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Symptoms and Stages

Four main symptoms of Parkinson’s1

  • Resting tremors.
  • Slow movement (bradykinesia).
  • Stiff or rigid muscles, especially of the arms, legs, neck, or torso.
  • Trouble with balance or falling.

Other symptoms may include2-7

  • Freezing, or being stuck in place, while walking.
  • Reduced arm swing on one side of your body.
  • Slight foot dragging.
  • Low voice.
  • Loss of automatic movements, such as blinking or swallowing.
  • Changes in your speech.
  • Changes in your handwriting.
  • Changes in taste or smell.
  • Sleep changes—sleeping too much or not enough.
  • Dizziness, blurred vision, or fainting upon standing up
    (postural hypotension).
  • Issues such as urinary urgency or constipation.
  • Erectile dysfunction.
  • Difficulty concentrating or remembering.
  • Changes in mood.
  • Loss of reality or hallucinations (psychosis).
  • Impulse control disorders.
Parkinson’s Disease Symptoms and Stages Page Image

Goals to Aim For When You Live With Parkinson’s Disease

Maintain Your Current Activity Level
Maintaining your current
activity level.
Experience More “On” Time, Decreased “Off” Time
Experiencing more “on” time
by decreasing “off” time.8
Move and Perform Daily Tasks
Being able to move and
perform daily tasks.
Maintain Relationships with Family and Friends
Maintaining relationships
with family and friends.

“Off” time

is when your medication isn’t working, and you have to cope with your symptoms. You might feel stiff, move slowly, or not be able to get around so easily because
your symptoms are getting in the way.8

“On” time

is when your symptoms are less apparent, and you can go about your day. You feel more mobile and flexible and are able to move around.

Keeping a positive attitude

Parkinson’s is a disease that progresses slowly for most people.9 Once you receive your diagnosis, you could be living with Parkinson’s for many years.10 Some people may experience only mild symptoms of Parkinson's disease for several years after their diagnosis.

This is why it’s important to keep a positive attitude and to learn as much as you can about managing your symptoms. Build a strong healthcare team and support system around you. Become an empowered patient.9,11

Stages of Parkinson’s Disease12

Early

You have symptoms that are
beginning to interfere with
your daily activities.

You may feel off-balance and
are fearful of falling.

You may also feel unusually
tired and lack energy.

Moderate

Symptoms have caused a level
of disability that requires
treatment with levodopa, a drug
used to help treat the symptoms
of Parkinson’s disease.

Freezing episodes may occur,
when you feel like your feet are
stuck to the ground. Freezing
can also affect the arms and
other parts of the body.
13,14

The Parkinson’s medication you
take may “wear off” between
doses, meaning your symptoms
start coming back sooner.

Advanced

You experience freezing
episodes that make it
difficult to walk.

You may require live-in help or
an assisted living facility.

Your friends notice a significant
change in your posture.

You may experience
hallucinations and see or hear
things that aren’t real.

Get your RYTARY Co-Pay Savings Card here and pay no more than $25*
*Up to $100 maximum benefit. Subject to eligibility. Individual out-of-pocket costs may vary. See terms, conditions, and eligibility criteria.

IMPORTANT SAFETY INFORMATION

Do not take RYTARY with antidepressant medications known as nonselective monoamine oxidase (MAO) inhibitors because taking these two drugs within two weeks of each other can result in high blood pressure.

Taking RYTARY may result in falling asleep while engaged in normal activities, even without warning and as late as one year after starting to take RYTARY. Other sedating medicines and alcohol taken together with RYTARY may have additional sedative effects. Tell your healthcare provider if you have any kind of sleep disorder or are experiencing drowsiness or sleepiness.

Some side effects of taking RYTARY including sleepiness and dizziness may affect your ability to drive or operate machinery. Do not drive a car, operate a machine, or do anything that requires you to be alert until you know how RYTARY affects you.

Talk to your healthcare provider before you lower the dose or stop taking RYTARY, as this may result in serious side effects. Call your healthcare provider immediately if you develop withdrawal symptoms such as fever, confusion, or severe muscle stiffness.

Make sure to tell your healthcare provider if you have any heart conditions, especially if you have had a heart attack or experience irregular heartbeat. Some people with a history of or risk factors for heart disease have experienced heart problems while taking RYTARY.

Some patients taking RYTARY can experience hallucinations (unreal visions, sounds, or sensations) or abnormal thoughts and behaviors (such as excessive suspicion, believing things that are not real, confusion, agitation, aggressive behavior, and disorganized thinking). If you have hallucinations or abnormal thoughts or behaviors, talk with your healthcare provider.

Some patients taking certain medicines to treat Parkinson’s disease have intense urges to gamble, increased sexual urges, other intense urges, and the inability to control those urges. If you or your family members notice that you are developing unusual urges or behaviors, talk to your healthcare provider.

Tell your healthcare provider if abnormal involuntary movements appear or get worse during treatment with RYTARY.

Tell your healthcare provider if you have ever had an ulcer, because RYTARY may increase your chances of having bleeding in your stomach.

