Dopamine drug interactions

On the other hand, the effects of two medications can counteract one another. The result is usually that both medications are rendered less effective. A common example is the patient with Parkinson s disease. On occasion, the L-DOPA that is the mainstay of treatment causes hallucinations. The treatment for hallucinations is an antipsychotic, which blocks the activity of dopamine. The problem is that using a typical antipsychotic to treat L-DOPA-induced hallucinations will interfere with the therapeutic effect of the L-DOPA, thereby worsening the symptoms of the Parkinson s disease. Fortunately, the advent of the newer atypical antipsychotics has provided a remedy to this particular Catch-22 drug interaction dilemma. 

At high concentrations, phenytoin also inhibits the release of serotonin and norepinephrine, promotes the uptake of dopamine, and inhibits monoamine oxidase activity. The drug interacts with membrane lipids this binding might promote the stabilization of the membrane. In addition, phenytoin paradoxically causes excitation in some cerebral neurons. A reduction of calcium permeability, with inhibition of calcium influx across the cell membrane, may explain the ability of phenytoin to inhibit a variety of calcium-induced secretory processes, including release of hormones and neurotransmitters. The significance of these biochemical actions and their relationship to phenytoin s clinical activity are unclear. 

DOPA to dopamine, by the cytosolic enzyme, DOPA decarboxylase. In the central and peripheral nervous systems, dopamine is converted to noradrenaline by dopamine-P-hydroxylase (DBH), which, though a relatively non-specific enzyme, is restricted to catecholamine-synthesizing cells. It can be inhibited by many drugs, which brings the risk of complex drug interactions. In the peripheral sympathetic nervous system, noradrenaline, in turn, is converted to adrenaline, by phenylethylamine N-methyl transferase, so inhibition of DBH can therefore, in principle, slow production of both adrenaline and noradrenaline but normally tyrosine hydroxylase is the rate-limiting step in the synthetic pathway. 

MAO inhibitors (MAOIs) These drugs (eg, phenelzine, tranylcypromine, isocarboxazid) are stmcturally related to amphetamines and are orally active. They inhibit both MAO-A (which metabolizes norepinephrine, serotonin, and tyramine) and MAO-B (which metabolizes dopamine). Tranylcypromine is the fastest in onset of effect but has a shorter duration of action (about a week) than do other MAO inhibitors (with durations of 2-3 weeks). In spite of these prolonged actions, the MAO inhibitors are given daily. These drugs are inhibitors of hepatic drug-metabolizing enzymes and cause many drug interactions. 

The ergolines have provided a number of drugs that show interaction with neurotransmitters. Depending on the substitution pattern, they may be dopamine agonists or antagonists, a-adrenergic blockers, or Inhibitors of the release of prolactin. A recent member of the series, pergolide... 

---