Medications for Parkinson Disease
by
Cynthia M. Johnson, MA Here are the basics about each of the medicines below. Only the common reactions are listed. Medicine is used to raise dopamine or make the brain think it is getting enough dopamine. Medicines may need to be changed over time as the disease gets worse or side effects happen. Prescription Medicines
Monoamine oxidase type B inhibitor
Selective serotonin inverse agonist (SSIA)
Istradefylline Prescription MedicinesLevodopaLevodopa is the main way to treat symptoms. It raises the amount of dopamine in the brain. This can help ease problems like rigidity and slowness. Common names are:
People who take levodopa alone should not take vitamin B6 pills. It can speed up the breakdown of levodopa. Foods high in B6 may also need to be limited. Levodopa and CarbidopaCommon names are:
The body breaks down levodopa quickly. Combining it with carbidopa can slow this breakdown. These medicines may not work as well over time. How much or how often it is taken may need to be changed as the disease worsens. Problems may be:
Entacapone, a COMT inhibitor (see below), may be added to levodopa/carbidopa. More side effects are listed below. Dopamine AgonistsCommon names are:
These drugs act on the brain in a way that is like dopamine. They may be given alone as an early way to treat the disease. They may also be given with other medicines as the disease gets worse. These medicines last longer and do not have as many side effects. Some problems are:
Cabergoline may also raise the risk of heart problems. And bromocriptine has rare but severe side effects, such as pulmonary fibrosis. Monoamine Oxidase Type B InhibitorCommon names are:
Selegiline and rasagiline are often given with levodopa or levodopa/carbidopa. They work to stop the breakdown of dopamine in the brain. Some problems are:
High doses of selegiline may cause a very high blood pressure when eating or drinking things that have tyramine, such as aged cheese and alcohol. Many medicines should also not be taken with selegiline and rasagiline. Reactions may happen. COMT InhibitorsCommon names are:
COMT inhibitors are taken with levodopa. They help slow the breakdown of levodopa. These medicines can cause severe liver problems. Liver health tests will need to be done when taking it. Some problems are:
AnticholinergicsCommon names are:
These medicines can ease tremors and stiffness and improve muscle control. Some problems are:
NMDA AntagonistCommon names are:
Amantadine can help ease stiffness and tremors and improve muscle control. It may stop working when taken for a long time. It may be stopped and restarted to improve how it works. Some problems are:
Selective Serotonin Inverse Agonist (SSIA)Common names are:
Pimavanserin is an antipsychotic medicine. It is used to help people with psychosis from the disease. It blocks some serotonin receptors that cause these problems. It should not be taken by people with kidney, liver, or heart problems. Problems may be:
Adenosine A2a InhibitorCommon names are:
Istradefylline is used with levodopa/carbidopa. It is given to people who have times when medicines are not working well and symptoms worsen. Problems may be:
References:Burack M, Aldred J, et al. Implementing levodopa-carbidopa intestinal gel for Parkinson disease: insights from US practitioners. Mov Disord Clin Pract. 2018;5(4):383-393. FDA approves new add-on drug to treat off episodes in adults with Parkinson's disease. US Food and Drug Administration website. Available at: https://www.fda.gov/news-events/press-announcements/fda-approves-new-add-drug-treat-episodes-adults-parkinsons-disease. Published August 27, 2019. Accessed February 24, 2020. Homayoun H. Parkinson Disease. Ann Intern Med. 2018 Sep 4;169(5):ITC33-ITC48. Parkinson disease. EBSCO DynaMed website. Available at:
https://www.dynamed.com/condition/parkinson-disease. Updated October 4, 2019. Accessed February 24, 2020. Parkinson disease. Merck Manual Professional Version website. Available at: ...(Click grey area to select URL) Updated December 2018. Accessed February 24, 2020. Parkinson's disease. American Association of Neurological Surgeons website. Available at: ...(Click grey area to select URL) Accessed February 24, 2020. Parkinson's disease information page. National Institute of Neurological Disorders and Stroke
website. Available at:
https://www.ninds.nih.gov/Disorders/All-Disorders/Parkinsons-Disease-Information-Page. Updated August 28, 2019. Accessed February 24, 2020. Last reviewed November 2019 by EBSCO Medical Review Board
Rimas Lukas, MD Last Updated: 1/27/2021 | |
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