Parkinson's Medications 101 – When is the "right" time to start?



guys welcome back to another Facebook live broadcast my name is Sarah King I am a physical therapist and founder of invigorate physical therapy and wellness here in Austin Texas and the goal of my practice is to help empower people who have been diagnosed with Parkinson's like yourself with resources and information that they need to feel back in control of their diagnosis maximize their independence and their vitality and really just live the best life that they possibly can and today we are covering a really exciting topic depending on where you're at in your journey and that is all about Parkinson's medications and we're gonna call it medication 101 today and I get a lot of questions about Parkinson's medication when to start you know what to take what it means to take medication what it helps with what it doesn't help with all those good things so I'm gonna be covering the question when to start medication the top five medications that are most prescribed for Parkinson's and then talk a little bit about why medication should not be your only treatment Avenue so as you guys get checked in just say hello in the comment section below we've got myself and my wonderful community manager Lauren helping out answering questions in the comments so tell me where you're tuning in from say hello I would love to hear from you just to know that you guys are out there you can always give me a thumbs up a big heart anything that you know inspires you right below this video so I do want to say before we get started here that these broadcasts are simply meant to be for educational purposes only in no way am i able to give you individual advice on your Parkinson's medication or really your treatment plan in general since you're not under my plan of care as a clinician and so take this information right down take notes and take it back to your health care team your movement disorder specialist your physical therapist so that they can help you fine-tune your individual of attack so I just wanted to make sure that you know everybody was very clear on that so as you tune in welcome welcome just let me know you're here in the comment section below and we'll just go ahead and roll right into it so the first thing that I wanted to emphasize is that medication does not slow the progression of the disease okay so – it really hit home on the importance of medication and exercise medication will address your symptoms but it does not slow the progression of your Parkinson's so the only thing that's been known to slow the progression of your Parkinson's is exercise and exercising in a way that is intense and specific to your Parkinson's disease and your Parkinson's symptoms so exercise is neuro protective which means that when you exercise there are certain chemicals released that actually protect the brain cells that you have and in Parkinson's as you likely know the area of your brain that produces dopamine it starts to degenerate and if we can protect that as much as possible then that's the number-one key because all mark all Parkinson's medication does is try to preserve the dopamine that you have or mimic it so that's what it means to be exercising for Parkinson's and exercise is medication because it will protect your brain it also rewires your brain so that you can do movements better and more efficiently that's called neuroplasticity so the key is if you can slow the progression of your disease then you can take less medications overall and obviously we want to be taking as few medications as you can to be optimal and to be functional since some Parkinson's medications can obviously have some side effects when taken over the long-term so if you have questions about that let me know but that's why my mission is so important to me which is spreading exercise for Parkinson's all across the globe and making sure that you guys have resources that you need to be active and healthy so I created a free 30 day Parkinson's movement challenge it challenges you to two and a half hours of exercise a week which comes out to be about 20 minutes a day and in order to maximize your function and that's what the research says 20 minutes a day for 30 days can actually help you improve your quality of life feel less hindered by your Parkinson's symptoms so if you haven't taken our movement challenge you can go to invigorate PT calms last 30 day challenge I would love to have you along last time I checked we were at around 1,800 people had taken the challenge so I would love to have you be a part of it maybe some of you guys have taken it out there and Lauren's gonna give you the link below but you can also find that link above below sideways to this video depending on when you're watching it okay so I see Nora checked in hello Nora from Ontario welcome you're always in here so good to see you okay so here's what the rundown is of Parkinson's medication so your medication should be part of a larger treatment program so there's medication then we also have support groups exercise programs rehab so physical therapy speech therapy occupational therapy and good nutrition and potentially sometimes something surgical like deep brain stimulation so medication plays a small part in your overall treatment plan and it can also you know be one of the most time-consuming when you're trying to get all of your levels ironed out and whatnot we're going to talk about that here in a little bit so in order to find your optimal treatment medication you're going to want to consider a few things your first one gonna want to consider your symptoms second you're going to want to consider your age third you're going to want to consider the stage and the severity of your symptoms and of your disease and then your level of physical activity so all of these play together and how much medication you're taking what potentially what kind of medication you're taking and can change over time so gonna probably have a dosage at the earlier phases of your journey Parkinson's journey and those will change over time so it's very rare for someone to be taking the same medication dosage and type first year after taking medication versus five years in ten years in 15-20 years in and if that resonates with you you can just give me a