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  • Side effects of MAO-B inhibitors include nausea, dry mouth, dizziness, postural hypotension, insomnia, confusion and hallucinations.

Often a combination of physiotherapy and psychological treatment together with one or more of the following approaches is needed. Opioids, for example methadone, sometimes work and techniques like nerve block with local anaesthetic or transcutaneous electrical nerve stimulation or the topical use of capsaicin as a counter-irritant may help.

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The anaesthetic is injected into the subarachnoid space via a lumbar puncture between vertebrae L Efferent nerves are affected by the local anaesthetic. This method carries a risk of damage to the spinal cord.

With ageing, body composition changes such that there is more body fat with respect to total body weight, and the proportion of body water falls. The importance of this is that highly lipid-soluble accutane purchases, for example benzodiazepines, tend to have prolonged duration of action. Plasma protein concentration also falls with age. This means that for extensively protein bound drugs there will be a greater concentration of free drug than expected. This could lead to increased incidence of side effects. This is the case with pethidine (an analgesic).

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MAO-B is more specific for dopamine, than for noradrenaline or serotonin. Inhibition of MAO-B slows the breakdown of dopamine thereby increasing its availability at synapses and prolonging its effects. An example of a MAO-B inhibitor is selegiline, which is used in combination with levodopa. The dose of levodopa can be reduced and there is evidence that this combination has a neuroprotective effect and slows the progression of the disease. This may be because in Parkinsons disease, MAO-B is involved in the production of an endogenous neurotoxin. Combination therapy with levodopa also reduces end of dose deterioration.


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