What Medications Are Prescribed For Parkinson’s Disease

Levodopa: The Most Effective Drug For Treating Parkinsons

Levodopa, also known as L-DOPA, has long been, and continues to be, the most effective drug in treating Parkinsons disease symptoms. Most people with Parkinsons 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 tolerated better. 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.

What Are The Latest Approved Treatments For Parkinsons Disease

Several medicines have been approved for the treatment of Parkinsons disease. Here are some of the available medicines for Parkinsons disease:

Nuplazid was approved for the treatment of patients with hallucinations and delusions associated with Parkinsons disease psychosis by the Food and Drugs Administration on April 29, 2016. On December 3, 2020 The approved an update to the prescribing information for Nuplazid that will allow the medication to be taken more easily by Parkinsons patients who have difficulty swallowing.

Ongentys is a medication used for the treatment of Parkinson disease. It is indicated for the treatment of adult patients with Parkinson disease. It is used as an add-on to levodopa/DOPA decarboxylase inhibitors in patients who are having fluctuations in the control of their condition.

Opicapone was approved for treating patients with Parkinsons Disease as an add-on to levodopa/DOPA decarboxylase inhibitors in patients who are having fluctuations in the control of their condition by the European Medicines Agency on June 24, 2016 and by the Food and Drug Administration on April 24, 2020.

Nourianz/Nouriast was approved by the Food and Drug Administration , USA, on August 27, 2019 and by the Pharmaceuticals and Medical Devices Agency , Japan, in June 2013.

Controlled Release Madopar And Sinemet

Controlled release preparations have the letters CR or HBS after the drug name.

These let the levodopa enter your body slowly instead of all at once. They can increase the time between doses.

They may be used when the dose of standard levodopa starts to wear off and the person taking it no longer feels the treatment is effective.

Controlled release options can sometimes reduce involuntary movements .

Carbidopa And Levodopa Side Effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

• uncontrolled muscle movements in your face ;

• worsening of tremors ;

• severe or ongoing vomiting or diarrhea;

• confusion, hallucinations, unusual changes in mood or behavior;

• depression or suicidal thoughts; or

• severe nervous system reaction–very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

Some people taking carbidopa and levodopa have fallen asleep during normal daytime activities such as working, talking, eating, or driving. Tell your doctor if you have any problems with daytime sleepiness or drowsiness.

You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medicine. Talk with your doctor if this occurs.

You may notice that your sweat, urine, or saliva appears dark in color, such as red, brown, or black. This is not a harmful side effect, but it may cause staining of your clothes or bed sheets.

Common side effects may include:

• jerky or twisting muscle movements;

Parkinson’s Drugs To Help With Your Non

Antidepressants

A significant portion of Parkinson’s disease patients will suffer from depression, and though talk therapy can be an integral part of treating it, antidepressants are also very effective. Parkinson’s patients are most commonly prescribed selective serotonin reuptake inhibitors , but tricyclic antidepressants are another option. 

Disordered sleep

Parkinson’s disease patients can suffer from a whole range of sleep disorders, from insomnia to fatigue and even acting their dreams out. Not all of these conditions can effectively be treated pharmacologically, but stimulants like modafinil and caffeine can help those patients who suffer from daytime fatigue.

Dementia

Especially in the later stages of the disease, dementia is extremely commonly seen in Parkinson’s patients. Cholinesterase inhibitors can be prescribed in this case. Initially developed for people suffering from Alzheimer’s disease, they can improve your memory and cognitive function. Options include:

• Rivastigmine

What Should I Avoid While Taking Carbidopa And Levodopa

Avoid driving or hazardous activity until you know how carbidopa and levodopa will affect you. Your reactions could be impaired. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Avoid taking iron supplements or eating a diet high in protein. These things can make it harder for your body to digest and absorb carbidopa and levodopa. Talk with your doctor or dietitian about the best foods to eat or avoid.

