Parkinson’s Management

Drug and Medication Therapies

The purpose of treating Parkinson’s is to reduce the effect of symptoms on your daily life. Without treatment, you will eventually find that the symptoms make it hard to perform daily activities. Symptoms, such as shaking and stiffness, may cause discomfort; the risk of injury from falls may increase, and swallowing may become more difficult. People are encouraged to maintain open and ongoing discussions with their Parkinson’s healthcare team when exploring treatment options.

Medication will help you function but may cause side effects. It is important to find the right balance between the medication’s benefits and side effects. Everyone with Parkinson’s is unique and will experience different symptoms, which means the treatment you receive will be geared to your specific needs. Drugs for Parkinson’s work on the brain’s complex chemistry and may need to be taken several times a day. Use them as prescribed and do not alter your doses without consulting your doctor. Current treatment neither cures Parkinson’s nor stops it from advancing.

When should I start taking medication?

If you have been diagnosed with Parkinson’s, you may be wondering when you should start treatment and with what medication. There is no single strategy that applies to everyone. The timing will differ from person to person. It depends on a variety of factors, such as:

  • your age
  • the nature of your symptom(s)
  • your lifestyle (e.g., if you are working or retired and the kind of leisure activities you enjoy)
  • your overall physical health
  • whether you experience balance problems with walking
  • changes in intellectual abilities, and
  • your own attitude toward taking medication

When to start taking medication can be decided in consultation with your neurologist or movement disorder specialist. The decision to delay taking medication requires close monitoring and evaluation for risks of falls and injuries, especially if you are older. The older you are, the more you are at risk for a fall, and Parkinson’s medication, when used appropriately, may reduce this risk.

What about medications for other health conditions?

The effectiveness of some Parkinson’s drugs can be reduced when combined with drugs for other health conditions. It is important to seek advice from your doctor or pharmacist regarding any new drug prescription.

What medications are used to treat Parkinson’s symptoms?

Since many of the motor symptoms of Parkinson’s are the result of a lack of dopamine in the brain, most drugs used to treat Parkinson’s are aimed at temporarily replenishing or imitating dopamine. The following list is a guide to medications approved by Health Canada to treat symptoms of Parkinson’s1. Speak to your doctor for detailed information regarding the effectiveness and side effects of a particular drug.

Levodopa (levodopa/benserazide [Prolopa®], levodopa/carbidopa [Sinemet®])

  • Converted into dopamine in the brain and stored in nerve cells to replace depleted dopamine
  • Combined with another drug, carbidopa or benserazide, allows more levodopa to get to the brain and reduces side effects
  • Helps improve muscle rigidity and movement
  • Side effects include dyskinesias (involuntary movements)
  • Over years of use, may be associated with “wearing off

Dopamine Agonists (bromocriptine [Parlodel®], pramipexole [Mirapex®], ropinirole [ReQuip®], rotigotine [Neupro®])

  • Mimics or imitates the action of dopamine
  • Can be used as initial treatment or with levodopa in advanced stages
  • Side effects include sleepiness, hallucinations, leg swelling, and obsessions with food, sex, and activities such as shopping, gambling, and Internet use Amantadine (Symmetrel®)
  • Enhances dopamine release and blocks glutamate, a brain transmitter
  • Used to treat early symptoms
  • Can reduce dyskinesias and improve wearing off

Dopamine Agonist (apomorphine hydrochloride [Movapo®])

  • Used, as needed, to treat “OFF” episodes
  • Taken with other oral medications for Parkinson’s disease
  • It is administered via injection under the skin
  • It is not known exactly how it works but seems to improve some of the chemical imbalance in the part of the brain affected in patients with Parkinson’s disease (the substantia nigra)
  • Common side effects include dyskinesia, syncope (fainting when standing up), hallucinations (seeing or hearing things that are not there), and compulsive behavior (inability to resist the impulse to perform an action that could be harmful such as gambling too much, increased sexual urges, uncontrollable urge to eat or spend money, or repeating meaningless actions).

