Medications for Parkinson’s
There is not yet a cure for Parkinson’s disease, but symptoms can be treated with medication
Should you start treating symptoms with medication now, or should you wait? Which medications are right for you? These are just some of the difficult questions faced by people living with Parkinson’s disease. Finding the right answers requires carefully balancing a variety of important considerations unique to each individual.
Before making any decisions about treatment of Parkinson’s disease, you will want to learn about the different types of medications available for Parkinson’s disease and discuss the pros and cons of each with your physician. It may help to know that there is no “right” answer, and if you try something that doesn’t work for you, you can always work with your doctor to adjust your plan.
Managing Parkinson’s Medications
In this session of Dr. Gilbert Hosts, special guest Dr. Stephanie Bissonnette discusses medication management in Parkinson’s disease and answers audience questions.
Levodopa: the most effective drug for treating Parkinson’s
Levodopa, also known as L-DOPA, has long been, and continues to be, the most effective drug in treating Parkinson’s disease symptoms. Most people with Parkinson’s disease will take this drug at some point. There are side effects that can occur with levodopa, including nausea, fatigue, and orthostatic hypotension. Often these side effects can be successfully treated so that levodopa can be better tolerated. In addition, as the disease progresses and the brain has less ability to produce and process dopamine, dyskinesias, or involuntary movements, can develop from levodopa.
If levodopa is ingested by itself however, it breaks down in the bloodstream before it crosses into the brain, so levodopa is typically ingested with another medication that stops it from breaking down. In the US, the combination of carbidopa/levodopa is used.
Carbidopa/Levodopa FAQs: Side effects, dosages, and more
Full List of Medications Approved for the Treatment of Parkinson’s Disease in the USA
Below is a full list of Parkinson’s medications that have been approved to treat Parkinson’s in the United States. We also provide information on medications to avoid. This material is intended to provide you with information. It should not be used for treatment purposes but rather as a source for discussion with the patient’s own physician. Work with your physician to determine which medications are best for you and know the risks and benefits of each.
| Generic Name | Trade Name | Mode of Action | Common Side Effects* |
|---|---|---|---|
| Carbidopa-levodopa | Sinemet | DOPA decarboxylase inhibitor/DA precursor | Nausea, dizziness, orthostatic hypotension, anxiety, dyskinesia, confusion, hallucinations, somnolence. |
| Carbidopa-levodopa (controlled release) | Sinemet CR | DOPA decarboxylase inhibitor/DA precursor | Nausea, dizziness, orthostatic hypotension, anxiety, dyskinesia, confusion, hallucinations, somnolence. |
| Carbidopa-levodopa (orally disintegrating tablet) | Parcopa | DOPA decarboxylase inhibitor/DA precursor | Nausea, dizziness, orthostatic hypotension, anxiety, dyskinesia, confusion, hallucinations, somnolence. |
| Carbidopa-levodopa (extended release capsultes | Rytary | DOPA decarboxylase inhibitor/DA precursor | Nausea, dizziness, orthostatic hypotension, anxiety, dyskinesia, confusion, hallucinations, somnolence. |
| Carbidopa-levodopa-entacapone (enteral suspension) | Duopa | DOPA decarboxylase inhibitor/DA precursor | Nausea, dizziness, orthostatic hypotension, anxiety, dyskinesia, confusion, hallucinations, somnolence. |
| Carbidopa and Levodopa extended reléase capsules | Crexont | DOPA decarboxylase inhibitor/DA precursor | Nausea, dizziness, orthostatic hypotension, anxiety, dyskinesia, confusion, hallucinations, somnolence. |
| Foscarbidopa/ foslevodopa | Vyalev | Soluble pro-drug of carbidopa/levodopa | Nausea, dizziness, orthostatic hypotension, anxiety, dyskinesia, confusion, hallucinations, somnolence. |
| Levodopa Inhalation powder | Inbrija | DA precursor | Nausea, dizziness, orthostatic hypotension, anxiety, dyskinesia, confusion, hallucinations, somnolence. |
