PHARMACEUTICAL MANAGEMENT IN PARKINSON'S DISEASE: SUPPLEMENTATION STRATEGIES FOR THERAPEUTIC OPTIMIZATION
DOI:
https://doi.org/10.66104/6m5xxx41Keywords:
Pharmaceutical Services; Parkinson Disease; Dietary Supplements.Abstract
Parkinson's disease (PD) is a neurodegenerative condition associated with oxidative stress and mitochondrial dysfunction, which makes antioxidant supplementation a promising adjunctive strategy. This study aimed to evaluate the evidence on the efficacy and safety of omega-3, coenzyme Q10 (CoQ10), and N-acetylcysteine (NAC) supplementation in Pd, as well as to discuss the role of the clinical pharmacist in this context. This is an integrative literature review, with searches conducted in the VHL, PubMed, and SciELO databases using descriptors related to PD and the supplements of interest. Eleven articles published between 2016 and 2025 were selected. The results indicate that omega-3, especially when combined with vitamin E, showed consistent results in delaying disease progression, as well as improving depressive symptoms and inflammatory markers. CoQ10, despite its neuroprotective potential in preclinical models, did not demonstrate significant efficacy when administered orally, likely due to its low bioavailability. NAC showed promising results in preclinical and early clinical studies, with improvements in dopaminergic biomarkers and motor function, although some studies indicate risks of adverse effects at high doses. It is concluded that omega-3 presents more consolidated evidence as an adjunctive therapy in PD, while CoQ10 and NAC require further investigation regarding their activity. The clinical pharmacist plays an essential role in the critical evaluation of the literature, individualization of treatment, and monitoring the safety and efficacy of supplementation.
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CARIDADE-SILVA, R. et al. N-Acetylcysteine Treatment May Compensate Motor Impairments through Dopaminergic Transmission Modulation in a Striatal 6-Hydroxydopamine Parkinson’s Disease Rat Model. Antioxidants v. 12, n. 6, 2023. DOI: https://doi.org/10.3390/antiox12061257. DOI: https://doi.org/10.3390/antiox12061257
COLES, L. D. et al. Repeated-dose Oral N-acetylcysteine in Parkinson Disease: Pharmacokinetics and Effect on Brain Glutathione and Oxidative Stress. J Clin Pharmacol., v. 58, n. 2, p. 158-167, 2018. DOI: https://doi.org/10.1002/jcph.1008. DOI: https://doi.org/10.1002/jcph.1008
DETOPOULOU, P. et al. Omega-3 fatty acids' supplementation in Parkinson's disease: A systematic review of randomized controlled trials. Clinical Nutrition Open Science, v. 55, 102-115, 2024. DOI: https://doi.org/10.1016/j.nutos.2024.03.007. DOI: https://doi.org/10.1016/j.nutos.2024.03.007
DJURICIC, I.; CALDER, P. C. Beneficial Outcomes of Omega-6 and Omega-3 Polyunsaturated Fatty Acids on Human Health: An Update for 2021. Nutrients, v. 13, n. 7, 2021. DOI: https://doi.org/10.3390/nu13072421. DOI: https://doi.org/10.3390/nu13072421
EL-HABTA, R. et al. N-acetylcysteine increases dopamine release and prevents the deleteriouseffects of 6-OHDA on the expression of VMAT2, α-synuclein, and tyrosinehydroxylase. Neurological Research, v. 46, n. 5, p. 406-415, 2024. DOI: https://doi.org/10.1080/01616412.2024.2325312. DOI: https://doi.org/10.1080/01616412.2024.2325312
KIM, T. Y. et al. Control of Reactive Oxygen Species for the Prevention of Parkinson’s Disease: The Possible Application of Flavonoids. Antioxidants (Basel), v. 9, n. 7, 2020. DOI: https://doi.org/10.3390/antiox9070583. DOI: https://doi.org/10.3390/antiox9070583
KIRAN, P. U. et al. Mitochondrial dysfunction and oxidative stress in Parkinson's disease: mechanisms, biomarkers, and therapeutic strategies. Tissue Barriers, 2025. DOI: https://doi.org/10.1080/21688370.2025.2537991. DOI: https://doi.org/10.1080/21688370.2025.2537991
MENDES, K. D. S.; SILVEIRA, R. C. C. P.; GALVÃO, C. M. Revisão Integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm., v. 17, n. 4, p. 758-64, 2008. DOI: https://doi.org/10.1590/S0104-07072008000400018
