Nuplazid™ – The first and only FDA-approved therapy for hallucinations and delusions associated with psychosis in Parkinson’s Disease.  Nuplazid™ (also known by the generic name pimavanserin) works by blocking some of the effects of the neurotransmitter serotonin for which one of the specific receptors is expressed excessively especially in certain brain areas important in processing visual information. It is thought that this is important in the development in of visual hallucinations which are the most symptom seen as part of Parkinson’s disease psychosis. Unlike other antipsychotic medications, Nuplazid does not block dopamine and as a result, importantly does not worsen motor function in PD patients. The onset of action is gradual and maximal effects are not seen for about 6 weeks after initiation of once-daily therapy. On average, the severity of psychotic symptoms is reduced 30 – 40 %, while 10-15% percent of patients have complete elimination of psychosis. Although generally well-tolerated, the most common side effects include nausea, swelling (edema), confusion, worsening fo hallucinations, and worsening of gait.

GOCOVRI™ – This is the first and only FDA approved medication to treat dyskinesia in PD. GOCOVRI™ is an extended release Amantadine preparation generally given as a high dose at bedtime to achieve high sustained levels during the following waking day. Typically, immediate release amantadine is given in lower doses which may not achieve the high levels needed to effectively block dyskinesia. It is thought that blocking the glutamate NMDA receptor underlies the antidyskinetic effects of amantadine. Dyskinesia was improved 40 to 50 % in the pivotal clinical trials within 2 weeks of starting therapy. Gocovri has also been shown to reduce off-time by about one hour per day compared to placebo and so improves motor fluctuations with antagonistic effects on the most common side effects include hallucinations, swelling (edema), livedo reticularis (blotchy patches on the skin of legs), orthostatic hypotension (low blood pressure on standing causing lightheadedness), dry mouth, blurry vision, and constipation. neurotransmitter glutamate.

DUOPA – Duopa is a gel formulation of levodopa/ carbidopa delivered by a pump that delivers carbidopa/levodopa directly into the small intestine via an implanted tube that markedly reduces motor fluctuations in advanced PD patients by reducing the variability of delivery and absorption of levodopa through the day. The tube is inserted during a simple outpatient surgical procedure. The patient wears a pump in holster or vest or fanny back all day. Most patients do not require continuous therapy at night and are able to disconnect the pump at bedtime. Patients that experience tube-related complications (which are common) or fail to benefit from the therapy can easily have the tube removed.

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