Table 5 Treatment options of autonomic failures in Parkinson’s disease
symptom | treatment options |
|---|---|
salivation | belladonna compounds, anticholinergic drugs, glycopyrrolate, botulinum toxin (off label use), 1% atropine eye solution (off label use) |
seborrhea | soaps, shampoos |
hyperhidrosis | botulinum toxin |
constipation | Various kinds of laxatives, sufficient hydration, fibers, prucaloprid (Reselor®), macrogel (Movicol®) |
gastrointestinal motility | Domperidone, prucaloprid (Reselor®) (off label use !) |
bladder dysfunction | genneral approach: reduced fluid intake at night is sometimes helpful. parasympatholytics, imipramine, Fesoterodinfumarat (Toviaz®) Darifenacin (Emselex ®), botulinum toxin (off label use !) (in case of imperative urgency due to overactive bladder syndrome [detrusor hyperreflexia or overactivity]) optimum dopaminergic drug titration (in case of frequent and/or involuntary urinary incontinence due to uninhibited contractions of the detrusor muscle) distigmine bromide, reduction of anticholinergic drugs, (in case of detrusor hyporeflexia [underactivity]) |
sexual dysfunction | sildenalfil, oral apomorphine, alprostadil, psychotherapy |
orthostatic syndrome | patient education, non pharmacological interventions, midodrine, fludrocortisone, yohimbine, droxidopa |