What options are available to provide more sustained dopaminergic therapy in patients with 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

Treating motor fluctuations in the absence of peak-dose dyskinesia is relatively easy. Several different strategies, either alone or in combination, can be used to provide more sustained dopaminergic therapy. Possible strategies include the following:

  • Adding a dopamine agonist, catechol-O -methyltransferase (COMT) inhibitor, or monoamine oxidase (MAO)-B inhibitor

  • Dosing levodopa more frequently

  • Increasing the levodopa dose

  • Adding intermittent levodopa inhaled doses

  • Switching from immediate-release (IR) to sustained-release (CR) levodopa/carbidopa or levodopa/carbidopa/entacapone

  • Continuous intrajejunal infusion of a carbidopa/levodopa enteral suspension [55]


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