Initial drug therapy in newly diagnosed Parkinson disease

For use in conjunction with UpToDate content on initial pharmacologic treatment of Parkinson disease (PD). Initial IR carbidopa-levodopa is preferred for most patients with early PD for motor symptom control. Alternative initial therapy (eg, a dopamine agonist, MAO-B inhibitor, or amantadine) may be appropriate in select patients (eg, patients <50 years old at risk for dyskinesia, mild symptoms and preference for once-daily dosing, or tremor-predominant PD, respectively); refer to topic for details.

COMT: catechol-O-methyl transferase; DBS: deep brain stimulation; IR: immediate release; MAO-B: monoamine oxidase B; MSA: multiple system atrophy; PSP: progressive supranuclear palsy.

* Common side effects (eg, nausea, somnolence, headache) are less likely with low starting doses and slow titration and tend to resolve over time.

¶ Good response is defined as sufficient to restore function and quality of life to where the patient wants it. The dose that leads to substantial clinical benefit will typically do so within days to 2 weeks, even if maximal benefit may be more delayed.

Δ If side effects limit dose titration (eg, dyskinesia, sleepiness, nausea), reduce the carbidopa-levodopa dose and consider adjunctive therapies (dopamine agonists, MAO-B inhibitors, amantadine, COMT inhibitors).

◊ Refer to UpToDate topic on management of motor complications in Parkinson disease.

§ Absence of response to total daily doses of levodopa of 600 mg should prompt consideration of alternative parkinsonian syndromes such as PSP or MSA, except in the case of the typical tremor of Parkinson disease, which may not respond well to levodopa.

Graphic 146285 Version 2.0

خرید پکیج

Initial drug therapy in newly diagnosed Parkinson disease