| Title | Orally Disintegrating Selegiline in Parkinson Patients With Dopamine Agonist-Related Adverse Effects. | | Author(s) | Lyons KE, Friedman JH, Hermanowicz N, Isaacson SH, Hauser RA, Hersh BP, Silver DE, Tetrud JW, Elmer LW, Parashos SA, Struck LK, Lew MF, Pahwa R | | Institution | *University of Kansas Medical Center, Kansas City, KS; daggerNeuroHealth, Warwick, RI; double daggerUniversity of California, Irvine, CA; section signParkinson's Disease and Movement Disorder Center of Boca Raton, Boca Raton, FL; parallelUniversity of South Florida, Tampa, FL; paragraph signHarvard Vanguard Medical Associates, Boston, MA; #Coastal Neurological Medical Group, La Jolla, CA; **The Parkinson's Institute, Sunnyvale, CA; daggerdaggerUniversity of Toledo, Toledo, OH; double daggerdouble daggerStruthers Parkinson's Center, Golden Valley, MN; section sign section signMethodist Plaza Specialty Clinic, Des Moines, IA; and parallel parallelUniversity of Southern California, Los Angeles, CA. | | Source | Clin Neuropharmacol 2009 Oct 22. | | Abstract | OBJECTIVE:: To determine whether adding orally disintegrating selegiline (ODS) while decreasing dopamine agonist (DA) dosages would reduce DA-related adverse effects (AEs) of excessive daytime sleepiness (EDS), pedal edema, hallucinations, and impulse control disorders (ICDs) without compromising efficacy in Parkinson disease (PD) patients.
METHODS:: This was a 12-week open-label study of 60 PD patients with motor fluctuations and DA-related AEs of EDS, pedal edema, hallucinations, and ICDs. Orally disintegrating selegiline was initiated at 1.25 mg once daily, and down titration of the DA was started with a goal of a 50% reduction by 1 week. At week 6, ODS was increased to 2.5 mg, and further reductions of the DA were allowed if the AEs were not resolved.
RESULTS:: The addition of ODS allowed a reduction in the mean daily dose of pramipexole from 2.3 to 0.5 mg and immediate-release ropinirole from 11.2 to 2.9 mg. Most subjects reported a reduction or resolution of DA-related AEs; 94% with EDS (n = 50), 73% with pedal edema (n = 26), 86% with hallucinations (n = 15), and 84% with ICDs (n = 25). Mean activities of daily living and motor scores from the Unified Parkinson's Disease Rating Scale as well as quality-of-life scores were significantly improved without an increase in daily "off" time. The most common AEs, most of which resolved after titration, were worsening of PD, nausea/vomiting, dyskinesia, increased off time, body aches, insomnia, orthostatic hypotension, and increased anxiety and depression.
CONCLUSIONS:: In most subjects, the addition of ODS with decreasing dosages of DAs substantially reduced EDS, pedal edema, hallucinations, and ICDs without compromising efficacy. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19855267 |
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