Any medicines used in the treatment of Parkinson’s should not be stopped suddenly, unless advised by your doctor, as problems can occur. Duodopa®. contains co-careldopa (see previous page), but instead of being in tablet form, it is a gel that can be continually administered directly into the intestine via a tube, using a pump. Duodopa®. is reserved for advanced Parkinson’s disease with severe symptoms. It is tested first with a non-permanent tube from the nose to the intestine, and if a good response to treatment is seen, a permanent tube is inserted. Any complications with the pump device or the tube should be reported without delay, as this could mean the medicine is not reaching the intestine where it is absorbed into your system. Any medicines used in the treatment of Parkinson’s disease should not be stopped suddenly, unless advised by your doctor, as serious problems can occur These medicines are known as dopamine agonists, and are used in the treatment of Parkinson’s disease, or sometimes in the treatment of restless legs. Ropinirole and pramipexole come as oral tablets and rotigotine comes as a patch that is changed every 24 hours. Replacement rotigotine patches should be placed on different areas (avoiding using the same area for 14 days). The possible side-effects when a dopamine agonist is first started are similar to co-careldopa and co-beneldopa (nausea, etc). However, the side-effects tend to ease off over several days or weeks. If nausea is a problem – it is more likely to happen with these drugs than with levodopa—then it can usually be eased by the anti-sickness drug called domperidone. Drowsiness can occur with dopamine agonists, and it may be severe and affect your ability to drive. Some patients develop sudden sleep episodes. If you develop this side effect you must stop driving and contact your Parkinson’s nurse or neurologist. Compulsive behaviour can also be a side-effect and is more common with this group of drugs than with co-careldopa/co-beneldopa. Compulsive behaviour such as excessive gambling or shopping, binge eating or excessive interest in sexual activity can develop over time. Other side-effects can include confusion, hallucinations and ankle swelling. Please report the development of any of these side effects to your Parkinson’s nurse, GP or neurologist as it is likely that the dose of dopamine agonist will have to be reduced (or the dopamine agonist stopped). There are other less common side effects. Read the leaflet in the medicine packet for a full list of possible side-effects. Any medicines used in the treatment of Parkinson’s disease should not be stopped suddenly, unless advised by your doctor, as problems can occur. Apomorphine is another dopamine agonist, which is used in combination with co-careldopa/co-beneldopa. It needs to be given by an injection under the skin. It is used in people who have Parkinson’s disease in its later stages who have severe 'off' episodes where they become immobile. It can help to reverse these 'off' episodes but its effect only lasts for about an hour, so frequent injections are needed. If very frequent injections are needed, apomorphine may be given as a continuous infusion, using tubing with a needle or cannula at the end that is inserted under the skin so that the drug can flow into your body. Apomorphine is started in hospital under the supervision of a doctor experienced in the treatment of Parkinson’s disease. The anti-sickness medicine domperidone is always needed in the first four to six weeks of apomorphine treatment and needs to be started 48 hours before the first injection is given. Some patients can develop confusion, hallucinations or compulsive behaviours (excessive gambling, shopping, binge eating or increased sexual behaviour), as with other dopamine agonists (see previous page). Skin problems can also occur at injection sites. Please report any of these side effects to your Parkinson’s disease nurse, your GP or your neurologist. Any medicines used in the treatment of Parkinson’s should not be stopped suddenly, unless advised by your doctor, as problems can occur. Entacapone and tolcapone help to prolong the effect of each dose of co careldopa or co beneldopa. These medicines are sometimes advised in addition to co-careldopa or co-beneldopa when symptoms are not well controlled. Stalevo®. contains entacapone and co-careldopa in one tablet. Entacapone should be taken at the same time as dos-es of co-careldopa or co-beneldopa. It may colour the urine reddish-brown but this is harmless. Other people develop too much movement (dyskinesia) which may require a dose reduction. Some patients develop diarrhoea as a side effect of entacapone or tolcapone. If this occurs it will not get better while you are still on the drug. Therefore please contact your Parkinson’s nurse, GP or neurologist as soon as possible as it is very likely that the drug will need to be stopped and an alternative used. Any medicines used in the treatment of Parkinson’s should not be stopped suddenly, unless advised by your doctor, as problems can occur. Rasagiline / Selegiline These medicines are alternatives to co-careldopa and co-beneldopa for early Parkinson’s disease. Most people will require co-careldopa or co-beneldopa eventually. However, if you take rasagiline or selegiline, it may delay the need for co-careldopa or co-beneldopa for months or years. Sometimes these medicines are used in combination with co-careldopa or co-beneldopa in the later stages of Parkin-son’s disease. Certain other medicines should be avoided while you are on rasagiline or selegiline, so check with your doctor or pharmacist before you start on any new medicines, especially antidepressants. This includes “over-the-counter” medicines that are not prescribed. Any medicines used in the treatment of Parkinson’s disease should not be stopped suddenly, unless advised by your doctor, as problems can occur. Amantadine Amantadine is added in to other therapies for the management of symptoms in Parkinson’s disease. Some patients find that amantadine can keep them awake at night time. If this happens the dosing times can be changed so the last dose of the day is taken at lunchtime instead of at night. A few patients develop confusion, hallucinations, a rash or ankle swelling. Any medicines used in the treatment of Parkinson’s disease should not be stopped suddenly, unless advised by your doctor, as problems can occur. Phenytoin / Sodium Valproate / Carbamazepine / Lamotrigine / Oxcarbazepine / Eslicarbazepine / Gabapentin / Pregabalin / Levetiracetam / Topiramate / Phenobarbital / Primidone / Clonazepam / Clobazam / Zonisamide / Ethosuximide / Lacosamide / Retigabine / Vigabatrin There are many medicines used to treat epilepsy. They each come with different brand names. (The brand names are not listed above.) These are all medicines used to treat or prevent seizures (fits). Some of them are also used to treat other conditions such as nerve pain, or to prevent migraines. One of the-se medicines will be prescribed if you have had one or more seizures, or if your doctor thinks you may be at risk of having a seizure, or alternatively to help control pain or prevent migraines. The following information applies to people who are taking these medicines for any of these reasons.