thumbs up if your medication regimen has changed over time hi Sharon – Montana hi okay so I wanted to recommend a really great book for you guys if you haven't read it yet it's called the new Parkinson's disease treatment book and Lauren's gonna give you a link down below but it's by dr. Eric else al Skog I can't say it but we'll put his name in the notes and he actually dives really deep into the medication question as well as a lot of other treatment options for you so it's the book is about thirty dollars and it can come in really handy as you're going through a lot of this exploration because I'm only gonna touch on the superficial level and then if you guys want to dive deep it's really gonna be up to you to research it and to pull it all together in your plan okay hi dr. Tyler Tracy welcome I'm not sure if I've ever seen you in here welcome welcome I always love having another PT in here okay so let's tackle the question when is the right time to start taking your Parkinson's medication something that I always say is that just because you have a Parkinson's diagnosis does not mean that you have to be on Parkinson's medication now realize that taking Parkinson's medication again does not slow the progression of your disease so the way the medication works when you take something like levodopa or a dopamine agonist which we'll talk about here in a little bit is your brain has produced less and less dopamine over time it's a brain chemical that helps you move and by the time you are diagnosed with Parkinson's you've lost potentially sixty to eighty percent of the cells that produce dopamine in your brain so when you're thinking about dedicating for Parkinson's it's the goal is to replace the lost dopamine it's not to slow the progression of the disease it's to replace the dopamine that is low in your body and dopamine helps you move so when your dopamine levels start to drop movement is harder you feel stiffer you feel slower you it's harder to walk those types of things so that's the dopamine correlation and that's the goal of medicating for Parkinson's so what when is the right time to take to start taking Parkinson's medications the right time depends really on the severity of your symptoms and how much your symptoms are limiting your ability to participate in your daily life so if you're still working are your Parkinson's medications inhibiting the way that you function at work in a way that's detrimental potentially forcing you to consider an earlier retirement that might be a good time to start a Parkinson's medication if it can help you reduce your symptoms and prolong the amount of time that you can work is it interfering with your ability to exercise since exercise is the only thing that can slow the progression of the disease if you can't be exercising then it's potentially time to consider starting to take a Parkinson's medication so that you can achieve high intensity exercise on a regular basis so that you can protect your brain as much as possible over the long run obviously an important philosophy of the right time to take medication is your your philosophy about medication I know or in Austin you know or very liberal City a very homeopathic City we're a very natural city most of the time and I have a lot of clients who don't want to start on a Parkinson's medication because they're afraid of the side effects and we're gonna talk about side effects here in a little bit and I've written multiple blog posts about the side effects of medications but sometimes taking small doses of medication earlier in your diagnosis when you're really trying to maximize the amount of things that you're doing in the day can be a net positive for you so that you can improve the quality of your life and achieve and stay active and stay involved in the community in you know stay participating in the things that you want to participate in so you're not alone if you want to minimize the amount of medication you take but think about it as just a tool in your toolbox and you and your healthcare team can make that decision together based off of your philosophy about medication the severity of your symptoms your age your disease process and all of those good things okay so we doing good I see some thumbs up so those are if you have any questions as we go by the way I put them in the comment section below I'd love to try and tackle them if I don't get to them live we can try and tackle them after we're done so the next thing I want to hit on are the five main types of medications available to treat Parkinson's symptoms you've probably heard of some of these but the first one is levodopa the second one is a class of drugs called dopamine agonist the third are medications that inhibit inhibit the breakdown of dopamine in your body it doesn't actually replace dopamine but it inhibits the breakdown of it the fourth one are a group of drugs called anti Koller genex which is a little bit less common nowadays and the fifth is something called amantadine so we're gonna cover these five different types in depth and by in-depth I mean where I'm gonna give you the lowdown on them and then you can take notes and take them back to your healthcare team okay so the first group of drugs are levodopa medications if you are on levodopa carbidopa give me a thumbs up or if you've ever been on it most of the time this is what you are prescribed when you are diagnosed with Parkinson's so brand names include Sinemet Park Koba right sorry dude oppa is the new injection that goes into your stomach and there's also inhaled levodopa which is in clinical trials as far as I know it's still only in clinical trials so those are levodopa carbidopa it's the levodopa is a precursor to dopamine so which just means that your body breaks down the levodopa to form dopamine and leave it open often paired with carbidopa which protects the levodopa from being broken down and also helps to decrease the side-effects of levodopa so most of the time levodopa is the most helpful for stiffness slowness and tremors it can also help with dystonia it can also actually help a little bit with anxiety and panic those are non-motor symptoms which means that they're not kind of movement related but anxiety and panic can actually respond pretty well to leave it open medications so the best