COMT Inhibitors (entacapone [Comtan®])

  • Block a key enzyme responsible for breaking down levodopa before it reaches the brain
  • Can improve the duration of response to levodopa
  • Side effects include dyskinesias

Levodopa/carbidopa/entacapone (Stalevo®)

  • Substitutes individually administered immediate-release levodopa/carbidopa + entacapone
  • Used to replace immediate-release levodopa/carbidopa (without entacapone) when patients experience end-of-dose wearing off

Levodopa/carbidopa intestinal gel (DuodopaTM®)

  • Levodopa/carbidopa gel administered throughout the day with a pump via a tube directly into the small intestine
  • Used in advanced Parkinson’s disease

Monoamine-Oxidase-B Inhibitors (MAO-B) (selegiline [Eldepryl®], rasagiline [Azilect®])

  • Enhance the effect of dopamine by preventing its breakdown
  • Side effects include dyskinesias

Anticholinergic Drugs (Apo®-trihex, benztropine [Cogentin®], trihexyphenidyl [Artane®])

  • Corrects imbalance between dopamine and acetylcholine

How can I get the most benefit from my Parkinson’s medications?

  • The timing of medications is an important way to control your symptoms. Follow the guidelines provided by your health care professional.
  • Use a timer to remind you to take your medication on time to avoid “double-dosing”.
  • Take each dose with a full glass of water to aid absorption.
  • Do not break, crush or chew controlled-release tablets, unless instructed by your doctor.
  • For nausea, take the drug after meals or with a cracker or fruit.
  • Keep an accurate list of all medications, including over-the-counter products, herbal remedies, vitamins, or supplements.

What are the side effects of Parkinson’s drugs?

The most common reactions (which occur within the first several days of a new treatment) include nausea, vomiting, dizziness (drop in blood pressure), sleepiness, and visual hallucinations.

In the last few years, levodopa and dopamine agonists in particular (ropinirole [ReQuip], pramipexole [Mirapex]) have been associated with the emergence of behavioral changes such as impulse control disorders. These are characterized by failure to resist an impulse to perform certain actions.

Impulse control disorders include a range of behaviors such as compulsive gambling (up to 5% of treated patients) or shopping, hypersexuality, binge eating, addiction to the Internet, or to other recreational activities. These activities are often pleasant at the moment, but over time may become harmful to you or to others. If you are experiencing these behaviors, tell your neurologist/doctor. Often the medication can be adjusted which can reduce or control the behavior.

Care partners can play an important role in helping to identify when these behaviors occur. If you are a care partner, tell the person if you have noticed a change in his/her behavior or personality and encourage him/her to speak with the doctor immediately so medication can be adjusted.

What are non-motor symptoms?

People with Parkinson’s often experience non-motor symptoms which can be more bothersome than motor symptoms. Some examples of non-motor symptoms include constipation, depression or anxiety, sleep disorders, and cognitive changes. Adjusting the Parkinson’s medications can often control these symptoms. If this approach doesn’t work, specific treatment may be required. For example, depression is common in Parkinson’s and usually responds well to treatment. Medications to improve cognitive function are also available. Read more about non motor symptoms.

How will my Parkinson’s change over time?

Parkinson’s will change over time. Often the changes are subtle and you may not notice them. This Medication Checklist may help you identify these changes. Complete the checklist every 9 to 12 months. Discuss the changes with your doctor.

What questions might I ask about treating Parkinson’s?

You might find it helpful to write down any questions you have before your next appointment. This can help your visit be more efficient. Here are a few questions you may wish to ask:

  • What are the benefits of each kind of medication?
  • What are the side effects and how can I manage them?
  • When do I take the medication relative to mealtime to get the best result?
  • How soon can I expect the treatment to start working?
  • How will treatment affect my daily activities?
  • How often do I need to follow up with my doctor about my medications?
  • Do drugs lose their effectiveness over time if I start treatment early on?
  • Should I be concerned about behaviors related to taking drugs, such as confusion or compulsive activities (e.g., shopping or gambling)?
  • Are my medications covered by the provincial drug plan?
  • Would a clinical trial be appropriate for me? Can you help me find one?

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