switching phenomenon. The switching phenomenon is unpredictable, and the patient is afraid of going out all day long. What is Parkinson’s “dyskinesia”? Dyskinesia is a long-term application of Medopa in patients with Parkinson’s disease. It is an uncontrollable abnormal action after treatment. Patients move from inactivity (the original symptoms of Parkinson’s disease patients) to the other extreme: uncontrollable disturbances, which are often very painful. Dyskinesia is an uncontrollable abnormal movement that occurs after long-term treatment of dopamine preparations (mainly levodopa) in patients with Parkinson’s disease. The patient moved from being unable to move (the original symptom of Parkinson’s disease patients) to the other extreme: uncontrollable disturbances such as tongue sticking, crooked mouth frowning, flicking hands, stomping feet, twisting his head, waist swinging and even dance-like movements all over the body, which was very painful. Clinical manifestations of dyskinesia: The dyskinesia symptoms of patients with Parkinson’s disease can be dance-like, stereotyped movements, and dystonia. Symptoms mainly affect the trunk and limbs or head and face. There are three common clinical types: off-stage dystonia: often manifested as painful cramps in the lower legs and feet, most of which occur when the blood concentration of levodopa is low before taking the medicine in the morning. How to prevent and manage dyskinesia: Once dyskinesia occurs, clinical treatment is very troublesome, and the best way is of course to delay its occurrence. At present, the early prevention strategy is mainly to use dopamine agonists for initial treatment. The dopamine receptor agonist CALM-PD study confirmed that compared with the initial treatment of levodopa, the initial treatment of dopamine receptor agonist can delay and reduce the occurrence of dyskinesia. Secondly, it is necessary to use drugs scientifically and standardizedly. Some patients in the clinic ignore this point. If they do not go to the hospital, a professional doctor will judge the condition and adjust the drug. They will adjust the dose and change the drug without authorization. Today, if someone hears that the drug is effective, try it. Add that medicine if it’s good. Irregular medication time, regardless of the interval between medications and dosage, as long as you are in good condition. This is also a relatively common cause of dyskinesia. If there is dyskinesia, you should consult your specialist in time. Generally speaking, the doctor may consider the following treatment options according to different types: reduce the dose of compound levodopa or reduce the amount of compound levodopa each time, and add dopamine to Body agonist or COMT inhibitor; add amantadine; after the drug adjustment, the effect of surgery is considered very little.

How to prevent and manage the factors that affect Parkinson’s disease drug treatment?

Dyskinesia is an uncontrollable abnormal movement that occurs in patients with Parkinson’s disease after long-term treatment with dopamine preparations (mainly levodopa). The patient moved from being unable to move (the original symptom of Parkinson’s disease patients) to the other extreme: uncontrollable disturbances such as tongue sticking, crooked mouth frowning, flicking hands and stomping feet, twisting his head and swinging his waist, and even dance-like movements all over the body, which was very painful. Pa You once described his experience when he was moving: when he was awake, his limbs experienced involuntary physical movements, and his brain was completely out of control. This phenomenon sometimes lasts for hours and is exhausted. Among Parkinson’s disease patients with a course of more than 15 years, 94% can have dyskinesia, and 12% of patients think that dyskinesia is very serious, resulting in a significant decline in the quality of life of these patients. Possible factors affecting dyskinesia: 1. Age of onset, course of disease and use of dopamine preparations: Patients with early-onset (onset age <59 years) have a higher risk of dyskinesia after taking the drug, and dyskinesia symptoms often appear early in the disease . 53% of patients with early-onset Parkinson's disease can develop dyskinesia within 5 years of treatment with levodopa, and within the same time limit, the proportion of patients with late-onset dyskinesia is 16%. 2. It is related to gender. The incidence of dyskinesia in women is higher than that in men. It may be related to the expression of dopamine receptor gene DRD2 in women is higher than that in men. In addition, the average body weight of women is lower than that of men. The bioavailability of the drug is higher than that of men. Therefore, the risk of female dyskinesia being higher than that of males may also be related to differences in body weight and pharmacokinetics. 3. Genetic factors: clinically, some patients will not experience any movement complications even if large doses of levodopa are used for a long time. It is known that some special gene polymorphisms of dopamine D2 receptor can reduce the occurrence of dyskinesia. How to prevent and manage dyskinesia? Once dyskinesia occurs, clinical management is very troublesome, and the best way is of course to delay its occurrence. At present, the early prevention strategy is mainly to use dopamine agonists for initial treatment. The dopamine receptor agonist CALM-PD study confirmed that compared with the initial treatment of levodopa, the initial treatment of dopamine receptor agonist can delay and reduce the occurrence of dyskinesia. Secondly, it is necessary to use drugs scientifically and standardizedly. Some patients in the clinic ignore this point. If they do not go to the hospital, a professional doctor will judge the condition and adjust the drug. They will adjust the dose and change the drug without authorization. Today, if someone hears that the drug is effective, try it. Add that medicine if it's good. Irregular medication time, regardless of the interval between medications and dosage, as long as you are in good condition. This is also a relatively common cause of dyskinesia. In general, the following treatment options may be considered according to different types: (1) reduce the dose of each compound levodopa; (2) or reduce the amount of compound levodopa, plus dopamine receptor agonist or COMT inhibitor ; (3) Add amantadine; (4) In severe cases, consider surgical treatment.

