- Clinical science
There are many pharmacologic options available for the treatment of Parkinson disease; regimens are tailored to the patient's age, symptoms, and symptom severity. While only symptomatic treatment is available at this point in time, drugs that may slow or reverse the course of the disease are currently being investigated. Since treatment of Parkinson disease at an early stage can significantly improve a patient's subjective well-being (honeymoon period), medical therapy should be initiated as soon as symptoms begin to interfere with the patient's daily life. For most patients, first-line treatment consists of levodopa (L-DOPA) or dopamine receptor agonists, e.g., ropinirole and pramipexole. Other drugs that are used to treat Parkinson disease include amantadine, MAO-B inhibitors, and COMT inhibitors.
|Substance class||Agent||Mode of action||Indication||Additional information|
|Dopamine precursors|| || |
|Decarboxylase inhibitors|| |
|Dopamine agonists||Non-ergot|| || |
|COMT inhibitors|| |
|NMDA antagonists|| || |
|MAO-B inhibitors|| |
Selegiline has high selectivity for the monoamine oxidase B found predominantly in the brain.
To remember that anticholinergics like benztropine and trihexyphenidyl are used in the treatment of Parkinson disease, think of “A Benz for a trip to the park.”
To remember the main drugs used to treat Parkinson disease, think of A2 B2 C2 D2: Antimuscarinics and Amantadine; Bromocriptine and MAO-B inhibitors; COMT inhibitors and Carbidopa; L-DOPA and nonergot Dopamine agonists.
- Becomes less effective over time: may require a shorter interval between doses
- Autonomic symptoms
- Psychotic symptoms
- Dyskinesia (hyperkinesia)
- Definition: : condition caused by severe dopamine deficiency (e.g., after discontinuation of L-DOPA therapy or insufficient L-DOPA absorption)
- Clinical features: complete inability to move , incomprehensible speech, possibly hyperthermia → increased risk of dehydration, deep-vein thrombosis, and pneumonia
- Treatment: : intensive medical care, volume substitution, administration of L-DOPA, apomorphine, amantadine
Side effects common to all dopamine agonists
- Autonomic: nausea; , vomiting, orthostatic hypotension; , dizziness, increased daytime drowsiness and sleep attacks
- Motor function: dyskinesia (rare)
- Psychiatric: unrest, confusion, hallucinations, impulse control disorders (e.g., compulsive gambling; , sexual activity, or shopping), psychosis
Dopamine agonist withdrawal syndrome
- Etiology: abrupt discontinuation of dopamine agonist therapy
- Clinical features: similar to → hyperthermia and rigor; akinesia; reduced vigilance; increased creatine kinase levels, transaminases, and leukocytes and
- Treatment: intensive medical care, volume substitution, administration of L-DOPA, apomorphine, amantadine
- Side effects of ergotamine-derived agonists: (e.g., bromocriptine): fibrosis (cardiac fibrosis, Raynaud disease, pleural pulmonary fibrosis, and retroperitoneal fibrosis)
- NMDA antagonists (amantadine): side effects are similar to L-DOPA but much less pronounced
- MAO-B inhibitors
- anticholinergics): See . (
- COMT inhibitors
We list the most important adverse effects. The selection is not exhaustive.