Table 5.

Treatment options of autonomic failures in Parkinson’s disease

symptom	treatment options
salivation	belladonna compounds, anticholinergic drugs, glycopyrrolate, botulinum toxin (off label use), 1% atropine eye solution (off label use)
seborrhea	soaps, shampoos
hyperhidrosis	botulinum toxin
constipation	Various kinds of laxatives, sufficient hydration, fibers, prucaloprid (Reselor®), macrogel (Movicol®)
gastrointestinal motility	Domperidone, prucaloprid (Reselor®) (off label use !)
bladder dysfunction	genneral approach: reduced fluid intake at night is sometimes helpful. parasympatholytics, imipramine, Fesoterodinfumarat (Toviaz®) Darifenacin (Emselex ®), botulinum toxin (off label use !) (in case of imperative urgency due to overactive bladder syndrome [detrusor hyperreflexia or overactivity]) optimum dopaminergic drug titration (in case of frequent and/or involuntary urinary incontinence due to uninhibited contractions of the detrusor muscle) distigmine bromide, reduction of anticholinergic drugs, (in case of detrusor hyporeflexia [underactivity])
sexual dysfunction	sildenalfil, oral apomorphine, alprostadil, psychotherapy
orthostatic syndrome	patient education, non pharmacological interventions, midodrine, fludrocortisone, yohimbine, droxidopa