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Medications

Medication is the main method used to control the symptoms of Parkinson’s. Parkinson’s symptoms happen when levels of a chemical messenger in the brain, called dopamine, become too low.

Medications aim to increase the level of dopamine that reaches the brain and stimulate the parts of the brain where dopamine works.

There are many different medications prescribed for Parkinson’s. None of them are perfect, however research into treatments is improving the options all the time.

Every person with Parkinson’s has a different experience of the condition. Your GP or specialist will aim to find the best treatment for you as an individual.

Your medication will be reviewed over time to make sure you receive the best combination for you as your condition progresses

You may need to be careful if you take medication for other reasons. Your GP, pharmacist or specialist can advise on this.

This section covers:


Main medications for Parkinson’s

The main types of drugs that are used to treat Parkinson’s are:

We’ve made every effort to ensure that the information presented on this website is accurate at the time of updating.

Please remember that information about medications may change. This website does not list all the uses and side effects associated with these medications.

We advise you to speak to your GP or specialist about your individual healthcare.


Side effects of Parkinson’s medication

Taking Parkinson’s medication can cause other problems for some people, including:

Side effects can usually be treated. Any problems should be discussed with a doctor.


Managing Parkinson’s medication

Each person with Parkinson’s has different medication needs and it can take time to find what works best. Getting into good habits early in your diagnosis will help, such as taking medications on time, every time.

Some people find the benefits of medication change and symptoms return over time. If you notice changes in your reaction over time you will need to speak with your neurologist. 


Managing medication interactions and side effects

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


Levodopa

Levodopa is one of the main drugs used to treat Parkinson’s symptoms. It can be used at all stages of the condition.

Levodopa is a chemical building-block that your body converts into dopamine. It replaces the dopamine that is lost in Parkinson’s.

There are branded and unbranded forms of levodopa available. These include:

  • Co-beneldopa (Madopar, Madopar CR)
  • Co-careldopa (Caramet CR, Duodopa, Sinemet, Sinemet CR, Kinson)
  • Co-careldopa plus entacapone (Stalevo)

Levodopa is given with benserazide or carbidopa, to make sure it can enter the brain more efficiently. Benserazide plus levodopa is known as co-beneldopa. Carbidopa plus levodopa is known as co-careldopa.

If you’re having, or have had, treatment for melanoma, tell your GP or specialist if you’re taking medication that contains levodopa.

Madopar and Sinemet

Most people can take Madopar and Sinemet without experiencing sickness or nausea.

Most people taking these medications will experience considerable long-term improvement, especially in stiffness and slowness of movement.

Treatment will usually start on a low dose. This is gradually increased until you and your GP or specialist agree that your symptoms are under control.

Madopar is available in capsules, which should not be broken, tablets or dispersible tablets, which can be dissolved in water. Sinemet can be taken in pill form. Both Madopar and Sinemet come in different strengths, depending on the dose your GP or specialist thinks you need.

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 (dyskinesia).

Dispersible Madopar

Madopar has a dispersible form that may be swallowed whole or dissolved in water.

It takes effect more quickly because it doesn’t need to be broken down in your stomach to release the active ingredient. This may be a good option at the start of a day to provide a ‘kick start’ or if you experience ‘wearing off’.

Non-dispersible tablets or capsules should not be crushed and put into water.

Duodopa

Duodopa is a gel that is pumped continuously through a tube that is inserted into the intestine, where it is absorbed through the gut into the bloodstream.

This option is suitable for a small number of people, who have had Parkinson’s for some time and whose symptoms can’t be controlled with more common treatments.

Because it’s given continuously, if you are prescribed duodopa you are less likely to experience involuntary movements. You might have fewer ‘off’ periods. And it may also help you control your symptoms at night.

Stalevo

Stalevo combines levodopa with carbidopa and entacapone in one tablet.

Levodopa and protein

Taking levodopa with food can sometimes help to reduce feelings of sickness. However, for some people, protein (found mainly in meat, fish, eggs, cheese and beans) seems to interfere with how well levodopa medication works, by stopping how well the drug is absorbed by the body.

This may mean the drug is less effective if taken with, or after, a protein-rich meal.

