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Patient education: Medicines for Parkinson disease (The Basics)

Patient education: Medicines for Parkinson disease (The Basics)

What do Parkinson disease medicines do? — They can help control or improve certain symptoms of the disease. These include 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. It also discusses some of the side effects of these medicines.

Which medicines might I take? — Doctors can use different medicines to treat Parkinson disease. You might take 1 or more medicines. The right medicines for you depend on:

Your symptoms

Your age

How active you are

Your doctor will help you find the combination that works best for you. This means trying different medicines and doses.

People do not always start taking medicines for their Parkinson disease right away. The medicines can help, but they can also cause problems of their own. Many people start taking medicines when their symptoms affect their daily activities. To decide when to start:

Think about what is most important to you.

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 help you decide 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. This is because it is the medicine that works best for most people. Levodopa comes in different forms, including:

Carbidopa-levodopa (brand names: Sinemet, Parcopa)

Levodopa-benserazide (brand names: Madopar, Prolopa)

The most common side effects are nausea, headache, feeling dizzy, and feeling sleepy. These problems are usually not serious and go away. 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. These are called "delusions." Your doctor will work with you to find the lowest dose and best time of day to take each dose. This can prevent problems with side effects.

When people first start taking levodopa, it usually works well with each dose. But up to half of people start having problems after taking it for several years. These are:

"Motor fluctuations" – These happen when the effect of levodopa starts to wear off too soon, or wears off suddenly. They often happen without warning. They cause 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" – This means 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. These can include nausea, feeling tired, leg swelling, and delusions. These medicines might also cause problems controlling certain behaviors. For example, people might gamble or spend too much money.

Dopamine agonists include:

Pramipexole (brand name: Mirapex)

Ropinirole (brand name: Requip)

Rotigotine (brand name: Neupro)

Apomorphine (brand name: Apokyn)

Dopamine agonists are usually used along with levodopa for people who have severe Parkinson disease.

Sometimes, doctors sometimes prescribe dopamine agonists first. Usually, this is for people younger than 65 so they can put off taking levodopa. That way, they might avoid or delay getting the movement problems 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 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 for 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 can also help with dyskinesia. 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 drug information handout from 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.

More on this topic

Patient education: Parkinson disease (The Basics)
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Patient education: Parkinson disease treatment options — medications (Beyond the Basics)
Patient education: Parkinson disease treatment options — education, support, and therapy (Beyond the Basics)
Patient education: Parkinson disease symptoms and diagnosis (Beyond the Basics)

This topic retrieved from UpToDate on: Jun 02, 2024.
Disclaimer: This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms. 2024© UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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