Here are the basics about each of the medicines below. Only the common reactions are listed.
Medicine is used to raise dopamine or make the brain think it is getting enough dopamine. Medicines may need to be changed over time as the disease gets worse or side effects happen.
Prescription Medicines
- Dopar
- Larodopa
- Carbidopa/levodopa
- Carbidopa/levodopa controlled-release
- Carbidopa/levodopa intestinal gel
- Carbidopa/levodopa/entacapone
- Bromocriptine
- Cabergoline
- Pramipexole
- Ropinirole
- Apomorphine
- Rotigotine patch
Monoamine oxidase type B inhibitor
- Selegiline
- Rasagiline
- Tolcapone
- Entacapone
- Trihexyphenidyl
- Benztropine
- Amantadine
Selective serotonin inverse agonist (SSIA)
- Pimavanserin
- Istradefylline
Prescription Medicines
Levodopa is the main way to treat symptoms. It raises the amount of dopamine in the brain. This can help ease problems like rigidity and slowness.
Common names are:
- Dopar
- Larodopa
People who take levodopa alone should not take vitamin B6 pills. It can speed up the breakdown of levodopa. Foods high in B6 may also need to be limited.
Common names are:
- Carbidopa/levodopa
- Carbidopa/levodopa controlled-release
- Carbidopa/levodopa intestinal gel
- Carbidopa/levodopa/entacapone
The body breaks down levodopa quickly. Combining it with carbidopa can slow this breakdown.
These medicines may not work as well over time. The doctor may change how much or how often it is taken as the disease worsens.
Problems may be:
- Nausea and vomiting
- Coughing
- Nightmares
- Problems controlling urges
Entacapone, a COMT inhibitor (see below), may be added to levodopa/carbidopa. More side effects are listed below.
Common names are:
- Bromocriptine
- Cabergoline
- Pramipexole
- Ropinirole
- Apomorphine
- Rotigotine patch
These drugs act on the brain in a way that is like dopamine. They may be given alone as an early way to treat the disease. They may also be given with other medicines as the disease gets worse. These medicines last longer and do not have as many side effects.
Some problems are:
- Lightheadedness
- Drowsiness or sudden need to sleep
- Dry mouth
- Nausea and vomiting
- Constipation
- Headache
- Ankle swelling
- Sudden low blood pressure
- Seeing or hearing things that are not real
- Problems controlling urges
Cabergoline may also raise the risk of heart problems. Bromocriptine has rare but severe side effects, such as pulmonary fibrosis.
Common names are:
- Selegiline
- Rasagiline
Selegiline and rasagiline are often given with levodopa or levodopa/carbidopa. They help stop the breakdown of dopamine in the brain.
Some problems are:
- Dry mouth
- Sudden low blood pressure
- Problems sleeping
- Nausea and vomiting
- Seeing things that are not real
- Nervousness
High doses of selegiline may cause a very high blood pressure when eating or drinking things that have tyramine, such as aged cheese and alcohol. Many medicines should also not be taken with selegiline and rasagiline. Reactions may happen.
Common names are:
- Tolcapone
- Entacapone
- Opicapone
COMT inhibitors are taken with levodopa. They help slow the breakdown of levodopa.
These medicines can cause severe liver problems. Liver health tests will need to be done when taking it.
Some problems are:
- Dark urine
- Diarrhea
- Lightheadedness
- Headaches
- Drowsiness
- Confusion
- Seeing things that are not real
Common names are:
- Trihexyphenidyl
- Benztropine
These medicines can ease tremors and stiffness and improve muscle control.
Some problems are:
- Drowsiness
- Lightheadedness
- Sensitivity to bright lights or blurry eyesight
- Dry mouth
- Problems urinating (peeing) or passing stool (pooping)
- Fast heartbeat
- Mood changes
- Memory problems or confusion
- Seeing things that are not real
Common names are:
- Amantadine
Amantadine can help ease stiffness and tremors and improve muscle control. It may stop working when taken for a long time. It may be stopped and restarted to improve how it works.
Some problems are:
- Low blood pressure
- Blurry eyesight
- Lack of focus
- Dry mouth
- Purplish-red blotchy skin rash
- Depression
- Problems sleeping or nightmares
- Confusion or seeing things that are not real
- Problems urinating
Common names are:
- Pimavanserin
Pimavanserin is an antipsychotic medicine. It is used to help people with psychosis from the disease. It blocks some serotonin receptors that cause these problems. It should not be taken by people with kidney, liver, or heart problems.
Problems may be:
- Nausea
- Swelling in the lower body
- Confusion
References
Burack M., Aldred J., et al. Implementing levodopa-carbidopa intestinal gel for Parkinson disease: insights from US practitioners. Mov Disord Clin Pract. 2018; 5(4): 383-393.
FDA approves new add-on drug to treat off episodes in adults with Parkinson's disease. US Food and Drug Administration website. Available at: https://www.fda.gov/news-events/press-announcements/fda-approves-new-add-drug-treat-episodes-adults-parkinsons-disease. Accessed April 5, 2022.
Homayoun H. Parkinson Disease. Ann Intern Med. 2018; 169(5): ITC33-ITC48.
Parkinson disease. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/parkinson-disease. Accessed April 5, 2020.
Parkinson disease. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/neurologic-disorders/movement-and-cerebellar-disorders/parkinson-disease. Accessed April 5, 2022.
Parkinson's disease. American Association of Neurological Surgeons website. Available at: http://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Parkinsons-Disease. Accessed April 5, 2022.
Parkinson's disease information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Parkinsons-Disease-Information-Page. Accessed April 5, 2022.
Revision Information
- Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
- Review Date: 03/2022
- Update Date: 04/05/2022