outcomes with levodopa combined medication into a program early on to improve function and ability to participate in an intense parkinson's specific exercise program so like I said taking a little bit of medication to help loosen you up and improve your ability to participate and exercise in your daily life is the main goal of taking a levodopa drug side effects definitely can come with levodopa use and they the research suggests that about 50% of patients have motor fluctuations or dyskinesias over the course of five years after starting levodopa however there are ways to minimize dyskinesias and if you're minimizing your dosages of motor count of the levodopa then by exercising and eating right and having this comprehensive plan then if you think about the cost-benefit ratio you know not taking Parkinson's medication but not being able to fully participate in your exercise program or taking medication worried about the side-effects down the road you have to weigh for yourself what's more important to you you know maybe even giving one or the other a try maybe a good fit for you so some people worry about dyskinesias and dyskinesias are those involuntary movements that can often come with cycling of your Parkinson's mat of your levodopa and I wrote an entire blog post about dyskinesias and Lauren will go ahead and put it below but if it's a book market bull guide to dyskinesia and it talks a lot about why it happens how it happens what you can do to prevent it what you can do to treat it the different types of dyskinesia so if you're having some dyskinesia or you're worried about it please read that blog post so that we can scale down your fears and make you or help you take a more realistic look at your medications as far as dyskinesia go okay so the next group of drugs I want to talk to you about is dopamine agonists so brand names of dopamine agonists include parla del Mira pecs Requip neuro Pro and the epic een injection so those are the brand names the oh it's funny somebody just asked this the generic names are bromocriptine Maxo pull from I always say that right from max that one pramipexole hey guys I stumble over these two rip in a roll and April morphine which is the a pokken injection so let's see somebody just asked Edie asked about pramipexole and that is a dopamine agonist so a dopamine agonist works directly by simulating dopamine receptors in the brain simulating dopamine to the dopamine receptors in your brain so mimics dopamine versus levodopa replaces something that produces dopamine so if that makes sense it's like a it pretends to be dopamine instead of actually being dopamine and initial symptom control with dopamine agonists is not usually as good as it is with levodopa dopamine agonists can be used by themselves I have notes here which is why I keep looking down dopamine agonist may be used alone as an initial treatment for those diagnosed with Parkinson's under the age of 65 and they can postpone the need for levodopa down the road maybe 2 or 3 years later most people switch from a dopamine agonist over to levodopa and the mindset there is that taking a dopamine agonist actually reduces the chances of developing motor fluctuations and dyskinesias and so it typically is used as the first attack if you're less than 65 years old and then potentially switching over to dopamine treatment down the road so the use of dopamine agonists rather than levodopa appears to postpone the onset of motor complications and dyskinesias like I just said and but they do come with some side effects so if you're taking a dopamine agonist and you're feeling really sedated you're having swelling in your legs potentially visual hallucinations the big one about dopamine agonists it's is important to recognize it they can often cause impulse control disorders so compulsive shopping compulsive sex compulsive gambling those types of impulsive control disorders can often come alongside dopamine agonist treatment so it's really important to recognize the symptoms of that and be aware that that could be a side effect so you can talk to your physician about it should you start to have some of those symptoms okay so hopefully that answers your question about Primak cEPAL my favorite word to say okay so the third group of medications were moving right along if you've got questions put them in the comment section we're talking about if you're joining late we're talking about Parkinson's medications when's the right time to start taking them and what they are exactly so the third group of Parkinson's medications are enzyme enzyme inhibitors which can be mao-b inhibitors comt inhibitors and what that means is be taking these medications the aim of the these medications is to prevent the breakdown of dopamine in your system so they don't act as dopamine they don't replayed on't replace dopamine they simply take the dopamine that you're already taking from likely another medication and try and protect it so that it actually gets into your brain because only about 10% of the dosage of levodopa will go into your brain will cross the blood-brain barrier is the lingo there so mao-b inhibitors include things like Sailaja lean wrists Adaline and Safina Meyde you might also recognize as elect as a brand name there comt inhibitors I feel like are a little less common but that's the brand name Tazz Marv and calm Tran so I see those less and less but that's just in my practice and they usually are used in combination with levodopa treatment like I said it's just trying to protect that dopamine in your system and why you would take an mao-b inhibitor would be to improve your motor symptoms early on in the progression of your Parkinson's and it could also reduce motor complications in the long run because the idea there is that it protects dopamine from breaking down in your system instead of in your brain when dopamine breaks down in your system and in your periphery which just means outside your brain that's where a lot of the side effects can come into play so the idea of the mao-b inhibitors is to protect that dopamine long enough or it's actually getting to your brain and minimize how much is absorbed in your periphery so comt inhibitors are typically prescribed with more advanced stages of Parkinson's to help you manage your on/off fluctuations