[Question answer] Why do patients with Parkinson’s disease take levodopa?

  In the Parkinson’s disease clinic, patients are often asked why they are diagnosed with Parkinson’s disease, but taking levodopa drugs (medopa or Xining) is not effective? Will the patient wonder if the diagnosis is wrong? Or is the medicine wrong? There are not many patients and family members who have such doubts. In the eyes of a specialist in Parkinson’s disease, this condition is a common problem. The specific reasons are as follows: 1. It is Parkinson’s syndrome rather than Parkinson’s disease. This is the most common cause. According to statistics, among patients with Parkinson’s performance, about 40% of patients have no clear effect after taking levodopa drugs, and 60% of patients have significant improvement after taking the drug. For patients who are ineffective, it is necessary to consider Parkinson’s syndrome rather than Parkinson’s disease, and further systematic examination is required to analyze which type of Parkinson’s syndrome.  Some patients are reluctant to perform the necessary specialist examinations, and some non-specialist doctors do not know what examinations to take. If they take the medicine rashly, problems and contradictions may occur.   2. Insufficient dose of medication    Some patients who complain about ineffectiveness of taking levodopa are actually caused by insufficient dose of medication. Although taking levodopa drugs, but did not reach the effective dose, so it is not effective or the effect is not satisfactory.  Because of the individual differences in patients with Parkinson’s disease, it is not that the effective dose of patients with early Parkinson’s disease is low. I have encountered some patients with Parkinson’s disease, the onset of which is within a year, but starting to take a small amount of levodopa drugs is not effective until it is increased to a large dose.   Sometimes the dosage of patients taking levodopa is not small, but due to the influence of gastrointestinal function and diet, they are not fully absorbed, resulting in poor or ineffective treatment. If the treatment is standardized by drugs, the effect is getting worse, and patients with diagnosed Parkinson’s disease can be suitable for the treatment of “branch pacemaker”, especially those drugs (medopa or Xining) are effective or Previously effective, but after long-term use, the efficacy has diminished, and there have been “on and off” fluctuations. Called the “off” state). This switching fluctuation is common in patients who have taken Medopa or Xining for many years, and most of them appear 3 to 5 years after starting the drug. For patients with primary Parkinson’s disease who have responded well to taking levodopa, the efficacy of anti-Parkinson’s drugs has gradually decreased or side effects have occurred. The patient’s motor symptoms have caused significant dysfunction. The patient’s physical and mental state is suitable for surgical treatment , Can accept brain stimulator treatment. Specific evaluation of each patient’s suitability for surgery requires professional evaluation.

Early “hidden” symptoms of Parkinson’s disease: stiffness and soreness in joints

If the elderly suffers from tremors in their hands and feet, they often attract the attention of their families and take them to the doctor. Diseases can be treated promptly and effectively. For patients with rigid Parkinson’s disease, the condition is often delayed. Mainly due to the stiffness of the limbs outsiders cannot see and are often overlooked. Generally speaking, in the early stages of the disease, patients will feel inflexible limb movements, do not like sports, neck and shoulder muscle pain. It is often considered to be a manifestation of aging, and some patients even go to the orthopedics clinic because of neck muscle stiffness and soreness. Therefore, if the elderly have the following symptoms, they need to go to the neurology department to seek medical treatment as soon as possible. 1. The limbs and body have lost their flexibility and become very stiff. 2. In the early stage, it usually starts from one limb. At the beginning, I felt that one limb was inflexible and stiff, and gradually increased. It was difficult to move slowly or even perform some daily activities. 3. Neck, shoulder, arm or leg pain. Parkinson’s disease patients with stiff lower limbs are often accompanied by paroxysmal cramps. Patients may have toe paw-like extensions during sleep at night or when they wake up. Toe cramps and pain may be associated with walking. Patients with low back pain are often accompanied by a flexion-like standing posture. When the patient stands up or lies down, the pain can be relieved quickly; the back leaning of the sitting position is often more obvious, accompanied by increased pain, which reflects the body posture and muscle rigidity. The main cause of pain can also be neck and shoulder pain, headache, and arm aches. When treating pain caused by Parkinson’s disease muscle rigidity, antipyretic analgesics such as aspirin are often ineffective; while applying levodopa to improve motor symptoms, most patients’ pain often relieves as muscle tone decreases. However, in the later period of medication, a small number of patients will have spastic pain in the lower limbs, especially the toes, during the peak period of levodopa effect. In this case, reducing the single dose of levodopa to increase the number of administrations, or increasing the dopamine receptor agonist, can generally achieve good results. In severe cases, you can consider local injection of botulinum toxin in the spasm muscle to control the symptoms .