Tell your healthcare provider if you have glaucoma, because RYTARY may increase the pressure in your eyes.

Parkinson’s disease patients are at an increased risk of developing melanoma, a form of skin cancer. See your healthcare provider for regular skin examinations when taking RYTARY.

The most common side effects that may occur with RYTARY include nausea, dizziness, headache, sleeplessness, abnormal dreams, dry mouth, abnormal involuntary movements, anxiety, constipation, vomiting, and low blood pressure upon rising. Rise slowly after sitting or lying down for a prolonged period.

In post marketing use, some patients taking RYTARY have experienced suicidal thoughts or have attempted suicide. A causal relationship has not been established. Tell your healthcare provider if you have thoughts of suicide or have attempted suicide.

Tell your healthcare provider if you have any side effects while taking RYTARY. He or she can make adjustments that may reduce these effects.

Notify your healthcare provider if you become pregnant or intend to become pregnant during therapy or if you intend to breast-feed or are breast-feeding an infant.

Make sure you tell your healthcare provider about all of the prescription and non-prescription medications you take, including supplements, and especially those for Parkinson’s disease, heart disease, blood pressure, abnormal thoughts, tuberculosis, and sleep problems, and supplements containing iron. Do not take other carbidopa-levodopa preparations with RYTARY without consulting your healthcare provider.

Be sure to take your medicine as instructed. You may take RYTARY with or without food; however, taking RYTARY with food may decrease or delay its effect. For this reason consider taking the first dose of the day about 1 to 2 hours before eating. Swallow RYTARY whole; do not chew, divide, or crush. If you have difficulty swallowing the capsule, twist apart both halves and sprinkle the entire contents of both halves of the capsule on a small amount of applesauce (1 to 2 tablespoons). Consume the mixture immediately. Do not store the drug/food mixture for future use.

Note: The above information for patients being treated with RYTARY is intended to aid in the safe and effective use of this medication. It is not a disclosure of all possible adverse or intended effects.

INDICATION

RYTARY is a prescription medication that contains a combination of carbidopa and levodopa for the treatment of Parkinson’s disease, Parkinson’s disease caused by infection or inflammation of the brain, or Parkinson’s disease resulting from carbon monoxide or manganese poisoning.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. To report SUSPECTED ADVERSE REACTIONS contact Impax Laboratories, Inc. at 1-877-994-6729.

Please read the full Prescribing Information For more information go to RYTARY.com and/or talk to your healthcare provider.

References:

1. Parkinson’s Disease Foundation website: http://www.pdf.org./symptoms_primary. Accessed December 12, 2014.
2. What are the symptoms of Parkinson’s disease? National Parkinson Foundation website.
http://parkinson.org/Parkinson-s-Disease/PD-101/How-do-you-know-if-you-have-PD. Accessed December 15, 2014.
3. Fahn S, Jankovic J, Hallett M. Parkinsonism: clinical features and differential diagnosis. In: Principles and Practice of Movement Disorders. 2nd ed. Saunders Elsevier;
2011:66-92.
4. Olanow CW, Stern MB, Sethi K. The scientific and clinical basis for the treatment of Parkinson disease. Neurology. 2009;72(21)(suppl 4):S1-S136.
5. Dorland’s Online Medical Dictionary. 32nd ed. Elsevier; 2012. http://www. dorlands.com. Accessed May 20, 2014.
6. Tortora GJ, Derrickson B. Nervous tissue. In: Tortora GJ, Derrickson B, eds. Principles of Anatomy and Physiology. 13th ed. Hoboken, NJ: John Wiley & Sons, Inc;
2012:447-491.
7. Fernandez HH. Updates in the medical management of Parkinson disease. Cleve Clin J Med. 2012;79(1):28-35.
8. Hauser RA, Friedlander J, Zesiewicz TA, et al. A home diary to assess functional status in patients with Parkinson’s disease with motor fluctuations and dyskinesia.
Clin Neuropharmacol.
9. What is Parkinson’s disease? National Parkinson Foundation website. http://parkinson.org/parkinson-s-disease/pd-101/what-is-parkinson-s-disease. Accessed
December 12, 2014.
10. McCoy K. Recognizing the progression of Parkinson's disease symptoms. Everyday Health.
http://www.everydayhealth.com/parkinsons-disease/parkinsons-disease-progressions.aspx. Accessed December 12, 2014.
11. Managing your PD. Parkinson's Disease Foundation website. http://www.pdf.org/managing_pd. Accessed December 12, 2014.
12. Fahn S, Jankovic J, Hallett M. Medical treatment of Parkinson disease. In: Principles and Practice of Movement Disorders. 2nd ed. Saunders Elsevier; 2011:119-156.
13. Hauser RA. Parkinson disease clinical presentation. Medscape. http://emedicine.medscape.com/article/1831191-clinical. Accessed December 12, 2014.
14. “Freezing” and Parkinson's. National Parkinson Foundation website.
http://wwww.parkinson.org/NationalParkinsonFoundation/files/68/68c7c64a-0b12-4fee-9cb2-a27b81f119ac.pdf. Accessed December 12, 2014.