when those if those ever become severe so those would be types of things that an inhibitor and mao-b inhibitor or your comt inhibitor would be taken so that is the third class of drugs I want to give you guys kudos for sticking around I know this is pretty heavy medical jargon but it can help you a lot when you're trying to figure out what your best plan of attack is you know your physicians are gonna throw all these words at you and it's good to be prepared when you walk in there it can be overwhelming and so hopefully we can dust some of the dust off of these big words so you can digest them and feel empowered when you walk in that clinic when you have to make that decision and you have to ask those questions about why am i taking a dopamine agonist why am I taking you know why can't I take something like levodopa what do you know about this enzyme inhibitors knowledge is power you guys and you guys need to maximize the amount of information you can get out of your very short time period with your physician so just my soapbox I'll hop off okay so here's the fourth class of medication which is called they're called anti color genex and they may be recommended to treat something like a tremor if you are less than age 70 or if you have significant difficulties with walking I don't see anti-coal or genetics prescribed a lot but I will read you some of the the generic names for anti Koller genex by perdón Ben's atropine obviously try hexyl phenol dole yeah wasn't a physician for a reason okay so those are some of the generic names for something like an anti chlorogenic but sometimes these are given alone or in combination with levodopa or dopamine agonists and people with more advanced Parkinson's disease who have a persistent tremor so those are anti chlorogenic again they're not super common as far as I've seen but if you're taking one that's probably why you're taking one or if you are over the age of 70 I'm sorry if you're less than the age of 70 and you have a tremor that's not really not responding to anything else they may try an anti Col or genic with you okay then we have our fifth and famous amantadine and I feel like this gets prescribed quite often maybe that's just the pool clients that I see and Austin but amantadine is also called symmetry and it it was an antiviral drug which is really interesting that they found actually helped to lessen Parkinson's symptoms including tremor and rigidity and so oftentimes you'll see or you'll hear your physician recommend pairing a manta diene with a carbidopa levodopa to help you reduce your dyskinesias so again dyskinesia we talked about a lot in the blog post that I wrote that Lauren's posted below but amantadine is given in combination typically with a Parkinson's medication and given by itself I haven't seen a big reduction in symptoms and I think the research supports that as well as far as being a primary treatment medication for Parkinson's symptoms like I said as a primary treatment its main goal is just to help you reduce your dyskinesias over time so those are the five areas of Parkinson's medications I hope that was really helpful for you I would love to hear what advice you have for other people with Parkinson's who are going through their medication journey or any questions that you have about what to consider you know again I can't answer specifics to your program but I can maybe help you find some resources and our community knows so much so if you want to continue this conversation we do have a private free Facebook group where people can get a little bit more personal I can get in there and be a little bit more active with our community and it's called the invigorated community it's over on Facebook if you just search for it you should be able to find it Lauren is our beautiful community manager she'll be able to get you in and you just hit request to join and hop in there and ask for other people's opinions I know we have a lot of conversations in there now about reducing Parkinson's medication trying these different types of approaches for their Parkinson's medication and you guys have so much experience and a wealth of knowledge to share so come over join our community Laura know fit the link in the comment section below and then if you found this video helpful I would love it if you shared with someone who you think may benefit the more people that we can inform around their diagnosis the more power that you guys have and I always love to help do that so make sure that you like invigorate physical therapy on Facebook if you don't already and you can also subscribe to our YouTube channel all of these videos will be over on our YouTube channel as well that's invigorate physical therapy and wellness on YouTube so again before I sign off I just want to reiterate how important it is to combine medication with your Parkinson's exercise program medication alone does not slow the progression of your Parkinson's disease it only helps you address your symptoms and so exercise should be your number one medication for your Parkinson's symptoms when you sign up for the 30 day challenge it add invigorate PT calm / 30 day challenge you get a starter kit from me that has a planner tons of exercise videos motivational tips and strategies for me on how to initiate your exercise program in a way that's sustainable and then you get weekly emails from me once or twice a week checking in seeing how things are going you have the support of myself and Ann Warren and our invigorated community because exercise is literally the very best medicine that you could possibly be taking and something I'm really passionate about I've really changed my life around helping spread that awareness all around the globe so I would love to have you be part of our our movement challenge or invite someone else to do the movement challenge with you that would be wonderful so like I said we've had almost 1,800 people join the challenge which adds up to about two years or more worth of exercise hours so which is pretty amazing we've gotten over two years of pure Parkinson's exercise going just from that challenge alone so I would love to have you be part of it and hopefully I'll see you inside the challenge but until then I would just say keep moving and I'm new lots of big hugs alright bye guys

