Table 1.
Current treatment strategies in clinical use.
| Drug class | Drug name/route | Clinical use | Advantages | Disadvantages |
|---|---|---|---|---|
| Levodopa (with Dopa Decarboxylase inhibitors) | Sinemet, Parcopa, Atamet | Monotherapy | Increase levels of endogenous DA | Motor fluctuations |
| Dyskinesias | ||||
| COMT Inhibitors | Entacapone, Tolcapone | Adjunct therapy | Decrease metabolism of L-Dopa | Dyskinesias |
| Decrease in daily dose of L-Dopa required | Diarrhea | |||
| Increase daily “on” time and UPDRS scores | Hepatic toxicity (tolcapone) | |||
| Dizziness | ||||
| Insomnia | ||||
| Nausea | ||||
| Dopamine agonists | Piribedil, Pramipexole, Pramipexole extended release, Ropinirole, Rotigotine, Cabergoline, Pergolide | Monotherapy (younger patients) | Increase levels of endogenous DA | Sedation |
| Bromocriptine | Adjunct therapy | Decrease motor symptoms in early stages of disease | Impulse control disorder | |
| Somnolence | ||||
| Edema | ||||
| Levodopa, Carbidopa, Entacapone combination | Stalevo | Monotherapy | Increase levels of endogenous DA | Dyskinesias may appear sooner |
| Decrease metabolism of L-Dopa | Side effects are the same as for individual drug classes | |||
| MAO-B Inhibitors | Rasagiline, Selegiline, Safinamide | Initial monotherapy (mild PD patients) | Decrease catabolism of DA | Generally well tolerated |
| Adjunct therapy | Decrease rate of progression on UPDRS | Mild nausea | ||
| Constipation | ||||
| Confusion | ||||
| Continuous L-Dopa | Intravenous bolus, Intravenous infusion, Intestinal carbidopa/L-Dopa gel | Monotherapy | Decrease pulsatile DA levels | Large volumes required (intravenous) |
| Increase control of on/off periods | Requires surgery and prosthetic device | |||
| Decrease dyskinesia severity and duration | Mechanical problems | |||
| Decrease non motor symptoms (eg mood shifts, dribbling and urinary function changes) | Gastronomy complications | |||
| Anticholinergics | Trihexyphenidyl, Benztropine, Orphenadrine, Procyclidine, Biperiden | Monotherapy | Decrease acetylcholine levels | Dry mouth |
| Adjunct Therapy | Decrease tremor | Blurred vision | ||
| Constipation | ||||
| Nausea | ||||
| Impaired sweating |
Abbreviations: COMT, catechol-O-methyl transferase; DA, dopamine; L-Dopa, levodopa; MAO-B, monoamine oxidase B; UPDRS, Unified Parkinson's Disease Rating Scale.