Patient education: Medicines for Parkinson disease (The Basics)

What do Parkinson disease medicines do? — Parkinson disease medicines can help control or improve certain symptoms of the disease, such as trouble moving the body, stiffness, and shaking (called "tremors"). Currently, no medicines can cure Parkinson disease or keep it from getting worse over time.

Besides medicines, there are other things that can make living with Parkinson disease easier. These include getting support from other people, learning about the disease, and staying active. Physical therapy and speech therapy can also help.

This article has basic information on the main medicines used to treat Parkinson disease, and discusses some of the side effects of these medicines.

Which medicines might I take? — Doctors can use different medicines to treat Parkinson disease. People might take 1 or more of these medicines. The right medicines for you will depend on your symptoms, your age, and how active you are. This is not the same for everyone, and your doctor will work with you to try different medicines and doses until you find the combination that works best for you.

People do not always start taking medicines for their Parkinson disease right away. That's because even though the medicines can help, they can also cause problems of their own. Many people start taking medicines when their symptoms affect their daily activities. To decide when you should start, think about what is most important to you, and talk with your family and your doctor. Ask your doctor about the benefits and side effects of the different medicines.

No matter what medicines you take, tell your doctor if you notice any side effects or problems. They can work with you to figure out if you should change or stop any of your medicines.

The table has some general tips about taking medicines (table 1).

Medicines to treat Parkinson disease — The main medicines used to treat Parkinson disease are levodopa and dopamine agonists.

Levodopa — Levodopa, or "L-dopa," can help people who have trouble moving the body. It can also improve stiffness and tremors. Doctors usually prescribe it first, because it is the medicine that works best for most people. Levodopa comes in different forms, including carbidopa-levodopa (brand names: Sinemet, Parcopa) and levodopa-benserazide (brand names: Madopar, Prolopa).

The most common short-term side effects are nausea, headache, feeling dizzy, and feeling sleepy. These problems are not usually serious. Serious side effects can happen, especially in older people, but they are less common. These can include losing touch with reality and believing things that aren't really true (called "delusions"). To prevent problems with side effects, your doctor will work with you to find the lowest dose and best time of day to take each dose.

When people with Parkinson disease first start taking levodopa, it usually works well with each dose. However, up to one-half of people who take levodopa for several years can start having problems called "motor fluctuations" and "dyskinesia."

●"Motor fluctuations" happen when the effect of levodopa starts to wear off too soon, or wears off suddenly. This problem often happens without warning. It causes the symptoms of Parkinson disease to get much worse. For example, people with this problem might suddenly find it hard to move or walk, at least for a short time.

●"Dyskinesia" is the name for different kinds of abnormal movements that people can't control. These movements can affect different parts of the body. They are usually jerky or twisting movements. Sometimes they are more like a cramp that makes the foot or the neck turn and pull.

If you have any of these problems while taking levodopa, talk to your doctor. They might need to change your dose, or add another medicine.

Dopamine agonists — These medicines control symptoms almost as well as levodopa, but they can cause side effects. Side effects can include nausea, feeling tired, leg swelling, and delusions (believing things that aren't really true). These medicines might also cause some people to have problems controlling certain behaviors. For example, they might gamble or spend too much money.

Dopamine agonists include pramipexole (brand name: Mirapex), ropinirole (brand name: Requip), rotigotine (brand name: Neupro), and apomorphine (brand name: Apokyn). Dopamine agonists are usually used along with levodopa for people who have severe Parkinson disease.

In other cases, doctors sometimes prescribe dopamine agonists first for people younger than 65 so they can put off taking levodopa. That way, they might avoid or delay getting the movement problems mentioned above that can affect people who take levodopa for several years. But it is not clear if taking dopamine agonists instead of levodopa actually lowers the risk of getting these problems.

Others — Other medicines for Parkinson disease include MAO B inhibitors, COMT inhibitors, anticholinergics, amantadine, and istradefylline. They are used less often than levodopa and dopamine agonists.

MAO B inhibitors — MAO B inhibitors are long-lasting medicines that help somewhat to reduce symptoms. Side effects can include nausea, headache, confusion, and trouble falling asleep.

MAO B inhibitors include selegiline (sample brand names: Eldepryl, Emsam), rasagiline (brand name: Azilect), and safinamide (brand name: Xadago).

Anticholinergics — These medicines can help control tremors. They are often used in younger people who have a tremor as their most severe symptom. Older people are more likely to get side effects, including dizziness, confusion, dry mouth, blurry vision, nausea, and trouble urinating or having bowel movements.

Anticholinergics include trihexyphenidyl (sample brand names: Artane, Trihexy), benztropine (brand name: Cogentin), and orphenadrine (brand name: Norflex).

Amantadine — Amantadine (brand name: Symmetrel) can help improve mild symptoms of tremor, stiffness, and trouble moving the body. It may also help with dyskinesia (abnormal movements). Side effects can include hallucinations (seeing or hearing things that aren't really there), confusion, ankle swelling, and skin changes.

COMT inhibitors — COMT inhibitors are medicines taken with levodopa that help levodopa work longer and better. They are mainly used to treat people whose levodopa "wears off" before the next dose. Side effects can include confusion, nausea, diarrhea, and abnormal movements.

COMT inhibitors include entacapone (brand name: Comtan), opicapone (brand name: Ongentys), and tolcapone (brand name: Tasmar).

Istradefylline — Istradefylline (brand name: Nourianz) can be used if levodopa "wears off" between doses.

Where can I get more information about my medicines? — For more detailed information about your medicines, ask your doctor or nurse for the patient hand-out from Lexicomp, available through UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.

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