Characteristics of sustained-release preparations for the treatment of Parkinson’s disease

The most profound feeling in the treatment of Parkinson’s disease patients is that they are really meticulous about taking medications, and they don’t dare to neglect them, because a little later, their ability to take care of themselves will be threatened. On the good side, Parkinson’s patients take medications with particularly good compliance. From a negative point of view, patients with Parkinson’s disease are still deeply troubled by drugs, many times a day, before and after meals, sometimes they get confused. Parkinson’s disease is a degenerative disease of the central nervous system that is common in middle-aged and elderly people with progressive vertebral extracorporeal dysfunction. The currently recognized pathogenesis “dopamine theory” believes that the dopaminergic neurons in the dense substantia nigra degenerate, causing substantia nigra Dopamine neurotransmitters in the striatum pathway are significantly reduced, leading to Parkinson’s disease. L-dopa has become the first choice for the treatment of Parkinson’s disease, but it cannot effectively prevent and delay the course of the disease. Long-term use can also cause serious adverse reactions such as hyperkinesia, symptom fluctuations and mental symptoms. In response to the deficiency of levodopa, dopamine receptor agonists have brought new hope for the treatment of patients with Parkinson’s disease. Dopamine receptor agonists, unlike levodopa, are more completely absorbed and are not affected by other factors such as food. After entering the brain, its half-life in the striatum is relatively long, producing a longer-lasting receptor stimulation effect than levodopa, which is beneficial to overcome the adverse reactions of levodopa symptoms fluctuations. Second, dopamine receptor agonists can directly stimulate dopamine receptors, without relying on the presence of endogenous dopamine and changes in its metabolism and synthetic storage. L-dopa therapy in the late stage of Parkinson’s disease, due to the depletion of dopamine decarboxylase activity in the substantia nigra striatum, so that exogenous levodopa cannot be decarboxylated into dopamine, even if the dose is increased, it is not effective for the treatment of Parkinson’s disease. Dopamine receptor agonists are still effective even in the later stages of Parkinson’s disease. Therefore, more and more neurologists now advocate dopamine receptor agonists as the preferred treatment for Parkinson’s disease to reduce or replace the use of levodopa. Then the question is coming again! Under normal physiological conditions, the activity of normal nigra dopaminergic neurons is stable, and the striatum dopamine content is also maintained at a relatively stable level. However, the stimulation of dopamine receptors on the striatum dopamine receptors by the common preparations of dopamine receptors taken several times a day is discontinuous and discontinuous, which is not consistent with its physiological state. As a result, scientists have developed a sustained-release preparation, which can be continuously stimulated by dopamine receptors. The main purpose of changing the dosage form is to meet the needs of clinical treatment. There are many types of clinical diseases, and there are symptoms and emergencies. The appropriate route of administration and corresponding dosage form should be determined according to the type and characteristics of the disease. For example, for the treatment of acute diseases such as angina pectoris, acute bronchial asthma, injections are generally preferred; while for the treatment of some chronic diseases, such as hypertension, Parkinson’s disease, epilepsy, depression, etc., slow-release preparations are suitable dosage forms, slow-control The release preparation can maintain a stable blood drug concentration, reduce the number of medications taken, facilitate the patient’s medication, and improve the patient’s compliance with medication. With the continuous deepening of the understanding of the pharmacological characteristics of drugs, the research direction of sustained and controlled release preparations in recent years has been a more high-tech time-release drug system, which releases effective therapeutic doses of drugs in a regular and quantitative manner according to physiological needs. To ensure a stable blood drug concentration and achieve the best therapeutic effect, I believe that more promising research results will emerge in the field of Parkinson’s disease treatment in the future. Xining and Medopa are levodopa drugs, and their principle of action is to compensate for the deficiency of the patient’s own dopamine content and adjust the corresponding damage to brain function caused by the reduction of dopamine. The difference is that Xining is a compound of carbidopa and levodopa in a ratio of 1: 4. It is a controlled-release tablet that can be slowly decomposed in the stomach and released for a long time, generally 4-6 Effective ingredients are released within hours, with slow onset and long duration of drug effects.