MILLICHAP, L. et al. The Effect of Neuronal CoQ10 Deficiency and Mitochondrial Dysfunction on a Rotenone-Induced Neuronal Cell Model of Parkinson’s Disease. Int. J. Mol. Sci., v. 25, n. 12, 2024. DOI: https://doi.org/10.3390/ijms25126622. DOI: https://doi.org/10.3390/ijms25126622
MONTI, D. A. et al. N-Acetyl Cysteine Is Associated With Dopaminergic Improvement in Parkinson's Disease. Clin. Pharmacol. Ther., v. 106, v. 4, p. 884-890, 2019. DOI: https://doi.org/10.1002/cpt.1548. DOI: https://doi.org/10.1002/cpt.1548
MONTI, D. A. et al. N-Acetyl Cysteine May Support Dopamine Neurons in Parkinson's Disease: Preliminary Clinical and Cell Line Data. PLoS Um., v. 11, n. 6, 2016. DOI: https://doi.org/10.1371/journal.pone.0157602. DOI: https://doi.org/10.1371/journal.pone.0157602
PARK, H. W. et al. Intrastriatal administration of coenzyme Q10 enhances neuroprotection in a Parkinson’s disease rat model. Scientific Reports, 2020. DOI: https://doi.org/10.1038/s41598-020-66493-w. DOI: https://doi.org/10.1038/s41598-020-66493-w
POEWE, W. et al. Parkinson disease. Nat Rev Dis Primers, v. 3, n. 17013, 2017. DOI: https://doi.org/10.1038/nrdp.2017.13. DOI: https://doi.org/10.1038/nrdp.2017.13
POGAČNIK, L.; OTA, A.; ULRICH, N. P. An Overview of Crucial Dietary Substances and Their Modes of Action for Prevention of Neurodegenerative Diseases. Cells, v. 9, n. 3, p. 576, 2020. DOI: https://doi.org/10.3390/cells9030576. DOI: https://doi.org/10.3390/cells9030576
SHTILBANS, A. et al. Combination of tauroursodeoxycholic acid, co-enzyme Q10 and creatine demonstrates additive neuroprotective effects in in-vitro models of Parkinson’s disease. Front Neurosci., 2024. DOI: https://doi.org/10.3389/fnins.2024.1492028. DOI: https://doi.org/10.3389/fnins.2024.1492028
TAGHIZADEH, M. et al. The effects of omega-3 fatty acids and vitamin E co-supplementation on clinical and metabolic status in patients with Parkinson's disease: A randomized, double-blind, placebo-controlled trial. Neurochemistry International, v. 108, p. 183-189, 2017. DOI: https://doi.org/10.1016/j.neuint.2017.03.014. DOI: https://doi.org/10.1016/j.neuint.2017.03.014
TECHA ANGKOON, P. et al. Impact of pharmacist physician collaboration on patient outcomes in Parkinson’s disease: a randomised controlled trial in tertiary care. International Journal of Clinical Pharmacy, v. 47, p. 834-843, 2025. DOI: https://doi.org/10.1007/s11096-025-01883-6. DOI: https://doi.org/10.1007/s11096-025-01883-6
YI, Z-M. et al. Impact of a Collaborative Pharmaceutical Care Service for Patients With Parkinson’s Disease. Front Pharmacol., v. 12, 2022. DOI: https://doi.org/10.3389/fphar.2021.793361. DOI: https://doi.org/10.3389/fphar.2021.793361
ZAFAR, S.; LUI, F.; YADDANAPUDI, S. S. Parkinson Disease. Treasure Island (FL): StatPearls Publishing; 2025. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK470193/. Acesso em: 16 de fev. de 2026.
ZAMPESE, E.; MORAN. J.; SURMEIER, D. J. Chapter 32 - Neuronal design and determinants of selective neuronal vulnerability of dopaminergic neurons in Parkinson's disease. Handbook of Behavioral Neuroscience. Elsevier, v. 32, p. 409-427, 2025. DOI: https://doi.org/10.1016/B978-0-443-29867-7.00039-6. DOI: https://doi.org/10.1016/B978-0-443-29867-7.00039-6
ZHU, Z. G. et al. The efficacy and safety of coenzyme Q10 in Parkinson’s disease: a meta-analysis of randomized controlled trials. Neurological Sciences, v. 38, p. 215-224, 2017. DOI: https://doi.org/10.1007/s10072-016-2757-9. DOI: https://doi.org/10.1007/s10072-016-2757-9
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Copyright (c) 2026 Ana Catarina Simonetti Monteiro, Carolayne da Silva Laurentino, Juliana Josefa da Silva, Maria Gleice Silva Monteiro, Gleiciane Adrielli Souza Guinho, João Paulo de Melo Guedes, Clayton Anderson de Azevedo Filho , Risonildo Pereira Cordeiro
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