28 comments

  1. meds just made to mask symptoms and are a cash cow for the industry, they wont do research for a cure as long as they are cashing in on the pd patients.

  2. I had a neurotransmitters urine analysis in 2016, and my dopamine levels were fine, there several other neurotransmitters out of normal ranges. My neurologist said my body makes dopamine but does not receive it.

  3. join my facebook group:
    "parkinson's thiamine hcl"
    https://www.facebook.com/groups/232260083958797 …
    Parkinson's Relief, Questions and Answers

  4. Hi, I'm Judy from California. I was diagnosed with adult onset dopa responsive Generalized dystonia. (side note, my mom had it too) back in2004. My sx got worse and lost my job as a nurse. Did some research and opted for dbs surgery at Mayo Clinic in2011. Last year the device broke and all my sx came flooding back. At first did ok with major increase in meds (8 lovodopa, 3 artane, and 2000 mg of ibuprophen, but now they lost their effectiveness. Would you think I should have the surgery again? I'm afraid of losing my new job. Presently being treated at Stanford in San Jose.

  5. I 'm Maria from New Jersey and I have learned about the educational programs.i am learning about the different things needed to help me .Since 2011 ,i have what called Clinical Parkinson's Syndrome. I would like to thank you for your program.I would like to join the movement challenge.

  6. I'm Don from Tucson AZ. I've been diagnosed with Parkinson for 6 years. I belonged to Becky Farley's PWR group and was doing very well until I fell and broke my wrist. I have lost my balance very badly.

  7. Greetings from Down the Jersey Shore~ Diagnosed 12 years ago at age 38. DBS two years later I experience RETROPULSION. Any advise is appreciated. ~ Cheers

  8. I'm pat from Florida and I watch and hAve felt encouraged after 13yrs and you give me hope to. Keep on keeping on. Can you email me the nutrition info I can't. WAit,.to start on eAting better. And start feeling better
    And. Potentially drop. Some. Meds. Thanks so Much for all your work and for your passion 💚💚❤️❤️

  9. Hello from Fort Carson Colorado. I am a " young onset " patient. I appreciate your information. Exercise is so difficult for me. I've gained a lot of weight in the last 5 years due to back surgery, mis diagnosis of Parkinson's, and thyroid issues. I am trying to get as much information as possible.

  10. Hello from Santa Clarita, CA. I really enjoy every one of your videos! Thank you. You are so informational!

  11. Hi. I'm from Scotland, but living in Germany at the moment .. I've been diagnosed this year in January…. feeling bad..

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