Confusion levodopa

Side effects include dyskinesias, orthostatic hypotension, dizziness, nausea, insomnia, sleep attacks, pathologic gambling, discoloration of urine/sweat, and psychiatric effects (confusion, hallucinations, nightmares, and altered behavior). Dyskinesias caused by adding other PD drugs to levodopa may be improved by decreasing the levodopa dose. Motor complications occur in about 40% of patients within 4 to 6 years of starting levodopa.1,8,24,25,37... 

The use of pergolide in patients on levodopa may cause or exacerbate pre-existing states of confusion and hallucinations or preexisting dyskinesia. 

Discontinuation of therapy Abrupt discontinuation of pergolide in patients receiving it chronically as an adjunct to levodopa may precipitate the onset of hallucinations and confusion. Discontinue pergolide gradually whenever possible, even if the patient is to remain on levodopa. 

Adverse reactions occurring in at least 3% of patients with advanced PD (with levodopa) included the following abdominal pain accidental injury accommodation abnormalities akathisia amnesia arthritis asthenia chest pain confusion constipation diarrhea dizziness dream abnormalities dry mouth dyskinesia dyspnea dystonia extrapyramidal syndrome falls flushing gait... 

Quazepam (Doral) [C IV] [Sedative/Hypnotic/ Benzodiazepine] Uses Insomnia Action Benzodiazepine Dose 7.5-15 mg PO hs PRN i in elderly hqjatic failure Caution [X, /-] NA glaucoma Contra PRG, sleep apnea Disp Tabs SE Sedation, hangovCT, somnolence, resp depression Interactions T Effects W/ azole antifungals, cimetidine, digoxin, disulfiram, INH, levodopa, macrolides, neuroleptics, phenytoin, quinolones, SSRIs, verapamil, grapefruit juice, EtOH effects W/carbamazepine, rifampin, rifabutin, tobacco EMS Use caution w/ other benzodiazepines, antihistamines, opioids and verapamil, can T CNS depression concurrent EtOH and grapefruit juice use T CNS depression OD May cause profound CNS depression, confusion, bradycardia, hypotension, and altered reflexes flumazenil can be used as antidote activated charcoal may be effective... 

These drugs were developed before levodopa which has largely replaced them, probably because of a lack of modern clinical research. Actually, the adverse effects of anticholinergic drugs (confusion, memory disorders, peripheral anticholinergic effects) and the interindividual variability of their effects considerably limit their use, particularly in subjects over 65 years of age. These compounds are considered to be effective against tremor and are... 

Amantadine was originally introduced as an antiviral compound (see Chapter 50), but it is modestly effective in treating symptoms of parkinsonism. It is useful in the early stages of parkinsonism or as an adjunct to levodopa therapy. Its mechanism of action in parkinsonism is not clear, but amantadine may affect dopamine release and reuptake. Additional sites of action may include antagonism at muscarinic and A-methyl-D-aspartate (NMDA) receptors. Adverse effects include nausea, dizziness, insomnia, confusion, hallucinations, ankle edema, and livedo reticularis. Amantadine and the anticholinergics may exert additive effects on mental functioning. 

Geriatric Considerations - Summary Ropinirole is a nonergot dopamine agonist which directly stimulates dopamine Dj receptors. It can be used in combination with levodopa or as monotherapy. If discontinued, ropinirole should be slowly tapered because abrupt discontinuation can cause confusion, hallucinations, and a condition similar to neuroleptic malignant syndrome. 

Plan to reduce the levodopa dosage if the patient experiences hallucinations. Keep in mind that hallucinations are usually accompanied by confusion and, to a lesser extent, insomnia... 

Dementia Psychotropic drugs, levodopa, antiepileptic agents Increased confusion, delirium... 

Adverse effects are postural hypotension, nausea, confusion, increased levodopa induced involuntary movements and confusion. 

Confusion, hallucinations, delusions, and other psychiatric reactions are potential complications of dopaminergic treatment and are more common and severe with dopamine receptor agonists than with levodopa. Disorders of impulse control may lead to compulsive gambling, shopping, betting, sexual activity, and other behaviors. They clear on withdrawal of the offending medication. 

Adverse effects of the COMT inhibitors relate in part to increased levodopa exposure and include dyskinesias, nausea, and confusion. It is often necessary to lower the daily dose of levodopa by about 30% in the first 48 hours to avoid or reverse such complications. Other adverse effects include diarrhea, abdominal pain, orthostatic hypotension, sleep disturbances, and an orange discoloration of the urine. Tolcapone may cause an increase in liver enzyme levels and has been associated... 

Entacapone Inhibits COMT in periphery does not enter CNS Reduces metabolism of levodopa and prolongs its action Parkinson s disease Oral Toxicity Increased levodopa toxicity nausea, dyskinesias, confusion... 

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