How To Make Your Treatment Most Effective

These are some complementary and supportive treatment strategies that can help ease your symptoms:

• Speech therapy can address the speech disturbances caused by Parkinsons disease and help improve speech volume and quality.
• Physical therapy can help with symptoms such as tremors, muscle rigidity, and gait difficulties.
• Occupational therapycan make everyday activities easier and help with the cognitive symptoms of Parkinsons.
• Massage therapy can help with muscle rigidity.
• Exercise can help improve your balance, flexibility, and strength.
• A healthy dietwith plenty of fiber can help combat the digestive issues caused by Parkinsons disease, such as constipation.

What Doesnt Medicare Cover For Parkinsons Disease Treatment

Unfortunately, Medicare doesnt cover everything you may think is medically necessary. These services include nonmedical custodial care for daily living activities, such as dressing, bathing, and cooking. Medicare also doesnt cover long-term care or around-the-clock care.

Devices that might make life easier at home are not always covered. These include items such as a walk-in bathtub or stair lift.

Mechanism Of Action Of Available Drugs

The major classes of drugs currently available for the treatment of idiopathic Parkinson’s disease are shown in Table 1. Many aim to increase dopamine in the brain, by increasing its production or altering its metabolism .

Drugs with alter metabolism in boxed red italics

Levodopa

Levodopa is absorbed from the small intestine and transported into the brain where it is converted to dopamine. Levodopa has a short plasma half-life of about one hour. Early in Parkinson’s disease, levodopa has a long duration of action which is independent of plasma concentration, but as the disease progresses, the duration of the effect reduces. The short-duration effect is strongly linked to plasma concentration and lasts, at most, hours.

Slow-release preparations are gradually absorbed, resulting in more sustained plasma concentrations. They have reduced bioavailability; higher doses are required to match the benefit of an equivalent strength of a standard preparation. Rapid release preparations are taken in liquid form to enhance passage through the stomach and absorption from the small intestine.

Dopamine agonists

Apomorphine is a potent emetic so patients must be pre-treated with domperidone 20 mg three times daily orally for at least 48 hours before the first injection. Domperidone should be continued for at least a few weeks once regular intermittent treatment has commenced. The dose can then be tapered slowly as tolerance to the emetic effects of apomorphine usually develops.

What Should I Know About Parkinsons Disease And Medications

There have been rapid and remarkable changes over the past decade in treating Parkinsons disease . The development of new medicines and the understanding of how best to use them and the older drugs have significantly improved the quality of life for people with the disease.

There is currently no treatment that has been proven to affect the disease progression or development of medication that can slow the disease process. There are two general approaches to the treatment of PD improve the symptoms with medications and engage in physical therapy. Most patients with PD can be adequately treated with medicines that alleviate their symptoms. For the approximately 15% of patients for whom medicines are not sufficiently effective, new, highly effective, and safe surgical treatments are available.

Choices about medicines made early in the course of the disease have a strong impact on the long-term course of the illness. Therefore, you should seek the advice of doctors specially trained in treating PD even when the illness is only suspected. Movement disorders specialists are neurologists who have completed their training in neurology and have received special advanced training in treating PD and other related diseases.

Duopa: Carbidopa/levodopa In Gel Form

The US Food and Drug Administration approved a gel form of carbidopa and levodopa more recently, sold under the brand name Duopa. This form, which is given through a feeding tube, is more suitable for people in the later stages of Parkinson’s whose carbidopa-levodopa wasn’t effective in another way any longer. Because of the way in which Duopa is administered, the levels of the drug in your body remain more constant and predictable. Just like levodopa/carbidopa taken by mouth, however, Duopa does eventually lead to fluctuations in efficacy. 

Medications To Avoid Or Use With Caution

Before making any decisions about treatment of Parkinsons disease, you will want to learn about the different types of medications available for Parkinsons 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 doesnt work for you, you can always adjust your plan.

To learn more about adjusting medication plans, view our webinar on What to Do When Your Medications Stop Working.

Side Effects Of Mysoline

Mysoline may cause unwanted side effects in the short term ; however, these side effects diminish with longer use. Side effects of Mysoline may include:

• Difficulty walking
• Fatigue

Serious complications with the drug are rare but could include blood cell and bone marrow problems. Your health care provider will check your blood counts every six to 12 months to screen for these problems. Mysoline has a drug interaction with phenobarbital, so the drugs should not be taken together.

