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Common Medicines Common Side Effects

Sunday March 30, 2014

Medication can help you move and treat a number of  symptoms such as mood, cognition and bladder control. When taking any medicine, it is important to understand both what medicines can do for you and the side effects to monitor.

Although each individual medicine will have specific side effects, medicines can be categorized into groups associated with more general side effects. Most Parkinson’s medicines work by enhancing the dopaminergic system deficient in the brain or blocking another neurotransmitter, acetylcholine. The following side effects can be associated with PD motor medications:

Dopaminergic medicines used to treat rigidity, bradykinesia, tremor (i.e., Ldopa, entacapone, Pramipexole, Ropinirole, Rotigitine, amantadine, rasagiline, selegiline):

  • Nausea
  • Sedation
  • Confusion
  • Hallucinations or Delusions
  • Leg Swelling
  • Lightheadedness
  • Headache
  • Impulsive Control Symptoms (gambling, spending)

Anticholinergic medicines used to treat tremor and dystonia (trihexyphenidyl, benztropine, ethopropazine):

  • Memory Loss and confusion
  • Constipation
  • Dry eyes and mouth
  • Bladder retention
  • Lightheadedness

Other medicines used to treat specific symptoms:

Botulinum toxin used to treat dystonia most commonly neck, arms and legs, eye and facial spasm,, and bladder control drooling (i.e. Botox, Myobloc, Dysport):

  • Weakness in muscles injected or adjacent to these muscles due to spread of toxin
  • Dry eye, mouth, reduced sweating
  • Swallowing (more common when toxin injected into neck muscles)

Bladder antispasmodic medicines used to treat overactive bladder causing urinary urgency (i.e., oxybutynin, tolterodine, solifenacin). These medicines block acetylcholine in the bladder but can also cross the blood brain barrier causing these side effects:

  • Memory Loss and confusion
  • Constipation
  • Dry eyes and mouth
  • Bladder retention
  • Lightheadedness

Antidepressants have a variety of action but most commonly enhance neurotransmitters serotonin, acetylcholine, dopamine and norepinephrine. Each antidepressant will have different side effects dependent on their unique properties. As a group these medicines are associated with the following side effects:

  • Jitteriness
  • Sedation
  • Insomnia
  • Gastric upset
  • Headache
  • Lightheadedness

Memory or cognitive enhancing medicines increase acetylcholine levels in the brain (rivastigmine, galantamine, donepezil.) Associated sides effects can include:

  • Nausea and gastric upset
  • Worsening of gastric ulcer (not recommended to be used in this situation)
  • Tremor
  • Heart arrhythmia in people with heart block (not recommended to be used in this situation)
  • Increased freezing of gait (uncommon)

Antipsychotics are used to treat visual hallucinations and psychosis caused, in part, by dopamine medicines for movement. Most antipsychotics should not be used in people with PD since they block dopamine activity and worsen movement. At present, the American Academy of Neurology recommends quetiapine and clozapine as the only two medicines in this class. Side effects include:

  • Lightheadedness
  • Sedation
  • Low white blood cell level (clozapine)

Note, any medicine can cause an allergic reaction ( hives, rash, itching, swelling of face, throat, breathing problems) and can interact with other medicines to create unique side effects problems, This list is not complete and should not take the place of advice or information from your doctor or healthcare provider.

Monique L. Giroux, MDMonique L. Giroux, MD
Medical Director, Northwest Parkinson's Foundation

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