Some people may benefit from taking their medication at least 30 minutes before they eat. This is not a concern in early Parkinson’s but becomes more important when you have Parkinson’s for sometime and may be experiencing ‘wearing off

As protein is essential for a healthy diet, before you make any changes you should speak to your your GP or specialist. They can advise you on timing your dose and can help you to get advice from a registered dietitian.

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 Parkinson’s 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 Parkinson’s for sometime extra involuntary movements (dyskinesia) can occur. Your neurologist will be able to help adjust medications to minimise dyskinesia.

Other side effects may include:

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 doesn’t work, other types of drug may be combined with levodopa.

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

Impulsive and compulsive behaviour

Some people taking levodopa may experience impulsive and compulsive behaviour, especially when given a combination with a dopamine agonist.


Dopamine Agonists

Dopamine agonist medications are one of the main ways to treat Parkinson’s symptoms.

Parkinson’s symptoms are caused by a decrease in the levels of the chemical messenger dopamine, due to the death of the nerve cells in the brain that make it.

Dopamine agonist medications act like dopamine and stimulate your nerve cells, to more effectively use dopamine.

There are branded and unbranded dopamine agonists available. These include:

  • Bromocriptine (Parlodel)
  • Cabergoline (Cabaser)
  • Pramipexole (Sifrol, Sifrol SR)
  • Rotigotine (NeuproPatan)
  • Apomorphine (Movapo)

Dopamine agonists are used at all stages of Parkinson’s. You might take them alone when treatment is being started, or alongside the drug levodopa to help it work better.

Treatment with dopamine agonists has to be started carefully, with the dose gradually increased until you and your specialist are happy that your symptoms are under control.

Taking dopamine agonists

While dopamine agonists are introduced gradually, benefits begin to appear as dosage is increased. They can prevent side effects such as involuntary movements (dyskinesia) and ‘on/off’ fluctuations.

Research has shown they can also have a good effect on the non-motor symptoms of Parkinson’s.

Most dopamine agonists are taken by mouth as tablets or capsules up to several times a day. These come in different strengths.

Some dopamine agonists are now being made as ‘one-a-day’ tablets, or as prolonged-release tablets. These work for longer in the body compared to normal capsules and tablets.

There is also a patch for Rotigotine that is applied once daily onto the skin. This may be good if you have trouble swallowing tablets.

Apomorphine is available in injection form or as a continuous infusion under the skin.

Side effects and problems with dopamine agonists

Common side effects of dopamine agonists include:

If you are taking Cabergoline (Cabaser), Pergolide (Permax) or Bromocriptine (Parlodel) your neurologist or GP will have to arrange a chest CT scan or ultrasound of your heart yearly as over time these medications may effect heart or lung tissue.

This precaution does not apply to the other dopamine agonists available in Australia.

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 Parkinson’s 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.


Glutamate Antagonists

There is one glutamate antagonist, Amantadine, that can be prescribed to treat Parkinson’s symptoms. The generic name is amantadine, but it is prescribed under the name Symmetrel.

Exactly how this drug works for Parkinson’s isn’t fully understood yet. It may modify levels of certain chemicals in the brain.

It is most likely to be given along with other drug treatments for Parkinson’s and is available in capsules.

The drug has only a mild effect, helps only a minority of people and its effectiveness may be short-lived.

It may have a stimulatory effect and can help some people with tiredness. It can be used to treat tremor and stiff muscles and it can reduce unwanted involuntary movements without making other symptoms worse.

Side effects of glutamate antagonist

It is not a first-choice treatment for Parkinson’s and has a limited effect. Side effects include:

  • Blurred vision, fainting, confusion or dizziness
  • Swelling of the ankles or a mottled appearance on the skin of the lower leg

Anticholinergics

Anticholinergics are a type of drug, less commonly prescribed now, used to treat the symptoms of Parkinson’s.

They block the action of acetylcholine, a chemical messenger that helps to send messages from your nerves to your muscles.

There are branded and unbranded anticholinergics available. These include:

  • Orphenadrine (Biorphen, Disipal,)
  • Procyclidine (Arpicolin, Kemadrin)
  • Trihexyphenidyl (Broflex, Artane)

Anticholinergics may be useful in the early stages of Parkinson’s when symptoms are mild. They tend to improve tremor more than slowness and stiffness.

