Insomnia 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... 

Levodopa is the amino precursor of dopamine. It is used to replenish depleted dopamine in Parkinson s disease. Levodopa may cause insomnia, reddish discoloration of urine and headache. 

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... 

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. 

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... 

Dopamine precursors are considered first-line in adults. Side effects include orthostatic hypotension, insomnia, daytime fatigue, and somnolence nausea, and augmentation may occur. Levodopa with benserazide or carbidopa (Sinemet) 100-125 mg or 200-250 mg at bedtime and additional doses may be needed. Dopamine agonists are becoming more popular because of the fewer side effects, and less augmentation. These are used to treat RLS and PLMD. Their side effects include nausea, orthostatic hypotension, insomnia, and somnolence also, the potential for tolerance exists. 

Untoward effects of levodopa are dyskinesia and rapid fluctuations related to rigidity, which may suddenly worsen. Psychologic effects such as confusion, disorientation, insomnia, and nightmares are common in 20% of patients. Various transplantation approaches have been tried based on the injection of dissociated fetal cells directly into the substantia nigra. An alternative approach includes the use of genetically modified nonneuronal cells (e.g., fibroblasts), so that they will secrete missing mediators such as dopamine and growth factors.62... 

Fatigue and light-headedness or dizziness have occurred relatively frequently during oral entacapone administration in small studies (up to 60% of patients) (4). Other less frequent central nervous system effects include confusion, anxiety, syncope (related to postural hypotension), and insomnia (5,6). Mood elevation has been observed occasionally (5). The inclusion of entacapone in levodopa therapy for Parkinson s disease increases the risk of dyskinesias, possibly through enhanced brain penetration of levodopa (4,5,7). This can be adjusted by reducing the dose of levodopa. 

A 28-year-old man received interferon alfa (5 MU/day for 28 days) for chronic hepatitis B. At the end of treatment he developed a slight parkinsonian gait, and 8 days later had a fever with vomiting, insomnia, restlessness, and raised serum creatine kinase activity (4946 IU/1). He had severe akathisia with psychomotor excitement and parkinsonism. Despite treatment with clonazepam, thioridazine, propranolol, trihexyphenidyl, and bromocriptine, his condition progressively worsened. He was finally given intravenous levodopa for 8 days and recovered dramatically within the next few days. 

The most frequent adverse effect of mesulergine is dyskinesia, mostly in patients who have had similar reactions with levodopa. Orthostatic light-headedness and visual hallucinations are also common. Other adverse effects include anorexia, nausea, drowsiness, ankle swelling, insomnia, confusion, irritability, visual disturbance, chest pain, rash, and augmented body odor. 

If hallucinations occur, they may be eliminated if levodopa dosage is reduced. Hallucinations generally are accompanied by confusion and to a lesser extend insomnia. 

Central side effects with long-term therapy of levodopa can be serious enough for treatment to be stopped. These include dyskinesias, restlessness, anxiety, confusion, disorientation, insomnia or a schizophrenia-like syndrome. Dyskinesias can be particularly severe, involving unusual writhing movements of the limbs and grimacing and chewing movements of the face. 

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