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Several types of drugs can help manage the motor and nonmotor symptoms of Parkinson’s in different ways. By Erin Archer Kelser, RNMedically Reviewed by Jason Paul Chua, MD, PhDReviewed: December 8, 2021Medically ReviewedPeople with Parkinson’s taking drug treatments need to be monitored over time to watch for side effects and ensure optimal dosing.iStockParkinson’s disease cannot be cured, but different types of medications can help treat its symptoms. Parkinson’s is best known for causing symptoms related to movement (known as “motor symptoms”), such as tremors, muscle stiffness, slow movement (bradykinesia), and impaired balance. But it can also cause nonmotor, or nonmovement, symptoms, such as dementia; psychosis, or loss of contact with reality; mood disorders such as depression, anxiety, and apathy; and sleep disorders such as insomnia. Many of the symptoms of Parkinson’s are the result of a loss of neurons in the brain that produce the neurotransmitter (or chemical messenger) dopamine. Not surprisingly then, many of the treatments for Parkinson’s disease either raise the level of dopamine in the brain or attempt to mimic its effect. Medications for Parkinson's disease fall into three general categories:Medications that increase the level of dopamine in your brainMedications that affect other neurotransmitters, to help control motor symptomsMedications that help control nonmotor symptomsTreating Parkinson’s disease with medication can be a balancing act between managing the symptoms of the disease and managing the drug or drugs’ side effects, notes Mayo Clinic. Medications That Increase Dopamine
The following prescription drugs increase the amount of dopamine in the brain.New guidelines from the American Academy of Neurology (AAN), published on November 16, 2021, in Neurology, aim to assist doctors in choosing among these drug therapy options to control motor symptoms in people with early-stage Parkinson’s disease while minimizing negative side effects. Dopamine-Like Medication
The most common and effective treatment of motor symptoms related to Parkinson’s disease is a combination of the drugs levodopa and carbidopa, sold under the names Duopa, Parcopa, Rytary, and Sinemet, according to MedlinePlus. Sometimes referred to simply as levodopa, or L-DOPA, the drug eventually becomes dopamine that your brain can use. Dopamine can't be taken directly as a treatment because it's broken down in the body before it reaches the brain.According to the new AAN guidelines, levodopa is superior to dopamine agonists (see below) for managing motor symptoms early in the disease. However, it’s also more likely to cause dyskinesia, a type of uncontrolled, involuntary movement that can include fidgeting, writhing, head bobbing, and body swaying, according to the Michael J. Fox Foundation. To minimize the risk of dyskinesia, doctors are advised to prescribe the lowest effective dose of levodopa and to monitor patients for dyskinesia and other drug side effects over time. Other possible side effects of levodopa include nausea, vomiting, sleepiness, and orthostatic hypotension, or low blood pressure that occurs when standing up after sitting or sitting up after lying down. The AAN practice guidelines note that in early Parkinson’s, taking levodopa with meals may decrease nausea, but in later stages of the disease, doing so may decrease the drug’s therapeutic efficacy.People who use levodopa sometimes experience “wearing off” or “off episodes,” in which motor symptoms occur between medication doses, or even mid-dose. Off episodes can come on gradually or suddenly. Certain drug treatments have been developed specifically to treat off episodes. These include Inbrija, an orally inhaled form of levodopa, and Nourianz (istradefylline), a medication taken alongside levodopa, according to Acorda Therapeutics. Stopping levodopa abruptly can cause unpleasant withdrawal symptoms, including fever, rigid muscles, unusual body movements, and confusion. For this reason, you should never change your dose of levodopa or stop taking it suddenly without first talking to your doctor. Dopamine Agonists
This group of drugs includes Apokyn (apomorphine), Mirapex (pramipexole), Neupro (rotigotine), Parlodel (bromocriptine), Northera (Droxidopa), Requip (ropinirole), and Kynmobi (apomorphine). These medications mimic the action of dopamine in the brain and can have side effects similar to those of levodopa. They may be taken alone or with levodopa.In rare cases, these medications may cause an uncontrollable desire to gamble, shop, or have sex, collectively known as impulse control disorders. According to the new AAN guidelines for treating early Parkinson’s, dopamine agonists are more likely than levodopa to cause impulse control disorders, excessive daytime sleepiness, and sleep attacks. They may also be more likely to cause hallucinations. And, like levodopa, they can contribute to orthostatic hypotension. Still, individual characteristics such as body size, sex, and disease severity also influence the likelihood of experiencing certain drug side effects, which is why people who are in the early stages of Parkinson’s disease should talk with their doctor about the potential benefits and risks of these medications before starting any of them. MAO-B Inhibitors
