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Suggest Alternative Medications For Rasagiline
Question: my mother aged 65 has been taking Ropark (ropinirole 1mg a day) and Amantrel (Amantadine HCL) for around two years now, as prescribed at AIIMS, New Delhi. Previously she was on Pramipex (pramipexole dihydrochloride) for around a year. She developed parkinsons symptoms 5 years ago some months after an incident of poisoning of food by domestic servant with large amount of sedative. (unknown substance, but she remained unconscious for around 48 hours even with medical intervention) Otherwise she has been a hypertension patient and taking medication for it since almost thirty years. Her tremors began in right hand thumb and gradually spread to right arm. Recently, the symptoms have aggravated suddenly and quickly over the last 3-4 months. Now the tremors have spread to her left side of body too.. both arms and mild tremors in feet too and she has a lot of trouble walking. The toes of her feet sometimes develop a clenching position. I have this doubt that since her symptoms had onset after poisoning, maybe they are similar to Parkinsonism and i read somewhere that drugs such as Pramipex and Ropark may sometimes aggravate the symptoms. Unsure what to do. Recently before aggravation of symptoms, doctor at AIIMS added Rasalect (Rasagiline) to her medication, but she had side effects such as heavy head and confusion so discontinued use after consulting a local physician. Basically she has not responded well to medications and the symptoms have consistently aggravated. I recently read Isradipine used for hypertension may have positive effects on Parkinsons patients. Mother is currently taking TOZAM(amlodipine + losartan) for her blood pressure. Is it advisable to switch over to Isradipine? So i'm looking for any help in this regard.. anything that may alleviate her symptoms and reverse the progression. I understand she is 65 years of age but all other members of her paternal family have had an average age of 80 and remained mostly healthy. Thanks
Brief Answer:
Isradipine is still Stage II or III
Detailed Answer:
Hi. Thanks for coming to HealthCareMagic. I am in shock about hearin how your mother developed Epilepsy. I am so sorry to hear that.
I have gone through your mother medications in detail and there are two points that I think I might be able to help you with.
1) Isradipine and its safety in Parkinsons patients.
2) Alternate medications to Rasagiline.
1) So, my information on Isradipine shows that there are many studies ONGOING about it's special neuroprotective qualities in Parkinsons patients. But none of them have led to any conclusion yet. Isradipine is still Phase II or III in the Parkinsons drugs pipeline (new drugs coming out). You may discuss it with you doctor at AIIMS but in my opinion, as long as her pressures are undercontroll, there is no need to switch out the medications for Hypertension
2) I would like you to ask your Neurologist if a drug like Entocapone (Brand names: Adcapone or Entacom, there may be others) would be appropriate as an adjunct therapy in your mothers case. It has been used in advanced cases of Epilepsy and in Trials with the newer drug Rasagiline, it performed equally well. You may wish to look into adding this medication to her regime if it hasn't been tried already.
So try those 2 avenues and see what happens. Feel free to follow-up with me whenever you want. Take care and thanks for coming to HealthCareMagic.com
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hi, is Epilepsy the same as symptoms of Parkinsons Disease? I will ask my mother's neurologist about Entocapone. incidentally his name is also Dr XXXXXXX (Goyal)! mother's blood pressure is generally under control, in fact sometimes recently she even develops hypo tension which may be attributed to Ropark and it is quickly corrected by taking a hot beverage. Generally is it advisable to periodically change med for hypertension? she has been on Tozam for several years now. I understand Isradipine is under trials but can it be substituted as her singular med for blood pressure control..even if it may or may not help her Parkinsonism? moreover can you suggest any supplements which may be beneficial. Thanks.
Brief Answer:
Typing mistake, thanks for pointing it out
Detailed Answer:
Dear god, my apologies. I meant to say Parkinsonism. I've been treating too many epilepsy patients recently. I should also be proofreading these emails more. Thanks pointing out the error. Anyway, What I said about Entocapone still stands for Parkinsons. It is not used in Epilepsy at all.
Isradipine is in the same class of medications as the AMLODIPINE portion of the Ropark. These drugs are called Calcium Channel Blockers. But you cannot substitute the two drugs without the loss of the effect of the other component... the Losartan. Losartan is a very good drug as it protects the kidney and is shown to increase life expectancy in people with Hypertension and/or kidney issues.
I have never been one to recommend switching blood pressure medications unless there is a clinical need. There are some other classes of medications that DO require a 'Drug Holiday" so they stay effective, but Amlodipine is not one of them.
As to supplements. The whole problem with the supplement industry is that there is no burden of proof on their claims. There have never been enough studies to show that any of these supplements help in Parkinsons.
Nevertheless there is some anecdotal evidence that a few supplements "MAY" be helpful. But I must warn you, your mother would be taking them at her own risk. Given her history and other health issues. I would not really be able to recommend anything more exotic than a healthy balanced diet and a daily multivitamin supplement.
I will list the supplements that "may" work below and you can discuss them with Dr. XXXXXXX (Vinay is such a nice name no? :-) )
1) Caffiene
2) Black Tea
3) Coenzyme-Q
4) Creatine
5) Vitamin E (special warning here, fat soluble vitamins can cause poisoning in high dosages, so use with EXTREME caution).
Remember, your mother can probably get all the CO-Q, Creatine and Vitamin E she needs from her diet as long as she is eating a healthy diet. If you would like you can talk to one of her dieticians about planning a diet for her that has all the essentials she needs.
I hopes this helped. Sorry about the epilepsy, parkinsons mistake. That was just silly of me. Feel free to follow-up anytime and thanks again for coming to HealthCareMagic.com
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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