Common questions about Parkinson’s disease patients taking medication

Frequently encountered patients ask the experts about how to eat Parkinson’s disease medicine: When is the best time to eat? Morning or evening? Is it better to take medicine before a meal or after a meal? Can you break the medicine apart or chew it up? Today, let me talk about some issues that need to be paid attention to when taking medicine for Parkinson’s disease. First of all, patients with Parkinson’s disease should take medication on time, which is the most important. There are many kinds of drugs for the treatment of Parkinson’s disease. Some drugs have to be taken several times a day, plus those for the treatment of other diseases. Many patients with Parkinson’s disease need to take more than 3-4 kinds of drugs a day. Because there are too many medicines to take, and most of the medicines have to be taken several times, sometimes I do n’t remember and forget to take it. Sometimes I should take it 3 times, but I only took it once. The result is naturally an effective control of the disease. Therefore, in order to be able to take the medicine on time, Professor Wang Maode strongly recommends that everyone make a timetable for taking medicine, although simple, but very practical. The first column records the time and name of the medicine to be taken, and then writes the time and dose of each meal according to how many meals a day, and then sets the alarm clock, so it is not easy to make a mistake. There is also a remark in the last column. If something is uncomfortable and what happened, you can write it down. If you need to see the doctor in the future, you can take out this form and the doctor can help you according to it. Adjust medication. Second, there is a problem with the time of taking the medicine. For example, these two drugs, selegiline and amantadine, should be taken in the morning and noon, preferably before 4 pm, not in the evening, what will happen if you eat them? Will not fall asleep, will cause insomnia and dreaminess. There is another medicine to pay special attention to. It must be taken with levodopa to be effective. It is called entacapone (Ketan). It is not effective to take it alone. Third, the medicine cannot be stopped at will, what happens when it stops? First of all, like antihypertensive drugs, if you do not take antihypertensive drugs, your blood pressure will become very high in a few days. Similarly, if you stop the treatment of Parkinson’s disease, you will not be able to wait for a few days. After the energy has passed, your symptoms will get worse. Secondly, drugs such as levodopa (including Medopa and Xining) cannot be stopped suddenly. Sudden withdrawal will cause serious consequences. In medicine, it is called malignant withdrawal syndrome. In severe cases, it may be life-threatening . Therefore, pay more attention to see if the medicine is almost finished and buy it in advance. Fourth, is it better to take medicine before meals, or is it better to take medicine after meals? Many patients searched on the Internet, and the result was, “This can’t be eaten, that can’t be eaten, but in the end, the patient won’t eat it anymore.” Deputy Chief Physician Chen Wei introduced that the above diet method is wrong, and the patients themselves need to eat rich Nutrition, as long as levodopa is required to eat 1h before or 1.5h after a meal, do not eat it with the meal to avoid the protein in the food from affecting the efficacy of the drug. In addition, entacapone must be taken with levodopa to be effective In addition to these two drugs, other drugs can be taken after meals to reduce the adverse reactions of the gastrointestinal tract. Selegiline should avoid high tyramine foods, as it may cause increased blood pressure. Finally, some patients with advanced Parkinson’s disease may have difficulty swallowing. Large or hard drug foods cannot be swallowed. Can you break the medicine or chew it? Drugs in the form of slow-release formulations such as Xining and Taishuda cannot be broken and chewed, which will affect the effective performance of the drug.

