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The "Wearing Off" Phenomenon in Parkinson's Disease: Current Strategies for Optimizing Dopaminergic Therapy in Long-Term Care

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Objectives: To present an overview of Parkinson's disease and review the available treatment options. To examine consensus guidelines for recommending appropriate therapy in individual patients.

Data Sources: Proceedings from live symposium; recent literature and published studies on Parkinson's disease; consensus guidelines from the American Medical Directors Association and the American Academy of Neurology.

Conclusions: Parkinson's disease is a significant and growing concern in long-term care facilities. Various pharmacologic treatment options exist for management of the disease; however, each approach has its limitations, and treatment must be individualized to meet the need of each patient, and adjusted over the course of disease progression.

Abbreviations: AAN = American Academy of Neurology; ADL = activities of daily living; AMDA = American Medical Directors Association; COMT= catechol-O-methyltransferase; MAO-B = monoamine oxidase type B; NMDA = N-Methyl-D-Aspartate; PD = Parkinson's disease.

Consult Pharm 2005;20:(Suppl B):s6-s14.

Objectives: To explain the phenomenon of “wearing off” and describe the therapeutic window of levodopa treatment; to discuss treatment approaches for the motor fluctuations and dyskinesias that manifest with long-term levodopa therapy.

Data Sources: Proceedings from live symposium; recent literature and published studies on Parkinson's disease and complications of levodopa therapy.

Conclusions: Long-term therapy with levodopa inevitably results in the wearing off phenomenon, in which motor complications become increasingly prevalent. A variety of pharmacologic approaches have been designed to treat these complications in both early and later stages of PD.

Abbreviations: PD = Parkinson's disease; COMT; catechol-O-methyltransferase; MAO-B = monoamine oxidase type B. Consult Pharm 2005;20:(Supp B):s15-s21.

Objectives: To specify the role of the consultant pharmacist in the interdisciplinary approach to Parkinson's disease (PD) management and to outline important issues consultant pharmacists should consider in optimizing treatment for PD residents in the long-term care setting.

Data Sources: Proceedings from live symposium; recent literature and published studies on geriatric and long-term care patient management; published guidelines from the America Medical Directors Association, American Society of Consultant Pharmacists, Health Care Financing Administration (now the Centers for Medicare & Medicaid Services), and the National Health Policy Forum.

Conclusions: Long-term care facilities face growing pressures to meet quality improvement initiatives, minimize polypharmacy and medication-related errors, and implement cost-containment measures. The consultant pharmacist serves a critical role in this environment, conducting drug regimen reviews, controlling costs, limiting polypharmacy, and communicating with medical directors and other health care professionals regarding the assessment, treatment, and monitoring of patients with PD.

Abbreviations: AMDA = American Medical Directors Association; ASCP = American Society of Consultant Pharmacists; CMS = Centers for Medicare & Medicaid Services; CNA = certified nursing assistant; MDS = Minimum Data Set; NHPF = National Health Policy Forum; PD = Parkinson's disease; QI = quality indicator.

Consult Pharm 2005;20:(SuppB):s22-s25.

Keywords: COMT inhibitor; Consultant pharmacist; Dopamine agonist; Dopaminergic therapy; Dyskinesia; Levodopa; Minimum Data Set; Motor complications; Motor fluctuations; Parkinson's disease; Quality indicators; Wearing off

Document Type: Research Article


Publication date: 2005-11-01

More about this publication?
  • The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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