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Drugs used in the treatment of PD

Table showing some of the standard drug treatments used in managing the symptoms of patients with Parkinson's disease.

Generic name(s) Trade name(s) Drug type Therapeutic use Interactions Side effects
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.
Bromocriptine, Cabergoline, Pergolide, Pramipexole, Ropinirole Parlodel, Dostinex, Permax, Mirapex, Requip Dopamine Agonists. 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. Seizures, stroke, heart attacks, sudden sleep episodes, confusion, hallucinations, decreased blood pressure, hair loss.
Benzotropine / Esthopropazine / Procyclidine / Trihexyphenidyl Cogentin / Parsitan / Kemadrin / Artane Anticholinergic (blocks cholinergic activity in the brain) Tremor in iParkinson's Disease, foot dystonia, excessive drooling, drug induced extra-pyramidal symptoms, motor function. May worsen PD when taken with antipsychotics or cholintergics (e.g. donezepil, galantamine, rivastigmine), increased toxicity when taken with other anticholinergics Confusion, drowsiness, cognitive problems, psychosis, drug mouth, constipation
Amantadine Symmetrel NMDA receptor antagonist, blocks reuptake of dopamine / increases dopamine release Used early may help with tremor, may decrease dyskinesias later, better tolerated in younger PD patients Decreased effectiveness when combined with antipsychotics; may decrease effectiveness of live influenza vaccine Confusion, irritability, insomina, ankle adema, seizures, visual impairment, decreased blood pressure, hallucinations
Entacapone Comtan Inhibits reversible COMT. Decreases gastrointestinal metabolism of levodopa to prolong half life, therefore increasing availability in the brain Idiopathic PD with wearing-off at end of levodopa dose, "Wearing off". Can also be combined with levodopa to reduce dose of the latter required, decreasing liklihood of dyskinesias. May increase heart rate with dobutamine, dopamine, epinephrine and isoproterenol. Nausea, vomiting, increase in dyskinesias, urine discolouration, sleepiness, diarrhoea
Selegiline Eldepryl Irreversibly inhibits monamine oxidase type B to decrease metabolism of dopamine Add-on therapy for PD (may aid "Wearing off" effects). Improves disability scores, may decrease freezing. Mild symptomatic benefit. Must be stopped 10 days before anesthetic. Increased toxicity with amphetamines, anti-depressants, dextromethorphan (found in cough syrup). Nausea, insomnia, hallucinations, dyskinesias, hair loss, arrhythmia, increased heart rate and blood pressure at higher doses
AbbreviationsTable modified from "Tips & Pearls"

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