These medications, which include Azilect (rasagiline) and Eldepryl or Zelapar (selegiline), inhibit the action of the enzyme monoamine oxidase B (MAO-B), which breaks down dopamine in the brain. This means that more dopamine stays intact for your brain to use, per an article published in 2016 in Frontiers in Pharmacology. Sometimes, an MAO-B inhibitor is taken with levodopa to prolong the effect of that drug. However, taking these drugs at the same time as certain antidepressants and sedatives should be avoided or monitored closely by your doctor because of potentially dangerous interactions. Common side effect of MAO-B inhibitors include mild nausea, dry mouth, lightheadedness, and constipation. The AAN practice guidelines note that MAO-B inhibitors are less effective than levodopa at improving mobility in early Parkinson’s and are additionally associated with a higher risk of drug discontinuation because of side effects. Your doctor can help you decide whether this kind of medication is a good choice for you. COMT Inhibitors
This group of drugs includes Comtan (entacapone), Ongentys (opicapone), and Tasmar (tolcapone).These medications inhibit the action of another enzyme that breaks down dopamine in the brain, catechol-O-methyltransferase (COMT). Taken with levodopa, they prolong the drug's effect. They may be prescribed if a person is experiencing “wearing off” between doses of levodopa, notes the UCSF Parkinson’s Disease Clinic and Research Center. The most common side effect of COMT inhibitors is diarrhea. They may also cause sleep disturbances, dizziness, or hallucinations. Tasmar has been shown to cause severe liver disease in some people, so you may need to undergo regular blood tests to assess your liver function if you take it. Symmetrel Amantadine
Symmetrel (amantadine) is an antiviral medication that may increase the effects of dopamine in the brain. Researchers are unsure why amantadine helps in this area. Amantadine is sometimes taken by itself early in the course of Parkinson's disease. It may also be taken later on to help with dyskinesia caused by levodopa. Medications That Affect Other Neurotransmitters
The following drugs may also help address certain symptoms of Parkinson's disease: Anticholinergics
Anticholinergics can be helpful for reducing tremor and dystonia associated with “wearing off.” They work by reducing the action of acetylcholine, a neurotransmitter involved in activating muscles. This group of drugs includes Artane (trihexyphenidyl), Cogentin (benztropine), Scopace (scopolamine), and Parsidol (ethopropazine).Side effects of anticholinergics may include blurred vision, dry mouth, constipation, and urinary retention. In older people, especially, they can cause confusion and hallucinations, so they are not recommended for people older than 70, notes the Parkinson’s Foundation. Medications for Nonmotor Symptoms
The following groups of drugs may be prescribed to address various nonmotor symptoms of Parkinson's disease: Antipsychotics
These drugs are used to treat the hallucinations and delusions that some people with Parkinson's disease experience, according to an article published in 2016 in Behavioral Neurology. Often, adjusting the doses of certain other Parkinson's medications will also help with these symptoms.Seroquel (quetiapine), Clozaril (clozapine), and Nuplazid (pimavanserin) appear to be safe and well-tolerated among people with Parkinson’s. These antipsychotic medications don’t worsen Parkinson’s symptoms as much as other ones do, according to the Parkinson’s Foundation. However, many traditional antipsychotic medications like Haldol (haloperidol) and Risperdal (risperidone) can worsen symptoms of Parkinson's disease because they work by blocking dopamine. Antidepressants
Depression is common in people with Parkinson's disease. If you're feeling extreme sadness or lack interest in activities you once enjoyed, an antidepressant may help, noted an article published in May 2017 in The American Journal of Psychiatry. Before prescribing an antidepressant, your doctor will want to know about any herbal supplements that you take, as well as any drug and alcohol use, since antidepressants may interact with these substances (and with some drugs for Parkinson's disease). Stimulants
