Table showing some of the standard drug treatments used in managing the symptoms of patients with Parkinson's disease.
Levodopa + benserazide / carbidopa / entacapone
Prolopa, Sinemet, Stalevo
Dopamine precursor. Added agents are peripheral dopamine decarboxylation inhibitors, decrease nausea and slow down dopamine metabolism.
Idiopathic, postencephalitic & symptomatic PD especially in patients who are rigid, have bradykinesia, or are elderly. Not useful for freezing. Restless leg syndrome. Controlled release (CR) may be useful to take at nighttime if having "off" periods the following morning. May slow progression or severity of symptoms.
Antipsychotic medication decreases levodopa effects. Monoamine oxidase inhibitors or antihypertensives may increase toxic potential.
Rapid withdrawal may worsen PD or cause Neuroleptic Malignant Syndrome. The brain will build up a tolerance to levodopa over time, causing unresponsiveness to drug. May lead to dyskinesias (involuntary jerky movements), especially at higher doses. May also cause hallucinations, nightmares, hypersexuality, decreased blood pressure, compulsive gambling behaviour, anemia.
Idiopathic PD, restless leg syndrome. Dopamine agonists may have fewer motor complications but an increased risk of hallucinations, sleepiness, or ankle edema (excess fluid). May be preferable in younger patients. May help to reduce the dose of levodopa required for same effect.
Antipsychotics, metoclopramide, nitroglycerin, and omeprazole may decrease dopamine agonist effects.