Medication

Medications for Parkinson’s

There is not yet a cure for Parkinson’s disease, but symptoms can be treated with medication.

Should I start treating my symptoms with medication now or should I wait a while? Which medications are right for me? These are among the tough questions people with Parkinson’s disease are faced with. Your answers will be balanced among many other considerations.

Before making any decisions about treatment of Parkinson’s disease, you will want to learn about the different types of medications available for Parkinson’s disease and discuss the pros and cons of each with your physician. It may help to know that there is no “right” answer, and if you try something that doesn’t work for you, you can always adjust your plan.

Levodopa: the most effective drug for treating Parkinson’s

Levodopa, also known as L-DOPA, has long been, and continues to be, the most effective drug in treating Parkinson’s disease symptoms. Most people with Parkinson’s disease will take this drug at some point. There are side effects that can occur with Levodopa including nausea, fatigue and orthostatic hypotension. Often these side effects can be successfully treated so that Levodopa can be tolerated better. In addition, as the disease progresses and the brain has less ability to produce and process dopamine, dyskinesias, or involuntary movements can develop from Levodopa.

Full List of Medications Approved for the Treatment of Parkinson’s Disease in the USA

Below is a full list of Parkinson’s medications that have been approved to treat Parkinson’s in the United States, as of May 2018. This material is intended to provide you with information. It should not be used for treatment purposes, but rather as a source for discussion with the patient’s own physician. Work with your physician to determine which medications are best for you, and know the risks and benefits of each.

 

Generic NameTrade NameMode of ActionCommon Side Effects*
Carbidopa-levodopaSinemetDOPA decarboxylase inhibitor/DA precursorNausea, dizziness, orthostatic hypotension, anxiety, dyskinesia, confusion, hallucinations, somnolence.
Carbidopa-levodopa (controlled release)Sinemet CRDOPA decarboxylase inhibitor/DA precursorNausea, dizziness, orthostatic hypotension, anxiety, dyskinesia, confusion, hallucinations, somnolence.
Carbidopa-levodopa (orally disintegrating tablet)ParcopaDOPA decarboxylase inhibitor/DA precursorNausea, dizziness, orthostatic hypotension, anxiety, dyskinesia, confusion, hallucinations, somnolence.
Carbidopa-levodopa (extended release capsultesRytaryDOPA decarboxylase inhibitor/DA precursorNausea, dizziness, orthostatic hypotension, anxiety, dyskinesia, confusion, hallucinations, somnolence.
Carbidopa-levodopa-entacopone (enteral suspension)DuopaDOPA decarboxylase inhibitor/DA precursorNausea, dizziness, orthostatic hypotension, anxiety, dyskinesia, confusion, hallucinations, somnolence.
EntacoponeComtanCOMT inhibitor, inhibits breakdown of Levodopa

Same as carbidopa/levodopa. In addition: diarrhea, discoloration of body fluids. Tasmar can cause elevated liver function enzymes.

TolcaponeTasmarCOMT inhibitor, inhibits breakdown of Levodopa

Same as carbidopa/levodopa. In addition: diarrhea, discoloration of body fluids. Tasmar can cause elevated liver function enzymes.

