Treatments

The type of treatment depends on the symptoms and how they affect the patients and factors such as age and lifestyle.The main drugs used in Parkinson’s fall under one of the following five categories:

a. Drugs which replace dopamine (levodopa; the most common drug treatment)

b. Drugs which mimic the role of dopamine (dopamine agonists)

c. Drugs which inhibit the activity of acetylcholine (a chemical neurotransmitter which becomes overactive whose excess, due to a lack of dopamine, and can cause tremor).

d. Drugs which prevent the body breaking down dopamine

e. Other drugs such as anti-sickness medication

Drug Names:

Levodopa → main class of Parkinson's drugs

Mechanism: a chemical in your body that converts into dopamine in the brain. Hence, taking it as a drug enables the nerve cells to make more dopamine (this medication takes about 2 to 3 weeks to work).

Types

Co-beneldopa (brand: madopar)

Co-careldopa (brand: apodespan, caramet, lecado, sinemet, duodopa)

Side effects: dyskinesia (involuntary movements) + impulsive behaviors + withdrawal symptoms

Dopamine Agonists

Mechanism: mimics the way dopamine works which helps in reducing symptoms.

This is usually prescribed in early stages of the disease but varies from patient to patient.

Types

pramipexole (Brand: Mirapexin, Pipexus, Glepark, Oprymea, Zentiva)

ropinirole (Brand: Adartrel, Ralnea, Requip, Spiroco, Ipinnia, Raponer, Repinex, Ropilynz)

rotigotine (Brand: Neupro)

apomorphine (Brand: Apo-go, Dacepton)

Side effects: heart problems, sleepiness, fatigue, impulsive and compulsive behaviors, hallucinations

MAO-B inhibitors

Mechanism: helps nerve cells make better use of the dopamine available by inhibiting monoamine oxidase type B - this is an enzyme that incorrectly removes domaine that is not used by the brain so MAO - B inhibitors prevent this from happening. (This may take about 2 to 3 weeks to work).

Types

rasagiline (Brand: Azilect)

Can be taken by itself but can also be taken with levodopa to prevent motor fluctuations.

selegiline (Brand: Eldepryl, Zelapar)

safinamide (Brand: Xadago)

COMT inhibitors

Mechanism: blocks COMT enzyme that breaks down levodopa medication and helps levodopa to work more efficiently.

This is usually prescribed in early stages of the disease but varies from patient to patient.

Types:

entacapone (Brand: Comtess)

co-careldopa and entacapone (Brand: Stalevo/Sastravi, Stanek, Tasmar)

opicapone (Brand: Ongentys)

Amantadine

Not much evidence indicating that it improves tremor and other motor related symptoms of Parkinson’s, but can be used to treat dyskinesia if other medications are not effective. Usually not prescribed and not as monotherapy.

Anticholinergics

Mechanism: blocks, acetylcholine, a chemical messenger, which helps to send messages to brain and muscles. It mainly helps to treat tremor.

Elderly people are more likely to experience more severe side effects such as confusion and hallucinations.

Types:

procyclidine (Brand: Kemadrin)

trihexyphenidyl or benzhexol

Side effects of treatment

Everybody is affected differently by medication. The possible side effects of Parkinson’s disease drugs include nausea (feeling sick), vomiting (being sick), tiredness Dizziness Some people might experience confusion, nightmares and hallucinations. For some people, dopamine agonists have been linked to compulsive behaviour such as addictive gambling or hypersexuality (an abnormally high sex drive and interest in sex).

The effectiveness of the main drug treatment levodopa can wear off over time and its long-term use can cause some people to develop involuntary twisting or writhing movements of the arms, legs or face (dyskinesia). To reduce the risk, doctors might delay the use of levodopa for younger people.

Dopamine should be avoided in patients with a history of addiction and impulsive personality.