Parkinson's disease management

  • Created by: MazzaW
  • Created on: 07-12-19 15:07

Levodopa + dopa-decarboxylase inhibitor

Examples: Sinomet, Madopar

Levodopa = dopamine precursor which is able to cross the blood brain barrier. Must be given with DDCI to prevent peripheral conversion to dopamine (reduce S/E)

Most effective treatment in PD: motor Sx improve in 20-70%

Short term S/E: N+V, decreased appetite, postural hypotension, confusion, visual hallucinations, delusions, sleep disturbance, tolerance develops over a few weeks (start low and go slow)

Long term S/E: tolerance (need to increase dose over time, so often use adjuvant Rx to prevent S/E), dyskinesias (occur in 50% patients after 6yrs and 100% yound patients after 6yrs), end-of-dose deterioration, unpredictable on/off switching, confusion, hallucinations

Mgmt of motor complications: fractionate dose, adjuvant Rx (dopamine agonist, COMT inhibitor, MAOI), DuoDopa, Apo infusion, deep brain stimulation

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Dopamine agonists

Examples: rotigotine, ropinirole, pramipexole (no longer use ergot-derived DAs e.g. bromocriptine, pergolide due to serosal complications- pericardial/pleural effusions- and cardiac valve abnormalities)

Common S/E:

  • N+V
  • loss of appetite
  • postural hypotension
  • confusion, hallucinations
  • somnolence
  • impulse control disorders (must warn patients before starting/increasing treatment, usually settle after withdrawal of meds)
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Irreversible inhibitors of MAOB. Cause decreased breakdown of dopamine so more is left in the synaptic cleft.

Examples: selegiline, rasagiline

Weak clinical effect- use in very early disease or as an add-on

Well-tolerated, may have neuroprotective effects


  • N+V
  • confusion
  • may interact with SSRIs (serotonin syndrome)
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COMT inhibitors

Increase amount of levodopa that crosses the blood-brain barrier to produce prolonged effect of levodopa

Examples: entacapone, tolcapone (Stalevo = Sinemet + entacapone)


  • as with others
  • diarrhoea
  • discolouration of body fluids
  • increased dyskinesias
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Antiviral, mostly used in later disease (treats dyskinesias)

Increases dopamine release

Should not be used in the elderly


  • confusion
  • hallucinations and psychosis
  • livedo reticularis
  • ankle oedema
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Examples: trihexyphenidyl, benztropine, orphenadrine, procyclidine, biperiden

Rarely used except in young patients with prominent tremor

Decreases effects of relatively central Ach excess


  • cognitive impairment (especially in elderly)
  • dry mouth
  • blurred vision
  • constipation
  • dizziness
  • urinary retention
  • glaucoma
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