Medications and Treatments

Medications for Parkinson's

Click on the links below for information on each topic.

• Parkinson’s Medications – An Overview
  
• Over-the-Counter Medications
  
• Managing Your Medications
  
• Saving on Medications
  

Parkinson’s Medications – An Overview

People with Parkinson’s disease often take a variety of medications in different doses in order to manage the symptoms of the disease.  These factors, combined with the frequency with which one must take their medicines, can result in confusion.  People with Parkinson’s and their caregivers should become familiar with their medications in order to use them most effectively and avoid possible interactions.  Understanding a medication regime and sticking to it will provide the greatest benefit from the drug and avoid unpleasant “off” periods due to missed doses or confusion. 

This section of our website contains information about medications for Parkinson’s disease.  Included is a table of Parkinson’s drugs, a section on over-the-counter medications, tips for administering drugs and hints to help you save money. 

Please note that the side-effects listed in the tables that accompany each class of medication are the most commonly experienced.  Not all patients will experience such side-effects.  For many people who do experience side-effects, they can often be effectively limited or eliminated with careful adjustments to dosage or the timing of the individual doses.  If any side-effects are experienced, speak to the treating physician immediately.  For a complete description of each drug and its possible side-effects, please request a “package insert” from your pharmacist for each drug being used.  It is recommended that all prescriptions be filled at the same pharmacy to avoid interactions between medications.  Interactions can be dangerous and even life-threatening, so make sure the pharmacist knows of all medications and supplements being taken – including over-the-counter medications and supplements.

Although there are general guidelines that doctors use to choose a treatment regimen, each patient must be individually evaluated to determine which drug or combination of drugs is best for them.  For some, a “first choice” drug might be one of the levodopa preparations, and for others, an initial prescription may be given for one of the agonists, an MAO inhibitor or an anticholinergic.  The choice of drug treatment depends on many variables including symptom presentation, other concurrent health issues (and the medications being used to treat them) and a person’s age.  And while the suggested starting dosages (as indicated by the package insert) are listed here, remember that they too can vary greatly depending on a person’s needs and metabolism.

Carbidopa/Levodopa (Sinemet®) Levodopa is a substance that is converted into dopamine by an enzyme in the brain.  It is then released by brain cells and activates dopamine receptors allowing for normal function of the movement control centers of the brain.  Forty years after its discovery, levodopa remains the most effective medication for Parkinson’s disease.  In fact, 70 to 80 percent of treated Parkinson’s patients are on levodopa therapy.  Levodopa is the “gold standard” by which all treatments for Parkinson’s are measured.  

Levodopa combined with carbidopa (or Sinemet®) represented a significant improvement in the treatment of Parkinson's disease. The addition of carbidopa prevents levodopa from being converted into dopamine in the bloodstream, allowing more of it to get to the brain. Therefore, a smaller dose of levodopa is needed to treat symptoms.  In addition, the nausea and vomiting often associated with levodopa treatment is greatly reduced by the presence of carbidopa.  Unfortunately, with increased dosing and prolonged use of levodopa, patients experience other side-effects including dyskinesias (spontaneous, involuntary movements) and "on-off" periods when the medication will suddenly and unpredictably start or stop working.

Check with a doctor before taking any of the following to avoid possible interactions: antacids, anti-seizure drugs, anti-hypertensives, anti-depressants and high protein food.

Stalevo® (carbidopa, levodopa and entacapone) is a combination tablet for patients who experience end-of-dose "wearing-off." The tablet combines carbidopa/levodopa with entacapone. While carbidopa reduces the side effects of levodopa, entacapone extends the time levodopa is active in the brain (up to 10 percent longer). The same drugs that interact with carbidopa/levodopa and entacapone interact with Stalevo®.

Dopamine agonists are drugs that stimulate the parts of the human brain that receive dopamine.  In effect, the brain "thinks" it is receiving dopamine, so these drugs help satisfy the brain's need for dopamine.  Dopamine agonists can be taken alone or in combination with medications containing levodopa. Agonists available in the United States include bromocriptine (Parlodel®), pramipexole (Mirapex®) and ropinirole (Requip®).  In March 2007, the dopamine agonist pergolide (Permax) was pulled from the market by the US Food and Drug Administration in response to reports of heart valve damage. In March 2008, UCB Inc., the manufacturer of Neupro® (rotigotine transdermal system), recalled the drug because of concern of a deviation from approved product standards that has apparently reduced the effectiveness of the treatment.  To learn more about this recall, click here.

Consult a doctor before taking any of the following to avoid possible interactions: alcohol, anti-psychotics, medications that lower blood pressure, Navane® (thiothixene), Taractan® (chlorprothixene), Haldol® (haloperidol), Reglan® (metoclopramide), phenothiazines, thiozanthenes, cimetidine, phenothiazines, butyrophenones, Cipro® and benzodiazepines.

Anticholinergics (trihexyphenidyl, benztropine mesylate, procyclidine, etc.) do not act directly on the dopaminergic system. Instead they decrease the activity of another neurotransmitter that controls movement, called acetylcholine, to balance out the production of dopamine and acetylcholine.  In general, mild PD that consists of tremor at rest can often be treated initially with anticholinergic agents.  Adverse effects of these drugs include blurred vision, dry mouth and urinary retention. Anticholinergics may be contraindicated in older patients because they can cause confusion and hallucination.

Check with a doctor before using anticholinergics with anti-histamines, Haldol®, Thorazine®, Symmetrel®, Clozaril® and alcohol.

MAO-B inhibitors such as selegiline or deprenyl (Eldepryl®) are used to block an enzyme in the brain that breaks down levodopa.  They have been shown to delay the need for Sinemet® when prescribed in the earliest stage of Parkinson’s, and have also been approved for use in later stages of the disease to boost the effects of Sinemet®.  Eldepryl® may interact with anti-depressants, narcotic pain killers and decongestants. Check with a doctor before taking any new medications.

COMT inhibitors such as entacapone (Comtan®) represent a different class of Parkinson's medications and they must be taken with levodopa.  COMT inhibitors prolong symptom relief by blocking the action of an enzyme which breaks down levodopa, allowing a larger amount of levodopa to reach the brain, which raises the dopamine level.  This helps provide a more stable, constant supply of levodopa.

Other medications