Which medications are used in the treatment of Parkinson disease (PD)?

Updated: Jan 24, 2019
  • Author: Robert A Hauser, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Answer

The cornerstone of symptomatic treatment for Parkinson disease (PD) is dopamine replacement therapy. The criterion standard of symptomatic therapy is levodopa (L-dopa), the metabolic precursor of dopamine, in combination with carbidopa, a peripheral decarboxylase inhibitor (PDI). This combination provides the greatest symptomatic benefit with the fewest short-term adverse effects.

Dopamine agonists such as pramipexole and ropinirole can be used as monotherapy to improve symptoms in early disease or as adjuncts to levodopa in patients whose response to levodopa is deteriorating and in those who are experiencing fluctuations in their response to levodopa.

Monoamine oxidase (MAO)-B inhibitors (eg, rasagiline, safinamide, selegiline) provide symptomatic benefit as monotherapy in early disease and as adjuncts to levodopa in patients experiencing motor fluctuations.

Catechol-O -methyl transferase (COMT) inhibitors inhibitors such as entacapone and tolcapone may be used to increase the peripheral half-life of levodopa, thereby delivering more levodopa to the brain over a longer time.

Anticholinergic medications can be used for the treatment of resting tremor. However, they are not particularly effective for bradykinesia, rigidity, gait disturbance, or other features of advanced Parkinson disease; and cognitive side effects are common. Therefore, anticholinergics are usually reserved for the treatment of tremor that is not adequately controlled with dopaminergic medications.

Pimavanserin is the first medication approved by the FDA for hallucinations and delusions associated with PD. It is a selective serotonin inverse agonists (SSIA) which preferentially targets 5-HT2A receptors and avoids activity at dopamine and other receptors commonly targeted by antipsychotics.


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