Before taking Mysoline, be sure to tell your doctor if you:

• Are pregnant or nursing
• Have kidney or liver problems
• Have blood count problems

In addition, you should avoid alcoholic beverages while taking Mysoline. Do not stop taking the drug suddenly or switch brands without first consulting with your health care provider.

Medical Treatment Of Parkinsons Disease

Enormous progress has been made in the treatment of Parkinsons disease over the past half century, but levodopa remains the most potent drug for controlling PD symptoms . Prior to instituting medical therapy, a correct diagnosis of PD must be established and the level of impairment determined . Each patients therapy is to be individualized, and diverse drugs other than levodopa are presently available. Among these are the dopamine agonists , catechol-o-methyl-transferase inhibitors and nondopaminergic agents . Head-to-head comparisons of drugs within classes are rare, and the differences that have emerged are related to the effects on motor fluctuations, dyskinesias, on/off times and adverse effects of the specific agents within each class .

Side Effects And Problems With Levodopa

In the early days of taking levodopa, you may feel sickness or nausea. In most people this will pass as your body adjusts to the medication.

Overtime as Parkinsons progresses the levodopa dose will need to be adjusted. Many people will become more aware that symptoms sometimes return between doses of medication. This is called wearing off and is a sign your dose needs to be adjusted.

As levodopa is absorbed through the gut, constipation or other stomach problems may impact on uptake of the medication. In some people who have had Parkinsons for sometime extra involuntary movements can occur. Your neurologist will be able to help adjust medications to minimise dyskinesia.

Other side effects may include:

• Confusion
• Psychological changes
• Sleepiness, fainting or dizziness

Side effects of levodopa can sometimes be improved by changing your dose, the form of the drug or how often you take it. If this doesnt work, other types of drug may be combined with levodopa.

Speak to your GP or specialist about the right treatment for you.

Keep A Medicine And Symptoms Diary

Keeping a diary is a helpful way of monitoring your condition and keeping track of your medicines. A diary can be a useful way of letting your doctor know what problems youre experiencing, any changes in your condition from day to day or over a period of time, and how well your medicine is controlling your symptoms. It can also help remind you of things you want to discuss during your appointment that you may otherwise forget. You can also use it to record any embarrassing issues that you want help with but find difficult to ask about. Examples of diaries:

• Monitoring your Parkinson’s

Impulsive And Compulsive Behavior

Some people taking dopamine agonists may experience problems with impulsive or compulsive behaviours. For example an increased desire to gamble or engage in sexual activity. These behaviours often develop slowly so may not seem to be a problem immediately. It is important for both the person living with Parkinsons and their family to be aware of this side effect. If affected by this side effect, a reduction in dose or stopping the medication will stop the behaviour.

Dealing With Side Effects Of Parkinsons Drugs

Its important to speak to your specialist or pharmacist if you notice anything unusual.

Changing or adding to your medication might help, and your specialist will be able to look into this.

For many people with advanced Parkinsons, medication may start to be reduced if side effects outweigh the benefits of taking medication.

But if some of the medication is reduced, you may find you get the benefits of the remaining ones, rather than the side effects.

If you experience side effects from your Parkinsons medication, you shouldnt stop taking it without guidance from your specialist.

Some Disadvantages Of Comt Inhibitors

These drugs can increase the side effects caused by levodopa, notably dyskinesias , nausea and vomiting.

If these side effects increase after starting the drug, people should raise the issue with their healthcare professional, as reducing the levodopa dose can often help.

COMT inhibtors will discolour urine making it a reddish-brown colour. Some people also experience diarrhoea which may occur some months after commencing the medication. 

Be aware that other drugs for Parkinsons or other conditions can affect the action of COMT inhibitors. The combination of apomorphine and entacapone needs careful supervision.