These drugs are often used to treat excessive daytime sleepiness in people with Parkinson's disease, according to an article published in 2017 in Frontiers in Neurology. If a sleep disorder persists in spite of efforts to address underlying causes (like pain or frequent urination), then your doctor may prescribe a medication like Provigil (modafinil) to reduce sleepiness during the day. Cholinesterase Inhibitors
These drugs are used to treat dementia, or memory and thinking problems, due to aging and the progression of Parkinson's disease. Medications like Aricept (donepezil), Exelon (rivastigmine), Namenda (memantine), and Razadyne (galantamine) were developed for Alzheimer's disease, but they may also help with dementia in people with Parkinson's. Estrogen
Estrogen is a hormone that’s sometimes given to postmenopausal women to help manage menopausal symptoms, and it may have some benefit for those women who have Parkinson's disease, notes Parkinson’s U.K.. Although research on the effects of estrogen hormone replacement therapy (HRT) among women with Parkinson’s is limited, no studies thus far have shown any harm in taking HRT alongside standard Parkinson’s medications. Estrogen alone is not considered a treatment for Parkinson’s. Resources We Love
American Parkinson Disease Association (APDA) The APDA funds educational efforts, research, and patient services for Parkinson’s disease. You could join a local chapter if you’re interested in getting involved in a support group, exercise class, or another resource in your area. Davis Phinney Foundation for Parkinson’s The mission of this foundation is to help people with Parkinson’s live well. If you’re a patient or caregiver, check out its Live Well TODAY webinar series for more information about living well with Parkinson’s. European Parkinson’s Disease Association (EPDA) The EPDA is the leading Parkinson’s organization in Europe. It provides free resources, such as at-home workouts geared toward people with Parkinson’s. The Michael J. Fox Foundation for Parkinson’s Research The actor Michael J. Fox, who was diagnosed with young-onset Parkinson’s disease in 1991, later established The Michael J. Fox Foundation for Parkinson’s Research in 2000. The foundation offers many resources, including the Parkinson’s 360 guide for living with Parkinson’s, and the Fox Trial Finder for those interested in joining a clinical trial. Parkinson’s Foundation This foundation aims to empower people with Parkinson’s by funding care- and treatment-related research. If you need more information about Parkinson’s or a referral to a health professional, call the foundation’s helpline at 800-4PD-INFO (800-473-4636). The helpline is staffed by social workers, nurses, and health educators. Learn More About Additional Resources and Support for Parkinson’s Disease Editorial Sources and Fact-Checking
Parkinson’s Disease: Diagnosis & Treatment. Mayo Clinic. December 8, 2020.Pringsheim T, Day GS, Smith DB, et al. Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary: A Report of the AAN Guideline Subcommittee. Neurology. November 15, 2021.Levodopa and Carbidopa. MedlinePlus. June 15, 2018.Dyskinesia. The Michael J. Fox Foundation.“Off” Time in Parkinson’s Disease. The Michael J. Fox Foundation.Acorda Therapeutics Announces FDA Approval of INBRIJA (Levodopa Inhalation Powder). Acorda Therapeutics. December 21, 2018.Brooks DJ. Dopamine Agonists: Their Role in the Treatment of Parkinson's Disease. Journal of Neurology, Neurosurgery, and Psychiatry. June 2000.Giladi N, Weitzman N, Schreiber S, et al. New Onset Heightened Interest or Drive for Gambling, Shopping, Eating, or Sexual Activity in Patients With Parkinson's Disease: The Role of Dopamine Agonist Treatment and Age at Motor Symptoms Onset. Journal of Psychopharmacology. July 2007.Finberg JPM, Rabey JM. Inhibitors of MAO-A and MAO-B in Psychiatry and Neurology. Frontiers in Pharmacology. October 18, 2016.Catechol-O-Methyl Transferase (COMT) Inhibitors. UCSF Parkinson's Disease Clinic and Research Center.Anticholinergic Drugs. Parkinson’s Foundation.Divac N, Stojanovic R, Vujovic KS, et al. The Efficacy and Safety of Antipsychotic Medications in the Treatment of Psychosis in Patients With Parkinson's Disease. Behavioral Neurology. July 18, 2016.Hallucinations/Delusions. Parkinson’s Foundation.Frenklach A. Management of Depression in Parkinson’s Disease. The American Journal of Psychiatry. May 4, 2017.Loddo G, Calandra-Buonaura G, Sambati L, et al. The Treatment of Sleep Disorders in Parkinson’s Disease: From Research to Clinical Practice. Frontiers in Neurology. February 16, 2017.Pagano G, Rengo G, Pasqualetti G, et al. Cholinesterase Inhibitors for Parkinson's Disease: A Systematic Review and Meta-Analysis. Journal of Neurology, Neurosurgery, and Psychiatry. June 12, 2015.Menopause and Parkinson’s. Parkinson’s U.K.Show LessNEWSLETTERS Sign up for our Healthy Living Newsletter
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