| Entacapone | Comtan | COMT inhibitor, inhibits breakdown of Levodopa |
Same as carbidopa/levodopa. In addition: diarrhea, discoloration of body fluids. |
| Tolcapone | Tasmar | COMT inhibitor, inhibits breakdown of Levodopa |
Same as carbidopa/levodopa. In addition: diarrhea, discoloration of body fluids. Tasmar can cause elevated liver function enzymes. |
| Opicapone | Ongentys | COMT inhibitor, inhibits breakdown of Levodopa |
Same as carbidopa/levodopa. |
| Carbidopa/Levodopa Entacapone | Stalevo | DOPA decarboxylase inhibitor/DA precursor/COMT inhibitor | Same as carbidopa/levodopa and Entacaopone |
| Pramipexole | Mirapex | DA agonist | Nausea, dizziness, orthostatic hypotension, swelling of ankles, dyskinesia, hallucinations, confusion, somnolence, sleep attacks, impulse control disorders. |
| Pramipexole (extended release) | Mirapex ER | DA agonist | Nausea, dizziness, orthostatic hypotension, swelling of ankles, dyskinesia, hallucinations, confusion, somnolence, sleep attacks, impulse control disorders. |
| Ropinirole | Requip | DA agonist | Nausea, dizziness, orthostatic hypotension, swelling of ankles, dyskinesia, hallucinations, confusion, somnolence, sleep attacks, impulse control disorders. |
| Ropinirole (extended release) | Requip XL | DA agonist | Nausea, dizziness, orthostatic hypotension, swelling of ankles, dyskinesia, hallucinations, confusion, somnolence, sleep attacks, impulse control disorders. |
| Apomorphine (injection) | Apokyn | DA agonist | Nausea, dizziness, orthostatic hypotension, swelling of ankles, dyskinesia, hallucinations, confusion, somnolence, sleep attacks, impulse control disorders. |
| Rotigotine (transdermal patch) | Neupro | DA agonist | Nausea, dizziness, orthostatic hypotension, swelling of ankles, dyskinesia, hallucinations, confusion, somnolence, sleep attacks, impulse control disorders. Neupro can cause a skin reaction. |
| Selegiline | Eldepryl | MAO-B inhibitor; inhibits breakdown of dopamine | Selegiline can cause insomnia. Dizziness, nausea, gastrointestinal upset, dyskinesia, hallucinations, confusion, headache. Note possible drug interactions. |
| Selegiline (orally disintegrating tablet) | Zelapar | MAO-B inhibitor; inhibits breakdown of dopamine | Selegiline can cause insomnia. Dizziness, nausea, gastrointestinal upset, dyskinesia, hallucinations, confusion, headache. Note possible drug interactions. |
| Rasagiline | Azilect | MAO-B inhibitor; inhibits breakdown of dopamine | Dizziness, nausea, gastrointestinal upset, dyskinesia, hallucinations, confusion, headache. Note possible drug interactions. |
| Safinamide | Xadago | MAO-B inhibitor; inhibits breakdown of dopamine | Dizziness, nausea, gastrointestinal upset, dyskinesia, hallucinations, confusion, headache. Note possible drug interactions.Safinamide acts through multiple mechanisms of action. |
| Amantadine | Symmetrel | Mixed mechanisms, including NMDA antagonism | Hallucinations, leg swelling, dizziness, mottled skin (livedo reticularis), confusion, dry mouth and eyes, constipation, dizziness, orthostatic hypotension, somnolence.
Dose needs to be adjusted in renal disease. |
| Amantadine (extended release) | Gocovri | Mixed mechanisms, including NMDA antagonism | Hallucinations, leg swelling, dizziness, mottled skin (livedo reticularis), confusion, dry mouth and eyes, constipation, dizziness, orthostatic hypotension, somnolence.
Dose needs to be adjusted in renal disease. |
| Istradefylline | Nourianz | Adenosine 2A antagonist | Dizziness, constipation, nausea, dyskinesia, hallucination and sleeplessness |
| Trihexyphenidyl | Artane | Anticholinergic | Dry mouth and eyes, constipation, urinary retention, memory impairment, confusion, depression, hallucinations. |
| Benztropine | Cogentin | Anticholinergic | Dry mouth and eyes, constipation, urinary retention, memory impairment, confusion, depression, hallucinations. |
COMT = Cathechol-o-methyltransferase
DA = Dopamine
DOPA = Dopamine
MAO = Monoamino oxidase
NMDA = N-methyl-D-aspartate
* The most common side effects are listed. Additional side effects should be discussed with your healthcare provider.
Download the Medications List (PDF) in English
Descarga la Tabla de Medicamento (PDF) en Español
