Medications and Treatments
Medications for Parkinson's
Click on the links below for information on each topic.
Parkinsons Medications An Overview
Over-the-Counter Medications
Managing Your Medications
Saving on Medications
Parkinsons Medications An Overview
People with Parkinsons disease often take a variety of medications in different doses in order to manage the symptoms of the disease. These factors, combined with the frequency with which one must take their medicines, can result in confusion. People with Parkinsons and their caregivers should become familiar with their medications in order to use them most effectively and avoid possible interactions. Understanding a medication regime and sticking to it will provide the greatest benefit from the drug and avoid unpleasant off periods due to missed doses or confusion.
This section of our website contains information about medications for Parkinsons disease. Included is a table of Parkinsons drugs, a section on over-the-counter medications, tips for administering drugs and hints to help you save money.
Please note that the side-effects listed in the tables that accompany each class of medication are the most commonly experienced. Not all patients will experience such side-effects. For many people who do experience side-effects, they can often be effectively limited or eliminated with careful adjustments to dosage or the timing of the individual doses. If any side-effects are experienced, speak to the treating physician immediately. For a complete description of each drug and its possible side-effects, please request a package insert from your pharmacist for each drug being used. It is recommended that all prescriptions be filled at the same pharmacy to avoid interactions between medications. Interactions can be dangerous and even life-threatening, so make sure the pharmacist knows of all medications and supplements being taken including over-the-counter medications and supplements.
Although there are general guidelines that doctors use to choose a treatment regimen, each patient must be individually evaluated to determine which drug or combination of drugs is best for them. For some, a first choice drug might be one of the levodopa preparations, and for others, an initial prescription may be given for one of the agonists, an MAO inhibitor or an anticholinergic. The choice of drug treatment depends on many variables including symptom presentation, other concurrent health issues (and the medications being used to treat them) and a persons age. And while the suggested starting dosages (as indicated by the package insert) are listed here, remember that they too can vary greatly depending on a persons needs and metabolism.
Carbidopa/Levodopa (Sinemet®) Levodopa is a substance that is converted into dopamine by an enzyme in the brain. It is then released by brain cells and activates dopamine receptors allowing for normal function of the movement control centers of the brain. Forty years after its discovery, levodopa remains the most effective medication for Parkinsons disease. In fact, 70 to 80 percent of treated Parkinsons patients are on levodopa therapy. Levodopa is the gold standard by which all treatments for Parkinsons are measured.
Levodopa combined with carbidopa (or Sinemet®) represented a significant improvement in the treatment of Parkinson's disease. The addition of carbidopa prevents levodopa from being converted into dopamine in the bloodstream, allowing more of it to get to the brain. Therefore, a smaller dose of levodopa is needed to treat symptoms. In addition, the nausea and vomiting often associated with levodopa treatment is greatly reduced by the presence of carbidopa. Unfortunately, with increased dosing and prolonged use of levodopa, patients experience other side-effects including dyskinesias (spontaneous, involuntary movements) and "on-off" periods when the medication will suddenly and unpredictably start or stop working.
Check with a doctor before taking any of the following to avoid possible interactions: antacids, anti-seizure drugs, anti-hypertensives, anti-depressants and high protein food.
Stalevo® (carbidopa, levodopa and entacapone) is a combination tablet for patients who experience end-of-dose "wearing-off." The tablet combines carbidopa/levodopa with entacapone. While carbidopa reduces the side effects of levodopa, entacapone extends the time levodopa is active in the brain (up to 10 percent longer). The same drugs that interact with carbidopa/levodopa and entacapone interact with Stalevo®.
Medication
Available Doses
Initial Dosing
Side Effects
Indications
Interactions
Carbidopa/
Levodopa
(Sinemet®)
10/100 mg
25/100 mg
50/200 mg
25/100 mg 2-3X/day
Low blood pressure, nausea, confusion, dyskinesia, dry mouth, dizziness
First course of treatment; converts to dopamine to manage major symptoms
Antacids, anti-seizure drugs, anti-hypertensives, anti-depressants, high protein food
Carbidopa/
Levodopa
controlled release
(Sinemet CR®)
10/100 mg
25/100 mg
50/200 mg
50/200 mg 2X/day
Low blood pressure, nausea, confusion, dyskinesia, dry mouth, dizziness
First course of treatment; converts to dopamine to manage major symptoms and may prolong effectiveness
Antacids, anti-seizure drugs, anti-hypertensives, anti-depressants, high protein food
Carbidopa/
Levodopa/
Entacapone
(Stalevo®)
12.5/50/200 mg
25/100/200 mg
37.5/150/200 mg
12.5/50/200 mg
Dyskinesia, nausea, diarrhea, hyperkinesia, abdominal pain, dizziness, harmless discoloration of urine, saliva and/or sweat
Secondary course of treatment; combines entacapone with levodopa/carbidopa to block COMT enzyme and prolong levodopas effectiveness
Same as levodopa/carbidopa, MAO inhibitors, Comtan, Sinemet, high doses (10 mg or more) of selegiline
Carbidopa/
Levodopa
Orally disintegrating tablet
(Parcopa®)
10/100 mg
25/100 mg
25/250 mg
25/100 mg 2-3X/day
Low blood pressure, nausea, confusion, dyskinesia, dry mouth, dizziness
First course of treatment; converts to dopamine to manage major symptoms; also for patients with swallowing difficulties
Antacids, anti-seizure drugs, anti-hypertensives, anti-depressants, high protein food
Dopamine agonists are drugs that stimulate the parts of the human brain that receive dopamine. In effect, the brain "thinks" it is receiving dopamine, so these drugs help satisfy the brain's need for dopamine. Dopamine agonists can be taken alone or in combination with medications containing levodopa. Agonists available in the United States include bromocriptine (Parlodel®), pergolide (Permax®), pramipexole (Mirapex®) and ropinirole (Requip®).
Consult a doctor before taking any of the following to avoid possible interactions: alcohol, anti-psychotics, medications that lower blood pressure, Navane® (thiothixene), Taractan® (chlorprothixene), Haldol® (haloperidol), Reglan® (metoclopramide), phenothiazines, thiozanthenes, cimetidine, phenothiazines, butyrophenones, Cipro® and benzodiazepines.