Parkinsons Disease Medications: The Facts

There have been many developments in Parkinson’s disease treatments in recent years. As such, doctors now have a greater understanding of traditional Parkinson’s disease medications and their side-effects. Scientists have also developed new drugs to help control tremors, slowed movement and other Parkinson’s symptoms.

Before we explore the best medication for Parkinson’s disease, it’s important to address the facts. Firstly, Parkinson’s disease medications cannot cure your condition, nor will they slow down the progression of your symptoms. These medications are prescribed to help patients live independently and improve their quality of life.

It’s important to note that some patients do not respond well to Parkinson’s disease medications. In this case, there are plenty of other treatment options to consider such as homeopathic remedies, physical therapy and surgical intervention. Again, none of these treatments provides a cure, but they can help ease or control your symptoms.

Neurosurgical Treatments Of Parkinsons Disease

It is beyond the scope of this manuscript to comprehensively review neurosurgical treatment of PD. Only a brief review will be provided here and the reader is referred to other published literature on for additional information about this important therapeutic strategy. The renewed interest in surgical treatment of movement disorders has been stimulated in part by improved understanding of the functional anatomy underlying motor control, as well as refinement of methods and techniques in neurosurgery, neurophysio logy, and neuroimaging .

Besides thalamotomy and pallidotomy, another promising surgical approach for the treatment of tremors and other movement disorders is high-frequency DBS via electrodes implanted in the VIM nucleus of the thalamus, GPi, STN or other subcortical nuclei. The mechanism of electrical stimulation is not known, but the following explanations have been offered: 1) disruption of the network , 2) depolarization block, 3) preferential activation of inhibitory neurons, and 4) a functional ablation by desynchronizing a tremorogenic pacemaker.

An Approach To The Treatment Of Parkinson’s Disease

No treatment can arrest or slow neurodegeneration in Parkinson’s disease. The aim is to relieve symptoms and avoid the complications of therapy.

Early Parkinson’s disease

Many studies have shown that early treatment with dopamine agonists reduces the incidence of dyskinesia.Fewer motor fluctuations were shown in some but not all of the studies. We recommend a dopamine agonist as the first treatment in younger patients who have mild disease and no cognitive deficit. It is necessary to add levodopa within 1-5 years in most patients. In more severe disease, treatment begins with levodopa but a dopamine agonist may be added to keep the daily dose of levodopa in the lower range if there is no cognitive deficit. Dopamine agonists are used infrequently and with caution in patients more than 70 years old because of the risk of neuropsychiatric adverse effects and postural hypotension. They are contraindicated in the presence of dementia.

Isolated resting tremor is rarely disabling, but if it interferes with function it can usually be managed with levodopa. When this is ineffective at low to moderate doses, the addition of an anticholinergic can sometimes be useful.

Patients with motor fluctuations

Role of physical therapy and surgery

Parkinsons Disease And Medicare Coverage

Medicare is made up of multiple parts. Each part covers different services and treatments that youll need to manage Parkinsons.

Original Medicare is composed of Part A and Part B. Part A covers a portion of your inpatient hospitalization costs. Part B provides coverage of outpatient medical needs including those for diagnosis, treatment, and prevention.

Looking Out For Side Effects If You’re A Carer

If youre a carer of someone with Parkinsons, medication side effects can be difficult and tiring to cope with.

It may be that the person having side effects such as hallucinations and delusions or impulsive and compulsive behaviour does not realise they are experiencing them.

Its important to seek help from your specialist as soon as you can.

Which Medications Are Used In The Treatment Of Parkinson Disease

The cornerstone of symptomatic treatment for Parkinson disease is dopamine replacement therapy. The criterion standard of symptomatic therapy is levodopa , the metabolic precursor of dopamine, in combination with carbidopa, a peripheral decarboxylase inhibitor . This combination provides the greatest symptomatic benefit with the fewest short-term adverse effects.

Dopamine agonists such as pramipexole and ropinirole can be used as monotherapy to improve symptoms in early disease or as adjuncts to levodopa in patients whose response to levodopa is deteriorating and in those who are experiencing fluctuations in their response to levodopa.

