Parkinson's Disease: Drug Treatments

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

There are two general approaches to the treatment of Parkinson's disease with medication. The first approach attempts to slow the loss of dopamine in the brain and the second approach attempts to improve the symptoms of Parkinson's disease by other means.

Most patients with Parkinson's disease can be adequately treated with medications that alleviate their symptoms. If medications are not sufficiently effective, new, highly effective and safe surgical treatments are also available.

Choices about medications 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 Parkinson's disease (called movement disorders specialists) even when the illness is only suspected. Movement disorders specialists are doctors who have completed their training in neurology (brain and nerve problems) and have received special advanced training in treating Parkinson's disease and other related diseases.

What Are the Most Common Medications Used to Treat Parkinson's?

Sinemet (levodopa/carbidopa)

Levodopa (also called L-dopa) is the most commonly prescribed and most effective medication for controlling the symptoms of Parkinson's disease, particularly bradykinesia and rigidity.

Levodopa is transported to the nerve cells in the brain that produce dopamine. It is then converted into dopamine for the nerve cells to use as a neurotransmitter.

Sinemet is made up of levodopa and another drug called carbidopa. Levodopa enters the brain and is converted to dopamine while carbidopa increases its effectiveness and prevents or lessens many of the side effects of levodopa, such as nausea, vomiting, and occasional heart rhythm disturbances. It is generally recommended that patients take Sinemet on an empty stomach, at least ½ hour before, or 1 hour after meals.

There are two forms of Sinemet, controlled-release or immediate-release Sinemet. Controlled-release (CR) Sinemet and immediate-release Sinemet are equally effective in treating the symptoms of Parkinson's disease, but some people prefer the controlled release version. Ask your doctor which approach is best for you.

While Sinemet is the most effective medication and has the least short-term side effects, it is associated with high risks of long-term side effects, such as involuntary movements (dyskinesia). Used on a long-term basis, levodopa may also cause restlessness, confusion, or abnormal movements. Changes in the amount or timing of the dose will usually prevent these side effects, but most experts now recommend alternatives to Sinemet, such as the dopamine agonists, and use Sinemet only when the alternatives fail to provide sufficient relief.