Parkinson disease treatment options — medications

PARKINSON DISEASE OVERVIEW

There are a wide variety of medical and surgical treatments available for Parkinson disease (PD). Medical treatment includes medications, education, support, exercise, physical and speech therapy, and nutrition. For some people with advanced Parkinson disease, surgical treatment with deep brain stimulation is another option. The optimal combination of treatments depends upon the person's signs and symptoms, age, stage and severity of disease, and their level of physical activity.

The information that follows can help patients and family members to better understand the potential risks and benefits of medications. Other types of treatment are discussed separately. (See "Patient information: Parkinson disease treatment options education, support, and therapy (Beyond the Basics)".) The symptoms and diagnosis of PD are also discussed separately. (See "Patient information: Parkinson disease symptoms and diagnosis (Beyond the Basics)".)

WHEN TO START PARKINSON DISEASE TREATMENT

The decision to start medication for Parkinson disease depends upon the severity of symptoms. The most important consideration is how much the symptoms interfere with the person's ability to perform daily activities. Another important factor is the person's personal philosophy about the use of medications. The healthcare provider, patient, and family (if applicable) should share in the decision making process.

There are six main types of medications available to treat symptoms of Parkinson disease: levodopa, dopamine agonists (DAs), inhibitors of enzymes that inactivate dopamine (MAO B inhibitors and COMT inhibitors), anticholinergics, and amantadine. Estrogen may be recommended for postmenopausal women with PD.

LEVODOPA

Levodopa is the most effective drug for the treatment of symptoms of Parkinson disease. It is most effective for reducing difficulties moving all or part of the body (akinesia) and rigidity. Tremor is less likely to get better with levodopa, while problems with standing and coordination are even less likely to improve.

There are several formulations of levodopa. In all forms, it is combined in various concentrations with another compound (carbidopa) to improve the efficiency of levodopa and reduce side effects. Carbidopa alone has no benefit.

DosingTreatment is usually started with a small dose of the quick-acting pill two to three times per day with a meal or snack (to minimize nausea, the most common early side effect). The dose is then slowly increased over several days, depending on the person's tolerance, to the lowest dose that controls symptoms. In some cases, a slow-release pill can then be substituted to reduce the number of doses required per day.

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Parkinson disease treatment options — medications