Anti- # Parkinson’s disease # drug-dopashydrazine (levodopa / benzazide)

1. Common drugs dopashydrazine tablets (medopa) and dopashydrazine capsules 2. Common dosage forms and specifications dopashydrazine tablets, dosazhydrazine capsules: levodopa 200mg and benzeshydrazine 50mg (equivalent to Benserazide hydrochloride 57mg). 3. Function characteristics Dopamine is a neurotransmitter in the brain, and the level of dopamine in the basal ganglia of patients with Parkinson’s disease is insufficient. L-dopa is an intermediate product of dopamine biosynthesis, which produces dopamine under the action of aromatic L-amino acid decarboxylase in the brain tissue, thereby playing a role in improving the symptoms of Parkinson’s disease. Levodopa can cross the blood-brain barrier, while dopamine itself cannot. After oral administration of levodopa, a large part of the intestinal mucosa, liver and other peripheral tissues are decarboxylated by dopa decarboxylase to form dopamine. Only about 1% of levodopa can enter the central nervous system to exert its therapeutic effect. Benserazide cannot penetrate the blood-brain barrier and only inhibits the decarboxylation of peripheral levodopa, so that more levodopa is transported to the center and converted into dopamine, reducing peripheral side effects and reducing the amount of levodopa. Dopashydrazine is a 4: 1 compound preparation of levodopa and benzathine, which has been shown to have the best efficacy in clinical trials and therapeutic applications, which is equivalent to the efficacy of high-dose levodopa alone. The efficacy of levodopa is related to the degree of nigrostriatal lesions. Mild or younger patients have better efficacy, and severe or elderly frail patients have poorer efficacy. It has a good effect on muscle rigidity and difficulty in movement, and a poor effect on muscle tremor. 4. Usage and dosage The individual usage and dosage of this medicine vary greatly. You must take the medicine as directed by your doctor. This medicine should be taken at least 30 minutes before a meal or 1 hour after a meal. The following table can be used as a reference for basic medication: The initial treatment takes medopa as an example, and its first recommended dose is 1/2 tablet of dopasazine each time, three times a day. From now on, the daily daily intake will increase by 1/2 tablet. Until the amount of treatment suitable for the patient is reached.

Why do patients with Parkinson’s disease suffer from joint and muscle pain?

Parkinson’s disease (PD) patients often have severe leg pain symptoms. However, sometimes the doctor hears that the patient has leg pain and rarely thinks that it is caused by PD. Patients with PD often feel pain in the deep calves and can appear before tremor symptoms. This article briefly summarizes the four common leg pains and treatments for PD. One of the common early symptoms of leg pain type PD patients is severe leg pain, which is more severe in the morning and night, and the pain worsens into persistent burning pain over time. This pain will penetrate into All aspects of the patient’s life. Central pain This pain is described as a persistent burning sensation and occasional intense pain, often exacerbated by cold and light touch. The patient could not bear to touch the skin with the bed sheet, or in a cold room, feeling the pain came from the roof. This pain is usually bilateral, but may also appear on the side where other symptoms of Parkinson’s disease begin. For some patients, it will appear on a trembling leg at rest. Leg pain caused by dystonia When it is related to levodopa, it usually occurs at the end of the dose, or it may occur at the peak dose. In most cases, this leg pain is unilateral and directly related to drug intake. When dystonia causes pain, it is more common in the early morning. This leg pain is usually accompanied by toe bending and abnormal posture of the foot. Musculoskeletal pain Musculoskeletal pain occurs due to stiffness, abnormal posture, and lack of activity resulting in leg pain. It may also affect joints, such as the hip or knee. This pain is usually more pronounced on the more affected side. It can be partial, extensive, or sudden. Nerve root pain In this case, the pain is caused by nerve compression in the lumbar area, which can cause weakness, numbness, and tingling, as well as loss of reflex in one nerve from the hip to the foot. It can be acute or chronic, and may be more severe when standing and sitting, and will be relieved when lying down. It is worth noting that some patients experience these symptoms, not because of herniated discs, but because of motor muscle stretching caused by severe musculoskeletal rigidity and abnormal posture. Treatment Bilateral pain in the legs is usually considered to be central pain. If the pain is caused by PD, rasagiline is very suitable for this pain. Other drugs can also be used to treat this pain. Massage therapy is suitable for all types of leg pain-patients also like this treatment, but the cost is more expensive. In addition to central pain, hydrotherapy is also suitable for all types of leg pain. Physical therapy (PT) can relieve dystonia pain, as well as musculoskeletal and nerve root pain. If the pain is caused by dystonia associated with levodopa intake, you need to determine when it occurs-the end of the dose or the peak dose. Usually need to be resolved by adjusting the drug dose. However, if dystonia is the initial symptom of PD, treatment with levodopa can be initiated. If medication adjustment does not work for levodopa-induced dystonia, another treatment option is deep brain stimulation (DBS). Pain not caused by dystonia can also be injected with botulinum and muscular relaxants with central effects. In order to avoid and reduce the pain caused by muscle stiffness, a good treatment option is to perform activities in the form of stretching exercises, such as Tai Chi or yoga. If a patient with PD has leg pain, be sure to consult a doctor.