Table 2. Food and Drug Administration–Approved Medications for Parkinson's Disease
| Drug Class/Druga |
Indication |
Adverse Effects |
| Carbidopa/Levodopa |
Primary treatment for symptomatic PD; improves ability to complete activities of daily living |
Dyskonesias, somnolence, confusion, dystonia |
| Dopamine agonists |
|
|
| Nonergot: Pramipexole (Mirapex); Ropinirole (Requip) |
Useful for early disease, can be used as monotherapy |
Nausea, vomiting, daytime sleepiness, hallucinations, orthostatic hypotension |
| Ergot: Bromocriptine (Parlodel); Pergolide (Permax) |
Useful for early disease, less risk of developing motor complications |
Pulmonary fibrosis, cardiac valve fibrosis, erythromelalgia |
| MAO-B inhibitors |
|
|
| Selegiline (Eldepryl); Rasagaline (Azilect) |
Useful to treat motor complications in late disease, may be used as monotherapy early in disease |
Risk of serotonin syndrome |
| COMT inhibitors |
|
|
| Entacapone (Comtan); Tolcapone (Tasmar) |
Useful for treating motor complications in patients taking Levodopa, decreases "off time," mild improvement in activities of daily living |
Diarrhea, exacerbates Levodopa adverse effects, Tolcapone is associated with fatal liver toxicity, urine discoloration: red, orange, or brown |
| Injectable dopamine agonist |
|
|
| Apomorphine (Apokyn) |
Reduces "off time" in late disease |
Tachycardia, chest pain, dizziness, sleepiness, regular subcutaneous injections |
| NMDA receptor inhibitor |
|
|
| Amantadine (Symmetrel) |
Useful for treating dyskinesias in late disease |
Hallucinations, edema, hypotension |
| Anticholinergics |
|
|
| Benztropine (Cogentin); Trihexyphenidyl (Artane) |
Useful for treatment of tremors in cognitively functioning patients < 60 years old |
Dry mouth, dry eyes, constipation, hypotension, cognitive impairment, urinary retention |
NMDA = N-methyl-D-asparate; PD = Parkinson's disease.
aTrade names: Apokyn (Mylan Lab, Canonsburg, PA); Artrane (TAJ Pharmaceuticals Ltd., Mumbai, India); Azilect (Teva Pharmaceutical Industries Ltd., North Wales, PA); Cogentin (Qualtest Pharmaceuticals, Huntsville, AL); Comtan (Novartis Pharmaceuticals Corporation, East Hanover, NJ); Eldepryl (Apotex Corp., Weston, FL); Mirapex (Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT); Parlodel (Validus Pharmaceuticals LLC, Parsippany, NJ); Permax (Eli Lilly and Company, Boston, MA); Requip (GlaxoSmithKline, Middlesex, UK); Symmetrel (Lannett Company, Inc., Philadelphia, PA); Tasmar (Valeant Pharmaceuticals International, Inc., Steinbach, MB, Canada).
