Medications for Parkinson's Disease

There have been many remarkable changes in treatments for Parkinson's disease in recent years. Scientists have developed new drugs, and they have a better understanding of how to use older treatments. That has made a big difference in everyday life for people with the disease.

Most people can get relief from their Parkinson’s symptoms with medicines. But some may need surgery if their medications stop working well enough.

The medicines you take early on have a strong impact on how your condition will unfold over time. So it’s important to work with a neurologist or other Parkinson’s specialist who can guide you through those treatment decisions.

Common Drugs for Parkinson's Disease

Levodopa and carbidopa (Duopa, Rytary,Sinemet). Levodopa (also called L-dopa) is the most commonly prescribed medicine for Parkinson’s. It’s also the best at controlling the symptoms of the condition, particularly slow movements and stiff, rigid body parts.

Levodopa works when your brain cells change it into dopamine. That’s a chemical the brain uses to send signals that help you move your body. People with Parkinson’s don’t have enough dopamine in their brains to control their movements.

Sinemet is a mix of levodopa and another drug called carbidopa. Carbidopa makes the levodopa work better, so you can take less of it. That prevents many common side effects of levodopa, such as nausea, vomiting, and irregular heart rhythms.

Sinemet has the fewest short-term side effects, compared with other Parkinson’s medications. But it does raise your odds for some long-term problems, such as involuntary movements. An inhalable powder form of levodopa (INBRIJA) and the tablet istradefylline (Nourianz) have been approved for those experiencing OFF periods, OFF periods can happen when Parkinson’s symptoms return during periods between scheduled doses of levodopa/carbidopa.

People who take levodopa for 3-5 years may eventually have restlessness, confusion, or unusual movements within a few hours of taking the medicine. Changes in the amount or timing of your dose will usually prevent these side effects.

Safinamide (Xadago) is an add-on medicine that may be prescribed when individuals taking levodopa and carbidopa have a breakthrough of Parkinson’s symptoms that were previously under control. Studies show that adding this drug helps individuals experience longer times with reduced or no symptoms. The most common side effects are trouble falling or staying asleep, nausea, falls, and uncontrolled, involuntary movements.

Dopamine agonists. These drugs act like dopamine in the brain. They include pramipexole (Mirapex), rotigotine (Neupro), and ropinirole (Requip), .

You can take one of these drugs on its own or along with Sinemet. Some doctors prescribe dopamine agonists first and then add levodopa if your symptoms still aren’t under control.

Dopamine agonists don’t have the same risks of long-term problems as levodopa therapy. So they are often the first choice of treatment for Parkinson's disease.

However, these drugs do raise the chances of some short-term side effects, such as nausea, vomiting, dizziness, light-headedness, confusion, and hallucinations.

Amantadine (Gocovri may help people with mild Parkinson's disease.

It works by raising the amount of dopamine that your brain cells can use, which helps you have fewer Parkinson’s symptoms. Recent studies have found that Symmetrel may help ease the involuntary movements that can happen with levodopa therapy. But it may cause side effects, such as confusion and memory problems.

Anticholinergics such as benztropine(Cogentin) and trihexyphenidyl (Artane). These drugs restore the balance between two brain chemicals, dopamine and acetylcholine. That eases tremors and muscle stiffness in people with Parkinson's. But these medications can harm memory and thinking, especially in older people. Because of that, doctors rarely prescribe them today.

Mao-B inhibitors like selegiline (Eldepryl,Zelapar)) and rasagiline. These drugs block the brain chemicals that break down dopamine. That helps your brain have more dopamine to work with.

Some evidence shows that selegiline may slow the progression of Parkinson's disease, especially early on. Common side effects include nausea, dizziness or fainting, and stomach pain.

Studies of animals suggest that rasagiline may also slow the progression of Parkinson's. Side effects include headache, joint pain, indigestion, and depression.

COMT inhibitors such as entacapone (Comtan), opicapone (Ongentys), and tolcapone (Tasmar).. When you take levodopa, a chemical in your body called COMT makes part of the drug useless. The drugs block COMT, so the brain can use levodopa more effectively, which eases Parkinson's symptoms.

Medication Guidelines for Parkinson's Disease

There is no one best mix of Parkinson’s medicines. You and your doctor will have to try a few treatment approaches to figure out the best one for you.

But there are some general guidelines for taking your medication. Be sure to ask your doctor or pharmacist for any specific tips for your treatment.

• Don’t split pills or pull capsules apart unless your doctor tells you to.
• Drink six to 10 glasses of water a day.
• Physical activity may help your body digest and absorb your medication.
• Know the names of your medications and how you take them. Know the generic and brand names, your doses, and the side effects you might have. Always keep a list of those details with you.
• Take your medications exactly as your doctor prescribes them.
• Don’t stop taking or change your medicines unless you talk to your doctor first. Even if you feel good, you still need to take them. Your condition can get worse if you suddenly stop your medicine.
• Have a routine for taking your medications. Take them at the same time each day. Set an alarm to remind you if you need to.
• Keep a medication calendar and note every time you take a dose.
• If you miss a dose at your scheduled time, don't panic. Take it as soon as you remember. But if it’s almost time for your next dose, skip the missed dose and return to your regular medication schedule.
• Don’t keep outdated drugs. Get rid of them by following the instructions on the drug label or patient information sheet. Or check with your pharmacist about how to dispose of them.
• Store drugs in a dry area away from moisture (unless your doctor or pharmacist tells you the medicine needs to be refrigerated).
• Don’t share your medications with others.
• Take extra medicine with you when you travel in case you need to stay away longer than planned. And keep it in your carry-on luggage, not in a checked bag.
• Refill your prescriptions before you are completely out of medicine. Call the pharmacy at least 48 hours before you run out. If you have trouble getting to the pharmacy, have financial concerns, or have other problems that make it hard for you to get your medications, let your doctor know. A social worker may be able to help you.

Stay Safe With Your Medicines

Read all labels carefully.

• Tell all your health care providers about all the medicines and supplements you take.
• Know all the medicines and foods you’re allergic to.
• Review any side effects your medicines can cause. Most reactions will happen when you start taking something, but that’s not always the case. Some reactions may be delayed or may happen when you add a drug to your treatment. Call your doctor right away about anything unusual.
• Use one pharmacy if possible. Try to fill all your prescriptions at the same location, so the pharmacist can watch for drugs that might interact with each other.
• You can use online tools to see if any of your medicines won’t work well together.

You have the right and responsibility to know what medications your doctor prescribes. The more you know about them and how they work, the easier it will be for you to control your symptoms. You and your doctor can work together to create and change a medication plan. Make sure that you understand and share the same treatment goals. Talk about what you should expect from medications so that you can know if your treatment plan is working.

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