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List of Medications Used to Treat Parkinson's Disease

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Updated July 01, 2009

If you have been diagnosed with Parkinson’s disease (PD) and you are a couple of years post-diagnosis, chances are that you will soon begin to experience symptoms that interfere with your daily activities. At that point your doctor will likely consider adding prescription medications to help reduce these symptoms. Here are some of the drug names you are likely to encounter.

Please note that all of these medications work (except the anti-cholinergics) in some way to increase brain concentrations of dopamine to near-normal levels. Despite the welter of pills with strange sounding names, there are really only about 6 distinct classes of drugs that are used to treat the motor symptoms of PD (see Table 1 at the end of this article). Let's look at each of these drug classes and the medications that comprise them.

1. Dopamine replacement therapy

Sinemet and Stalevo make up the dopamine replacement class of drugs. Sinemet is composed of levodopa and carbidopa and is the gold standard therapy for PD.

Levodopa is a chemical normally used by the brain to manufacture dopamine. By introducing levodopa into the system, the brain can manufacture more dopamine. When levodopa is administered alone, it tends to cause significant side effects including nausea, loss of appetite, vomiting, and lowered blood pressure. These side effects emerge when too much dopamine builds up outside of the brain and in the bloodstream. When administered with carbidopa, however, all of these side effects are reduced or absent as carbidopa prevents formation of dopamine outside of the brain.

The carbidopa/levodopa or sinemet prescription includes two numbers—usually 25/100. The first number refers to the amount of carbidopa and the second is the amount of levodopa. You usually take the pill 3 or 4 times a day. As the symptoms of PD progress, your doctor may increase the dosage and shorten the periods between doses. The controlled-release (CR) form of Sinemet contains a formulation that prolongs the release and the effect of levodopa so that you are less likely to experience episodes of "wearing-off" of the effects of the medication.

2. The Catechol-O-methyl Transferase Inhibitors (COMT)

The COMT-inhibitors block the enzyme 3-O-methyldopa that normally breaks down levodopa and thus allows even more levodopa to reach the brain. Entacapone (brand name Stalevo) is a new dopamine replacement therapy that combines the COMT inhibitor with carbidopa/levodopa. Another COMT inhibitor, tolcapone (brand name Tasmar), is available but has been associated with serious liver damage in some persons.

3. Dopamine Agonists

Dopamine agonists (DA) stimulate greater dopamine activity in the brain by imitating the characteristics of dopamine at cells that use dopamine. While dopamine agonists certainly help with PD symptoms, they also tend to have serious side effects such as excessive daytime sleepiness, low blood pressure and behavioral problems.

Pramipexole and ropinirole are more often used than bromocriptine and pergolide because the latter two drugs have more serious side effects than pramipexole and ropinirole.

4. Monoamine Oxidase Inhibitors (MAOi)

Monoamine oxidase is an enzyme that helps inactivate a certain class of brain chemicals, the monoamines, including dopamine. A monoamine oxidase inhibitor turns off monoamine oxidase, thus ultimately leading to more dopamine in the system.

Selegiline and rasagiline (brand name Azilect), are generally given in the early stages of PD in order to slow the progression of symptoms of PD. MAO inhibitors, however, can have serious side effects if they are taken in concert with a selected class of other medicines like cough medicines, antidepressants or when eating or drinking foods rich in tyramine (anything aged or fermented).

5. Anti-cholinergics

These drugs reduce the action of acetylcholine in the brain. Because acetylcholine often opposes the activity of dopamine it can have the ultimate effect of increasing dopamine activity in the brain.

6. Amantadine

Amantadine affects a class of chemicals called the catecholamines, one of which is dopamine. Interestingly, it was originally used as an anti-viral medicine but it was soon discovered to have beneficial effects on motor symptoms of PD at least in some persons. Side effects include nausea and insomnia.

Ebadi M and Pfeiffer R F (Eds). (2005). Parkinson's Disease, CRC Press, Boca Raton FL

J.N Gracies and C. W. Olanow (2005) Current and experimental therapeutics of PD. In: Davis et al., (2005). Neuropharmacology: the fifth generation of progress p. 1802.

Medications

Medications Used in the Treatment of Parkinson's Disease
Class of Drug Generic Name Brand Name
Dopamine Replacement
Carbidopa/levodopa Sinemet
Carbidopa/levodopa controlled release Sinemet CR
Carbidopa/levodopa/entacapone Stalevo
Carbidopa/Levodopa orally
disintegrating tablet (ODT)
Parcopa
Dopamine Agonsists (DA)
Bromocriptine Parlodel
Pergolide Permax
Pramipexole Mirapex
Ropinirole Requip
Rotigotine (transermal system) Neupro
COMT inhibitor
Entacapone Comtan
Tolcapone Tasmar
MAO-B Inhibitors
Selegiline Eldepryl
Selegiline OTD Zelapar
Rasagiline Azilect
Anti-cholinergic
Benztropine Cogentin
Trihexyphenidyl Artane
Others
Amantadine Symemetrel
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