Dopaminergic Side Effects

05/07/2010

Dopaminergic side effects:

All dopaminergic share similar side effects. These side effects are listed below (click here for more informaiton on dopaminergic medicines);

Nausea and vomiting
Heartburn
Sedation, daytime sleepiness, sudden sleep attacks (may be more frequent with agonists)
Impulsive or compulsive behaviors such as gambling, overeating, hypersexuality problems (especially with agonists)
Leg swelling
Lightheadedness or dizziness

Medicine Specific Side Effects

Selegeline- insomnia, anxiety, hallucinations

Amantadine- memory problems, dry mouth, constipation, urine retention, leg swelling and rash

Agonists- Sedation and sleep attacks (falling asleep during activity), impulsivity control

Entacapone (Stalevo) and tolcapone- orange urine and perspiration, diarrhea

Medication Cautions:

Alcohol can intensify or increase the risk of sedation, confusion, low blood pressure and falls when taking dopaminergic medications.

Selegiline (Eldepryl, Zelopar) and Rasagiline (Azilect). Talk with your doctor if you are taking an antidepressant as some medications must not be taken along with selegiline or rasagiline due to potential interactions. Do not take these medicines with mepiridine (Demerol) due to a potential life-threatening drug interaction. Other medicines that should not be used with MAO B inhibitors include appetite suppressants, St John’s Wort, cyclobenzaprine, dextromethorphan, tramadol (Ultram), and propoxyphene (Davocet).

Note that this list is not complete, so talk to your doctor or pharmacist about these and other medicines you should not take with MAO B inhibitors.

Dopamine agonist ropinirole (Requip) and pramipexole (Mirapex) can be associated with sedation, and sleep attacks. Sleep attacks include falling asleep during activities such as eating, talking or driving. Most people feel a sense of excessive sleepiness on these medicines and this serves as a warning sign that you may be at risk for sleep attacks. Dopamine agonists can increase your risk of impulsivity control problems such as pathological gambling, excessive spending, hypersexuality and excessive eating. Although impulsivity control problems and sedation are more common with dopamine agonists, these problems can occur with any dopaminergic therapy.

Remember dopaminergic medicines are sometimes used in combination which can increase the risk of side effects and potential interaction with your other medications. New side effects are often experienced when a new medicine is added. If you experience a side effect from a new medicine it could be related to that medicine or the combined effect of other PD medicines you may be taking. It is important to tell your doctor about any side effects you are experiencing.

Helpful Hint: Help your doctor help you by keeping a current list of all medications including prescription and non-prescription drugs. Update this list and bring to each medical appointment. Statements like “my doctor knows what I am on” or “same as before” is one of the biggest sources of medical errors in an outpatient clinic.

Complete the Medication Log. Be sure to list all medicines you have tried or are currently taking for Parkinson’s. This will help you and your doctor. Update this medication log every time you have a doctor’s appointment or change in prescription. Outdated medication lists are a common source of medication error and problems.

If you stopped a medicine due to a side effect, record any benefit from the drug, if any, as well as the side effects, the highest dose and duration of time you were taking the medication. As movement changes over time, medications will be changed so this information will help you and your doctor review what has already been tried and what did or did not work.

Author: Monique Giroux, MD

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