They can be prescribed alone in the early stages, before the drug levodopa is necessary. They can be used in conjunction with levodopa or a glutamate antagonist too.

Anticholinergics can be used to reduce excess saliva.

They can also reduce bladder contractions that can cause a strong, frequent urge to urinate. The action of anticholinergics is similar to that of Dopamine agonists, but is much milder.

Side effects and problems of anticholinergics

Another reason these drugs are not a first choice for treating Parkinson’s are their side effects. Some people may experience confusion, a dry mouth, constipation and blurred vision when taking anticholinergics.

Anticholinergics may interfere with levodopa absorption in the small bowel, which reduces the effectiveness of Madopar or Sinemet, forms of the drug levodopa.

Anticholinergics are not usually prescribed to older people with Parkinson’s because there is an increased risk of memory loss and, in men, problems urinating.


COMT Inhibitors

COMT inhibitors are a type of medication used to treat the symptoms of Parkinson’s.

COMT inhibitors do not help Parkinson’s on their own – they have to be used with the drug levodopa.

COMT inhibitors reduce Parkinson’s symptoms by blocking an enzyme that breaks down levodopa, prolonging its effect.

There are branded and unbranded COMT inhibitors available. These include:

  • Entacapone (Comtan)
  • Tolcapone (Tasmar)- not available in Australia

Entacapone (Comtan)

Entacapone (Comtan) can be taken with levodopa. It is effective from the first dose and you should feel the benefit within a day or two.

Advantages of COMT Inhibitors

When used with levodopa, COMT inhibitors can reduce the daily ‘off’ time and increase the ‘on’ time.

In many cases, the dose and frequency of levodopa can also be reduced.

The terms ‘on/off’ or ‘motor fluctuations’ refer to the period when people can no longer rely on the smooth and even symptom control that their drugs once gave them.

Some disadvantages of COMT inhibitors

These drugs can increase the side effects caused by levodopa, notably dyskinesias (involuntary movements), 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 Parkinson’s or other conditions can affect the action of COMT inhibitors. The combination of apomorphine and entacapone needs careful supervision.


MAO-B Inhibitors

MAO-B inhibitors are used to treat the symptoms of Parkinson’s.

They prevent the breakdown of the chemical messenger dopamine in the brain, by blocking an enzyme that breaks it down, called monoamine oxidase type B (MAO-B).

They are used to make the drug levodopa last longer or reduce the amount required.

The generic drug names and brand names are:

  • Rasagiline (Azilect)
  • Selegiline (Eldepryl, Zelapar)

Advantages of MAO-B inhibitors

A MAO-B inhibitor can be used on its own in early Parkinson’s, or in combination with other drugs at all stages of Parkinson’s.

These drugs are available as tablets. There is also a form that dissolves on the tongue, which may help if you have trouble swallowing.

MAO-B inhibitors may reduce fluctuations in effectiveness of drugs that some people with Parkinson’s experience after the first few years.

By itself, selegiline has very few side effects.

Because Zelapar is absorbed better, a smaller dose is needed.

Some disadvantages of MAO-B inhibitors

When selegiline is taken together with levodopa, side effects such as dyskinesias (involuntary movements), hallunications or vivid dreaming may sometimes occur or worsen.

When people have taken rasagiline on its own (without levodopa), the most commonly reported side effects have been:

  • Headache
  • Aching joints
  • Indigestion
  • Flu-like symptoms
  • Depression

When taken with levodopa, the most common reports have been of uncontrolled movements and accidental falls.

Many of these side effects may be due to the increase in dopamine caused by rasagiline or selegiline. Your doctor or consultant can alter the dosage to correct these effects. 

If you’re taking some types of antidepressant, you might not be able to take MAO-B inhibitors, as these drugs can interact with each other to raise blood pressure to a dangerous level.

Your neurologist or pharmacist is the best person to advise on potential interactions with other medications.


Managing Medication Interactions and Side Effects

Getting into good habits and taking medications on time, every time is a great way to start. 

