Table 2.
Pharmacological therapies currently used for initial and adjunctive treatment of motor symptoms in Parkinson's disease
| Class | Drugs | Indication | Motor benefit | Common adverse effects | Comments |
|---|---|---|---|---|---|
| Levodopa (with dopa-decarboxylase inhibitor) | Levodopa + carbidopa (co-careldopa)Levodopa + benserazide (co-beneldopa) | Initial therapy | +++ | Motor fluctuationsDyskinesia | CR preparation only routinely used at night, immediate release preparation during the day |
| Dopamine agonist | Pramipexole Ropinirole Rotigotine (skin patch) |
Initial/adjunctive | ++ | Nausea Drowsiness Hallucinations Ankle oedema Postural hypotension Impulse control disorder |
All available as once-daily preparation |
| Apomorphine pen (sub-cutaneous) | Rescue therapy for off periods | +++ | Nausea Drowsiness Hallucinations Ankle oedema Postural hypotension Impulse control disorder |
Rapid onset shorter duration of action Skin nodules |
|
| Monoamine oxidase inhibitor (reduces central dopamine catabolism) | Selegiline Rasagiline Safinamidea |
Initial/adjunctive Initial/adjunctive Adjunctive |
+ Improved wearing-off Improved wearing-off |
Mood changes Dry mouth Dyskinesia |
Once daily Once daily Once daily |
| COMT inhibitor (inhibit peripheral levodopa catabolism) | Entacapone | Adjunctive | Improved wearing-off | Diarrhoea Dyskinesia |
With each levodopa dose or as combined preparation |
| Opicapone | Adjunctive | Improved wearing-off | Dyskinesia | Once daily | |
| Tolcapone | Adjunctive | Improved wearing-off | Dyskinesia Hepatotoxicity |
Three times daily | |
| NMDAR antagonist | Amantadine | Adjunctive | Improved dyskinesia | Skin rash Ankle oedema Hallucinations |
a= combined monoamine oxidase and sodium channel/glutamate release inhibitor; COMT = catechol-O-methyltransferase; CR = controlled release; NMDAR = N-methyl-D-aspartate receptor. Motor benefit: +++ = excellent; ++ = good; + = fair.