Antidopaminergic therapy for managing comorbidities in patients with Parkinson’s disease

Abstract

Although clozapine can be used to treat psychosis in patients with PD, managing nausea, vomiting, hiccups, and emergent psychotic symptoms in these patients remains a challenge due to a lack of evidence for currently available options.

Morning akinesia in Parkinson's disease: challenges and solutions

“…[22][23][24] Other drugs, including dopamine agonists, anticholinergics, amantadine, inhibitors of monoamine oxidase and catechol-O-methyltransferase (COMT), may also contribute to GId. 25 L-dopa can increase gastric acid secretion, impair gastric relaxation, and delay gastric emptying; 14,26,27 anticholinergics and amantadine commonly cause dry mouth and constipation; and COMT inhibitors can cause diarrhoea.…”

“…Compared to metoclopramide, domperidone does not cross the blood-brain barrier, consequently having minimal effects on the central nervous system, while at the same time significantly improving gastric emptying without affecting PD motor symptoms. 14,25,27 Long-acting dopamine agonists allow more stable and continuous dopaminergic stimulation (CDS) and improve nocturnal disability. In previous studies, cabergoline, in particular, appeared to be more effective than the L-dopa controlled-release formulation in relieving nocturnal painful dystonia, nocturnal and morning akinesia, and early morning dystonia.…”

Treatment of dysautonomia in extrapyramidal disorders

“…Domperidone speeds up the emptying of the stomach, facilitates resorption of levopopa in the small intestine, and hence increases levopoda plasma levels. Domperidon can also be used as adjunct to levodopa therapy which reduces side-effects such as nausea [31]. In a small percentage of patients the insertion of a gastrostomy or jejunostomy feeding tube may be indicated for administration of dopaminergic drugs and optimal nutritional care [47].…”

Therapie autonomer Dysfunktion bei Patienten mit extrapyramidalen Erkrankungen

“…Domperidon beschleunigt die Entleerung des Magens, erleichtert die Resorption von Levodopa im Dünndarm und erhöht somit den Levodopa-Plasmaspiegel. Außerdem kann Domperidon zusätzlich zu einer Therapie mit Levodopa eingesetzt werden, um Nebenwirkungen wie Übelkeit zu reduzieren[86]. 65%), vorzeitige Ejakulation (41%) und Schwierigkeiten beim Erleben des Orgasmus (40%) an.…”