“This advice is for the newly diagnosed. One doctor told me that it is not good to overmedicate. He says treat the symptoms you can’t live with and live with the symptoms you can endure. Overmedication can bring serious side effects (painful constipation, heavy drowsiness during the day, serious back pain, rapid blinking, etc.). I followed this advice and removed one medication from my regime. I feel a lot better and, more importantly, can function satisfactorily.”
—ANONYMOUS, PWP
Regardless of which antiparkinsonian medication(s) your doctor prescribes, you will most likely have to deal with side effects. Though they can be a pain in the butt, most side effects either go away over time as your body adjusts to the medication or are treatable through various means.
The most common side effects of levodopa are nausea and vomiting. These occur most often when first taking the drug and usually disappear over time. Nausea is much less common with controlled release Sinemet (Sinemet CR), which is absorbed more slowly than the regular Sinemet.
In addition to a queasy stomach, you may feel drowsy or experience low blood pressure or hallucinations.
The following are ways to control or relieve nausea.
• Take the medication with a small carbohydrate snack, such as crackers or toast.
• Your doctor may add extra carbidopa to your medication.
• Drink liquids that are clear, cold, and contain sugar. These types of fluids often help calm the stomach better than others.
• Avoid most fruit juices because they have a high acidity level that can make your nausea worse.
• Eat and drink slowly.
• Take your time eating and drinking. Smaller meals spread throughout the day and drinks consumed in between these meals may help reduce your nausea.
• Eat bland foods (e.g., saltine crackers, bread, rice) and be sure to avoid greasy and sweet snacks.
• Keep your food one temperature—if you are eating hot food, don’t also include cold food. If you are feeling nauseated by the smell of hot or warm foods, trying eating foods that are either cold or at room temperature instead.
• Keep your head elevated after eating.
• Rest and avoid activity right after eating so as not to induce vomiting.
• Do not brush your teeth directly after eating.
• If you often feel nauseous when you wake up in the morning, leave crackers on your bedside table and snack on them before you get up. You can also eat a high-protein snack before bed.
The following conditions should be discussed with your doctor before starting Sinemet.
• An allergy to carbidopa, levodopa, or any other part of the medicine
• Narrow-angle glaucoma, history of melanoma, unexplained skin spots
• Whether you have taken a monoamine oxidase inhibitor (phenelzine, tranylcypromine, isocarboxazid) in the last 14 days
Dopamine agonists can cause nausea, especially if they are the first antiparkinsonian drugs you have taken. Building up your dose very slowly can help, even though you may be impatient to feel the improvement in your PD symptoms. (It can take many days or weeks for your body to adjust to your first PD medications.)
If nausea is a problem for you, your doctor may suggest one of the following.
• Reduce the dosage of meds you start on.
• Take your medications with food.
• Take an antihistamine one hour before each dose of dopamine agonist. (Ask your doctor which one might be right for you.)
Another common side effect of dopamine agonists is low blood pressure, which can make you feel dizzy or lightheaded. You may also have swelling in your legs, see things that aren’t there (hallucinations), feel drowsy, or fall asleep without warning. If you have problems with daytime drowsiness, make sure you stop driving until you’ve talked to your doctor. Usually drowsiness goes away, but your doctor may prescribe a drug to help keep you more alert.
One note about dopamine agonists: You may have heard that some people have a reaction to these drugs that leads to compulsive gambling, shopping, or eating, or to hypersexuality. Recent reports indicate that this is more common than previously thought. If you experience feelings of compulsion, you should discuss them with your doctor so that your medications can be adjusted before behavioral changes occur. It is also important to note that compulsive behaviors can manifest in those who are taking carbidopa-levodopa. One way to help control unwanted behaviors is to reduce the dosage of the medication you’re on.
COMT inhibitors can cause diarrhea and dark yellow urine. Though the discoloration of urine is harmless, you should stop taking Comtan or Tasmar if you have problems with diarrhea. Tasmar can also cause liver damage, so your doctor will monitor your liver function through regular blood tests. Since COMT inhibitors work with levodopa, you may also have side effects associated with that drug, such as dyskinesia.
MAO-B inhibitors can cause (though in rare instances) flu-like symptoms, changes in blood pressure, and joint pain. You may also experience hallucinations or insomnia, especially if you are older or have more advanced PD. Nausea, insomnia, dyskinesia, and falls can be problems for those taking Xadago (safinamide).
Note: There are certain drugs, including antidepressants, muscle relaxants, pain and cold medications, and herbal supplements, that can interfere with MAO-B inhibitors and cause a potentially severe reaction called serotonin syndrome. Though this reaction is rare, it’s important that you talk to your doctor and pharmacist about any other medications you are taking if you are going to be starting on an MAO-B inhibitor.
In addition, if taken in high doses, MAO-B inhibitors can sometimes react with large amounts of foods that contain tyramine (e.g., cured meats and aged cheeses) and raise your blood pressure significantly. If you have a fondness for these types of foods, you may want to eat them in moderation while on an MAO-B inhibitor.
Anticholinergics can cause dry mouth and eyes, blurred vision, and constipation. They can also cause confusion, short-term memory loss, and hallucinations. Because older people are more susceptible to side effects, these drugs should be avoided in individuals over the age of 70.
Amantadine’s side effects can include reddish-purple blotchy spots on the skin (called livedo reticularis), swelling of legs and feet, insomnia, constipation, nausea, dry mouth, and dizziness. My mom had an issue with livedo reticularis on the lower part of one leg (the side that was predominantly affected by Parkinson’s), though we didn’t know it was related to her PD at the time. It didn’t bother her other than it did not look so great when she was in her bathing suit.
Another side effect of amantadine is seeing things that aren’t there (hallucinations). This tends to happen in older people with PD and was something my mom experienced in the later stages of her disease. Sometimes her hallucinations were scary (e.g., she thought there was a big black hole in front of her that her grandkids kept falling into), while other times not (e.g., her deceased husband was sitting in her room with her). At first we talked them out with Mom to see if she understood that what she was seeing was not real. Eventually the hallucinations became too scary for her, so we had her doctor reduce the amount of amantadine she was taking to help ease (successfully) the frequency of these events.
If you have been prescribed Nourianz, you may experience side effects that include dyskinesia, constipation, nausea, dizziness, insomnia, and hallucinations.