Common Medications for PD Motor Symptoms
There is no one standard treatment for Parkinson’s Disease (PD) and each person is treated individually. In this post we will go over common medications prescribed to manage motor symptoms of PD. As always, work with your physician to find the right balance of medications for you to improve your life with PD. Remember that medication is only part of effectively treating PD. Regular exercise is also an important aspect of best care!
Treatment for Motor Symptoms – medications used due to the changes in dopamine levels in the brain.
Levodopa
KEY POINTS: Treats symptoms most effectively. Delaying meds is problematic. Effects wear off 25-50% within 5 years. Unpredictable ON/OFF periods.
TYPES: Carbidopa/levodopa (Sinemet or Sinemet CR), oral disintegrating (Parcopa), extended release capsules (Rytary), enteral solution (Duopa).
*Carbidopa/levodopa is currently the Gold standard for treatment of motor symptoms in PD.
FUNCTION:
Levodopa
- Precursor to dopamine that is able to cross the blood brain barrier (dopamine cannot)
Carbidopa
- DOPA decarboxylase inhibitor (DDCI) that prevents levodopa from converting into dopamine in the periphery
COMMON SIDE EFFECTS: nausea, vomiting, drowsiness, loss of appetite, orthostatic hypotension, dyskinesia, motor fluctuations, lightheadedness.
OTHER: It is often recommended that individuals take Sinemet on an empty stomach (30 minutes before or 1 hours after eating meals). Protein can slow absorption of Sinemet.
ON/OFF Times Explained
On times: Medication is effectively controlling symptoms.
Off times: Regular and predictable decline in symptoms control between doses. *As PD medications wear off, motor symptoms return which can impact your ability to function.
Therapeutic window: Over time, the duration of target clinical response (therapeutic window) becomes shorter
Dyskinesia: Abnormal movements usually occur at peak dose
Medication for Motor Symptoms continued.
Dopamine Agonists
KEY POINTS: Used with younger people because it can cause confusion. Impulse control disorders, confusion, hallucinations.
TYPES: Ropinirole (Requip), Pramipexole (MIrapex), Rotigotine (Neupro), Apomorphine (Apokyn).
FUNCTION: Directly stimulates dopamine receptors.
OTHER: Initial or adjunct therapy – may delay or reduce motor fluctuations. Not as effective as Sinemet, but provides relief of symptoms with longer half life.
MAO-B Inhibitors
KEY POINTS: Modest symptomatic benefit. May delay progression.
TYPES: Rasagiline (Azilect), Selegiline (I-deprenyl, Eldepryl), Selegiline HCL oral disintegrating (Zelapor).
FUNCTION: Monoamine oxidase inhibitor. Blocks breakdown of dopamine in the brain for more availability.
COMT-Inhibitors
KEY POINTS: Can increase ON time. Allows reduction of levodopa. Can worsen dyskinesias.
TYPES: Entacapone (Comtan), Tolcapone (Tasmar), Carbidopa/levodopa entacapone (Stalevo)
FUNCTION: Catechol-O transferase inhibitor. Prevents peripheral degeneration of levodopa.
OTHER: May decrease OFF times or reduce levodopa dose necessary for clinical effect.
Amantadine
KEY POINTS: Only medication that decreases dyskinesias and improves other symptoms.
TYPES: Amantadine (Symadine, symmetrel), Extended release amantadine (Gocovri, Osmolex ER).
Anticholinergics
KEY POINTS: Most effective for tremors. Significant confusion - do not give if cognitive complaints.
TYPES: Trihexyphenidyl (formerly Artane), Bentropine (Cogentin), Ethopropazine (Parsitan).
FUNCTION: Reduce over-activity of acetylcholine; inhibit dopamine reuptake in the striatum.
Other: Used mainly for tremors and rigidity.
Symptoms that are unresponsive to medications:
Postural instability/Balance
Medication Concerns:
You need to take your medications ON TIME, EVERY TIME – do not skip or postpone doses!
Set a timer on your phone for the exact time of day medications are to be administered so that doses are given on the same schedule.
Be alert for symptoms of dysphagia (trouble swallowing) and risk pneumonia.