Many commonly available medications may have an effect of blocking the Parkinson’s medications or interact in a way making symptoms worse. Common medications such as Maxolon or Stemetil should not be used in Parkinson’s for this reason.

Managing medication timing

Parkinson’s medications help to boost dopamine levels in the brain, but only for a short amount of time. For this reason, doctors will prescribe a strict schedule for timing of your medications. Effective management of Parkinson’s symptoms is dependent on getting medications on time, every time.

To help manage medication timings, it can be useful to use medication timers. Some people use their mobile phones to set alarms to remind them to take medications. Other people use specialised medication timers such as vibrating watches or timed pill boxes.

For more information on equipment such as this, please call the Parkinson’s Victoria Health Team on 1800 644 189.

Swallowing medications

Some people with Parkinson’s have difficulty swallowing their medications. If swallowing medications has become a challenge for you, consider consulting a speech pathologist for some practical tips to help improve your swallowing. This will help to ensure the effectiveness of your medications.

Side effects of medication

All prescribed medication can have potential side effects, including those used to treat Parkinson’s.

Many people find their Parkinson’s medication works very well when they start taking it, but this may change over time and side effects can develop.

Some things you think are symptoms of Parkinson’s may actually be side effects of medication.

Some people’s side effects will have a big impact on their lives and have to be kept under control along with the symptoms.

Side effects that may be experienced

To check what side effects your medication may have, ask your pharmacist for a copy of the consumer medical information. 

Don’t be afraid if your specialist also tells you about the potential side effects of medication. You may not experience them, but it’s useful to know about them.

Side effects of individual medication

We have listed some side effects in our information about individual Parkinson’s medications:

If you’ve been taking Parkinson’s medication for some time, you are more likely to experience some of the following side effects.

Wearing off

When Parkinson’s medication is working well, Parkinson’s symptoms will be well-controlled. This is called ‘on’ time.

When symptoms are not well-controlled and don’t respond to medication, this is called being ‘off’.

As Parkinson’s progresses, some people find that a dose doesn’t last as long as it used to. This is called ‘wearing off’. Symptoms will include more noticeable tremor, stiffness, feeling tired, low mood, sweating and anxiety.

Sometimes the effects of wearing off can happen quickly and there will be a sudden change between being ‘on’ and ‘off’.

Involuntary movements (dyskinesia)

Some people who have been taking levodopa for some time experience involuntary movements (dyskinesia). These are uncontrollable, often jerky movements that you do not intend to make.

These movements can affect your arms, legs, head or your whole body and may be mild with a gently rocking movement to a more generalised ‘wriggly’ movement.

Other side effects

The following can also be side effects of some Parkinson’s medication:

Dealing with side effects of Parkinson’s drugs

It’s 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 Parkinson’s, 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 Parkinson’s medication, you shouldn’t stop taking it without guidance from your specialist.

Dopamine agonist withdrawal syndrome

If you suddenly stop taking dopamine agonists, this can lead to dopamine agonist withdrawal syndrome, which can cause symptoms such as depression, anxiety or pain.

Any withdrawal from Parkinson’s drugs needs to be done in a tapered way, under the supervision of a health professional.

Speak to your specialist for advice.

Looking out for side effects if you're a carer

If you’re a carer of someone with Parkinson’s, 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.

It’s important to seek help from your specialist as soon as you can.


Useful tips

  • Keep a diary of symptoms
    This may be helpful to track when symptoms occur so that your doctor can work out the most effective timing and dosage. It is important to avoid changing times or doses without talking to the doctor.
  • Keep a list of current medications
    As some treatments for other conditions can cause problems for people taking Parkinson’s medication, it helps to keep an up to date list of all medicines to show to the doctor or pharmacist before taking any new medicines or stopping any medicines.
  • Inform hospital staff of medication timing 
    When going to hospital, it is essential that hospital staff understand that Parkinson’s medication needs to be taken at the time prescribed and not just at routine drug rounds. Ensure that the admitting doctor records the prescribed dose and times on the patient’s drug chart.

Support for you

  • Call the Parkinson's Victoria Health Team on 1800 644 189
  • Email info@parkinsons-vic.org.au
  • Speak to your doctor, health nurse or specialist

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