Monoamine oxidase -B inhibitors provide symptomatic benefit as monotherapy in early disease and as adjuncts to levodopa in patients experiencing motor fluctuations.

Catechol-O -methyl transferase inhibitors inhibitors such as entacapone and tolcapone may be used to increase the peripheral half-life of levodopa, thereby delivering more levodopa to the brain over a longer time.

Anticholinergic medications can be used for the treatment of resting tremor. However, they are not particularly effective for bradykinesia, rigidity, gait disturbance, or other features of advanced Parkinson disease; and cognitive side effects are common. Therefore, anticholinergics are usually reserved for the treatment of tremor that is not adequately controlled with dopaminergic medications.

References

Managing Medication Interactions And Side Effects

All prescribed medications can have potential side effects, including those used to treat Parkinsons. Some things you think are symptoms of Parkinsons may actually be side effects of medication. Some peoples side effects will have a big impact on their lives and have to be kept under control along with the symptoms.

How Dopamine Agonists Are Used

Dopamine agonists are used at all stages of Parkinsons. You might take them alone when treatment is being started, or alongside levodopa to provide a more effective treatment with fewer side effects.

Treatment with dopamine agonists has to be started carefully to minimise the risk of side effects, with the dose gradually increasing until you and your specialist or Parkinsons nurse are happy that your symptoms are under control. Some dopamine agonists are available as one a day tablets. These can be a better option for the body and may help both movement and other symptoms of Parkinsons.

Medicare Coverage For Parkinsons Disease

• Medicare covers medications, therapies, and other services involved treating Parkinsons disease and its symptoms.
• Physical therapy, occupational therapy, and speech therapy are all included in this coverage.
• You can expect some out-of-pockets costs, even with your Medicare coverage.

Medicare covers medically necessary treatments for Parkinsons disease, including medications, different types of therapy, and hospital stays. Based on the type of coverage you have, you may have some out-of-pocket expenses, such as copays, coinsurance, and premiums.

Medicare may not cover all of the services youll need, such as assistance for normal daily living.

If you or a loved one has Parkinsons disease, its important for you to understand which parts of Medicare cover which treatments to avoid large, unexpected expenses.

Dopamine Agonist Withdrawal Syndrome

Recent research has discovered dopamine agonist withdrawal syndrome, which can happen when someone very suddenly stops taking dopamine agonists, perhaps because they are experiencing impulsive and compulsive behaviour. It can lead to symptoms including depression, anxiety or pain . Any withdrawal from Parkinsons medications needs to be gradual, under the supervision of a health professional, to avoid the risk of this syndrome.

Injections of apomorphine are taken in a similar way to insulin for diabetes. There is a ready-to-use injection pen that works within 10 minutes and is often used as a rescue measure. This is very useful if you have a sudden off period.

Soreness or nodules can develop where the needle enters your skin. If this happens, do not stop the treatment and quickly seek advice from your specialist or Parkinsons nurse. It is important to change injection site to minimise scarring or infection. Simple massage, silicone gel patches or ultrasound can help to reduce any nodules that form.

Medication Guidelines For Parkinson’s Disease

There is no one best mix of Parkinsonâs medicines. You and your doctor will have to try a few treatment approaches to figure out the best one for you.

But there are some general guidelines for taking your medication. Be sure to ask your doctor or pharmacist for any specific tips for your treatment.

How Should I Take Carbidopa And Levodopa

If you already take levodopa, you must stop taking it at least 12 hours before you start taking carbidopa and levodopa.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Take carbidopa and levodopa at regular intervals, with or without food.

Swallow the capsule whole and do not crush, chew, break, or open it.

The tablet is sometimes broken in half to give the correct dose. Always swallow a whole or half tablet without chewing or crushing.

Place the orally disintegrating tablet in your mouth and allow it to dissolve, without chewing.

It may take up to several weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve. Tell your doctor if the effects of this medicine wear off quickly between doses.

If you use this medicine long-term, you may need frequent medical tests.

This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using carbidopa and levodopa.

Do not stop using carbidopa and levodopa suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.

Store at room temperature away from moisture, heat, and light.