Mouth levodopa

Antimuscarinic drugs such as atropine have been used to modest effect in the treatment of PD for more than a century attenuating tremor and rigidity but with little effect on akinesia. Currently benzhexol and benztropine are sometimes added to levodopa therapy but peripheral effects such as dry mouth, blurred vision and constipation are unpleasant. They are also often used to counteract neuroleptic-induced extrapyramidal effects. 

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... 

Vitamin B complex is the collective term for a number of water-soluble vitamins found particularly in dairy products, cereals and liver.Vitamin B (thiamine) is used by mouth for dietary supplement purposes and by injection in emergency treatment of Wernicke-Korsakoff syndrome. Vitamin B2 (riboflavin) is a constituent of the coenzyme FAD (flavine adenine dinucleotide) and FMN (flavine mononucleotide) and is therefore important in cellular respiration. Vitamin Be (pyridoxine) is a coenzyme for decarboxylases and transamination, and is concerned with many metabolic processes. Overdose causes peripheral neuropathy. It may be used medically for vomiting and radiation sickness and for premenstrual tension. Pyridoxine has a negative interaction with the therapeutic use of levodopa in parkinsonism by enhancing levodopa decarboxylation to dopamine in the periphery, which does not then reach the brain. The antitubercular drug isoniazid interferes with pyridoxine, and causes a deficiency leading to peripheral neuritis that may need to be corrected with dietary supplements. Vitamin B ... 

Abnormal involuntary movements frequently accompany optimal improvement with levodopa. The duration and the dose are related to the occurrence of these movements so that up to 73% of patients have them after 12 months of treatment. Abnormalities are seen earliest in the head and mouth, then later in the limbs and trunk, sometimes becoming violent and severe. Usually they can be reversed by lowering the levodopa dose or by adding other drugs (phenothiazines, haloperidol or pyridoxine) but with both approaches some therapeutic benefit is often lost. 

The morphanthridine elantrine (XIII, Ex 10-029) has been tested in man and its pharmacological action appears to be mainly, but not exclusively, related to its anticholinergic action . Two clinical trials (25 and 13 patients) report efficacy alone at doses of 30-60 mg/day and with levodopa . Side effects were predominately of the anticholinergic type. A recent substantial multiclinic controlled study in 89 patients found that elantrine, UO mg daily, effectively reduced tremor and possibly rigidity more than the same dosage of trihexyphenidyl. Elantrine caused more dry mouth. Thus elantrine was effective but not clearly more selective. 

Diphasic dyskinesia is described, when 3/4 hours after the dose of levodopa and lasting for 30—60 minutes, abnormal violent movements of limbs occur with retrotorsion of the head and neck, open mouth, forced vocalization and sometimes repetition of words and phrases (64 ). Twelve parkinsonian patients on long-term levodopa therapy developed intermittent myoclonic body jerks. The movements consisted of single unilateral or bilateral abrupt jerks of the extremities and occurred most frequently during sleep (65 "). After 5 years on levodopa 3 g daily a 52-year-old man developed dysphonia which occurred at the peak of activity of the drug (66 ). 

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