Carbidopa/Levodopa EntacoponeStalevoDOPA decarboxylase inhibitor/DA precursor/COMT inhibitorSame as carbidopa/levodopa and COMT inhibitor
PramipexoleMirapexDA agonistNausea, dizziness, orthostatic hypotension, swelling of ankles, dyskinesia, hallucinations, confusion, somnolence, sleep attacks, impulse control disorders. Neupro can lead to a skin reaction at the patch site.
Pramipexole (extended release)Mirapex ERDA agonistNausea, dizziness, orthostatic hypotension, swelling of ankles, dyskinesia, hallucinations, confusion, somnolence, sleep attacks, impulse control disorders. Neupro can lead to a skin reaction at the patch site.
RopiniroleRequipDA agonistNausea, dizziness, orthostatic hypotension, swelling of ankles, dyskinesia, hallucinations, confusion, somnolence, sleep attacks, impulse control disorders. Neupro can lead to a skin reaction at the patch site.
Ropinirole (extended release)Requip XLDA agonistNausea, dizziness, orthostatic hypotension, swelling of ankles, dyskinesia, hallucinations, confusion, somnolence, sleep attacks, impulse control disorders. Neupro can lead to a skin reaction at the patch site.
Apomorphine (injection)ApokynDA agonistNausea, dizziness, orthostatic hypotension, swelling of ankles, dyskinesia, hallucinations, confusion, somnolence, sleep attacks, impulse control disorders. Neupro can lead to a skin reaction at the patch site.
Rotigotine (transdermal patch)NeuproDA agonistNausea, dizziness, orthostatic hypotension, swelling of ankles, dyskinesia, hallucinations, confusion, somnolence, sleep attacks, impulse control disorders. Neupro can lead to a skin reaction at the patch site.
SelegilineEldeprylMAO-B inhibitor; inhibits breakdown of dopamine Selegiline can cause insomnia. Dizziness, nausea, gastrointestinal upset, dyskinesia, hallucinations, confusion, headache.
Note possible drug interactions.
Safinamide exerts its effects through other mechanisms of action as well.
Selegiline (orally disintegrating tablet)Zelapar MAO-B inhibitor; inhibits breakdown of dopamine Selegiline can cause insomnia. Dizziness, nausea, gastrointestinal upset, dyskinesia, hallucinations, confusion, headache.
Note possible drug interactions.
Safinamide exerts its effects through other mechanisms of action as well.
RasagilineAzilect MAO-B inhibitor; inhibits breakdown of dopamine Selegiline can cause insomnia. Dizziness, nausea, gastrointestinal upset, dyskinesia, hallucinations, confusion, headache.
Note possible drug interactions.
Safinamide exerts its effects through other mechanisms of action as well.
SafinamideXadago MAO-B inhibitor; inhibits breakdown of dopamine Selegiline can cause insomnia. Dizziness, nausea, gastrointestinal upset, dyskinesia, hallucinations, confusion, headache.
Note possible drug interactions.
Safinamide exerts its effects through other mechanisms of action as well.
AmantadineSymmetrelMixed mechanisms, including NMDA antagonismHallucinations, leg swelling, dizziness, mottled skin (livedo reticularis), confusion, dry mouth and eyes, constipation, dizziness, orthostatic hypotension, somnolence.
Amantadine (extended release)GocovriMixed mechanisms, including NMDA antagonismHallucinations, leg swelling, dizziness, mottled skin (livedo reticularis), confusion, dry mouth and eyes, constipation, dizziness, orthostatic hypotension, somnolence.
TrihexyphenidylArtaneAnticholinergicDry mouth and eyes, constipation, urinary retention, memory impairment, confusion, depression, hallucinations.
BenztropineCogentinAnticholinergicDry mouth and eyes, constipation, urinary retention, memory impairment, confusion, depression, hallucinations.

Mechanism of action

Generic
name

Trade name®

common side effects*

DOPA Decarboxylase inhibitor/DA precursor

Carbidopa/Levodopa

Sinemet

 

Nausea, dizziness, orthostatic
hypotension, anxiety, dyskinesia, confusion, hallucinations, somnolence.

Carbidopa/Levodopa
(controlled release)

Sinemet CR

Carbidopa/Levodopa
(orally disintegrating)

Parcopa

Carbidopa/Levodopa
(extended release capsules)

Rytary

Carbidopa/Levodopa
(enteral suspension)

Duopa

COMT inhibitor, inhibits
breakdown of levodopa

Entacapone

Comtan

Same as carbidopa/levodopa. In addition: diarrhea, discoloration of body fluids. Tasmar can cause elevated liver function enzymes.

Tolcapone

Tasmar

DOPA decarboxylase inhibitor/DA precursor/ COMT
Inhibitor

Carbidopa/Levodopa
Entacopone

Stalevo

Same as carbidopa/levodopa and COMT inhibitor.

DA agonist

Pramipexole

Mirapex

 

Nausea, dizziness, orthostatic hypotension, swelling of ankles, dyskinesia, hallucinations, confusion, somnolence, sleep attacks, impulse control disorders.
Neupro can lead to a skin reaction at the patch site.

Pramipexole (extended
release)

Mirapex ER

Ropinirole

Requip

Ropinirole
(extended release)

Requip XL

Apomorphine (injection)

Apokyn

Rotigotine (transdermal patch)

Neupro

MAO-B inhibitor,
inhibits breakdown of dopamine

Selegiline

Eldepryl

Selegiline can cause
insomnia.

Dizziness, nausea,
gastrointestinal upset, dyskinesia, hallucinations, confusion, headache.

Note possible drug interactions.

Safinamide exerts its effects through other mechanisms of action as well.

Selegiline
(orally disintegrating)

Zelapar

Rasagiline

Azilect

Safinamide

Xadago

Mixed mechanisms,
including NMDA antagonism

Amantadine

Symmetrel

Hallucinations, leg swelling, dizziness, mottled skin (livedo reticularis), confusion, dry mouth and eyes, constipation, dizziness, orthostatic hypotension, somnolence.

Amantadine
(extended release)

Gocovri

Anticholinergic

Trihexyphenidyl

Artane

Dry mouth and eyes, constipation, urinary retention, memory impairment, confusion, depression, hallucinations.

Benztropine

Cogentin

COMT = Cathechol-o-methyltransferase
DA = Dopamine
DOPA = Dopamine
MAO = Monoamino oxidase
NMDA = N-methyl-D-aspartate

* The most common side effects are listed. Additional side effects should be discussed with your healthcare provider.

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