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Parkinson's disease Medicines for Parkinson's disease provide symptomatic relief. No medicine has yet been shown to slow progression of the disease. There are also some medicines that should be avoided.
Medicine regimens are individual Avoid interactions with meals Doses, preparations, frequency and timing need to be individualised Food, particularly protein, can interfere with absorption of according to symptoms, and to minimise side effects. levodopa. It is best if levodopa medicines are given consistently 30 to 60 minutes before meals. Parkinson's medicines come in various doses and preparations (e.g. control ed release, immediate release, subcutaneous infusion).
Chart Parkinson's medicines before surgery Give Parkinson's medicines on time Make sure Parkinson's medicines are charted before surgery, or contact the anaesthetist for further instructions.
Even 15 minutes late can make symptoms significantly worse.
Review medicines if pain persists Let the person with Parkinson's self-medicate Many people with Parkinson's have pain, either from muscle rigidity or dystonias (sustained cramps). Pain due to dystonia is not usual y This may give the best chance of medicines being taken on time helped by analgesics, but is helped by Parkinson's medicines. If dystonia (providing there is no significant cognitive impairment).
persists, slow-release levodopa or agonists in combination may be needed, especial y during ‘off' periods such as during the night.
Don't stop or reduce the dose without consulting a neurologist or geriatrician Some people may need to take Parkinson's medicines with juice Abrupt withdrawal or reduction in dose of Parkinson's medicines or jel y to reduce nausea. If nausea persists, domperidone (Motilium) may cause serious symptoms, such as worsening tremor, rigidity is usual y recommended if an oral medicine is appropriate, and and bradykinesia. Abrupt withdrawal may also trigger neuroleptic ondansetron (e.g. Zofran) IV if an oral medicine is not appropriate. malignant syndrome, resulting in acute worsening of Parkinson's Note: Ondansetron is contraindicated in patients on apomorphine. symptoms, high fever, reduced level of consciousness and Avoid metoclopramide (e.g. Maxolon) and prochlorperazine autonomic dysfunction. (e.g. Stemetil) as they can worsen Parkinson's symptoms.
Medicines that must be avoided in people with Parkinson's diseaseThis is only a small selection — many other medicines can worsen Parkinson's symptoms or interact with Parkinson's medicines. Check the contraindications on the prescribing information carefully before starting any new medicine.
Antinausea medicines to avoid Antipsychotic medicines to avoid metoclopramide (e.g. Maxolon) chlorpromazine (e.g. Largactil) olanzapine (e.g. Zyprexa) prochlorperazine (e.g. Stemetil).
haloperidol (e.g. Serenace) risperidone (e.g. Risperdal).
The above medicines are a common cause of serious adverse Some antidepressants and some blood pressure effects in people with Parkinson's. Domperidone (Motilium) is lowering medicines usual y recommended if an oral medicine is appropriate and ondansetron (e.g. Zofran) IV if an oral medicine is not appropriate. Check the contraindications on the prescribing information Note: Ondansetron is contraindicated in patients on apomorphine.
careful y before starting any new antidepressant medicine or any new blood pressure medicine.
Fact Sheet Medicines for Parkinson's disease Types of Parkinson's disease medicines AnticholinergicsThese medicines are seldom used for Parkinson's due to a high side Dopamine replacement effect profile in the elderly and a lack of therapeutic effect. They reduce The mainstay of Parkinson's treatment is dopamine replacement acetylcholine effects in Parkinson's, and may be useful for treating (levodopa) in combination with a dopa-decarboxylase inhibitor tremor in younger people.
(carbidopa or benserazide) to reduce peripheral side effects of levodopa. benzhexol (Artane) levodopa/carbidopa (Sinemet, Kinson) benztropine (Benztrop, Cogentin) levodopa/benserazide (Madopar) biperiden (Akineton). levodopa/carbidopa/entacapone (Stalevo).
Possible side effects include blurred vision, dry mouth, urinary Levodopa stays in the blood for only 60–180 minutes, but has a longer retention and constipation.
action — especial y in early Parkinson's. In some people with more advanced Parkinson's, it may only last 60–120 minutes, leading to MAO type B inhibitors ‘on' / ‘off' motor fluctuations. Possible side effects include nausea These selectively inhibit monoamine oxidase B (MAO-B), one (initial y), hypotension, motor fluctuations, hal ucinations and dyskinesia.
of the enzymes that catabolises dopamine in the brain, and also block dopamine reuptake. They prolong the effect of dopamine. Dopamine agonists selegiline (Eldepryl, Selgene) These act on dopamine receptor sites in the basal ganglia, in a similar rasagiline (Azilect).
way to levodopa. They can al ow a decrease in levodopa dosage and improve motor fluctuations. Possible side effects include sleep disturbances, hypotension, headache pramipexole (Sifrol, Simipex) and nausea. MAO-B inhibitors have dangerous interactions with some other medicines, including pethidine and some antidepressants, and can cabergoline (e.g. Bergoline, Cabaser, Cobasol) contribute to serotonin toxicity. Check interactions before prescribing.
pergolide (Permax) bromocriptine (Kripton, Parlodel) rotigotine patches (Neupro) Possibly acts as an indirect dopamine receptor agonist as well apomorphine (Apomine) — injectable medicine.
as having some anticholinergic activity. It is also used for treatment of severe dyskinesias. Possible side effects include those for dopamine replacement. amantadine (Symmetrel). These medicines can also cause or contribute to daytime sleepiness. There are also potential risks associated with ergot-derived agonists Side effects include ankle swel ing and difficulty sleeping.
(cabergoline, pergolide and bromocryptine) of cardiac valvular disease and pleuropulmonary/retroperitoneal fibrosis. Please note that dopamine agonists have been associated with impulse Treatments for advanced disease control disorder (ICD). People whose Parkinson's symptoms are not well control ed may require one of the fol owing advanced treatments: levodopa/carbidopa (Duodopa) intestinal gel — medicine These inhibit catechol-o-methyl transferase, which breaks down is directly infused into the duodenum or upper jejunum by levodopa. This results in higher and more sustained levodopa an electronic pump plasma concentrations, prolonging its action. At present, there is only one medicine available on PBS: apomorphine (Apomine) — administered by injection or infusion subcutaneously by an electronic pump entacapone (Comtan).
deep brain stimulation — a surgical y implanted device Possible side effects include gastrointestinal upset electrical y stimulates the brain.
and increased dyskinesia.
The Parkinson's Passport, Medicines List for people with Parkinson's and Checklist for managing my Parkinson's symptoms are available in editable PDF format for download and print from nps.org.au/parkinsons-passport and parkinsons.org.au. Copies can be ordered from Parkinson's Australia by phoning 1800 644 189.
On time, every time with Parkinson's medicines Level 7/418A Elizabeth St Independent, not-for-profit and Surry Hills NSW 2010 evidence based, NPS enables better decisions about medicines and medical tests. We are funded Strawberry Hills NSW 2012 by the Australian Government Department of Health and Ageing.
National Prescribing Service Limited and Parkinson's Australia Incorporated 2013.
Reasonable care is taken to provide accurate information at the date of creation. This information is not intended as a substitute for medical advice from health professionals. Do not use the information to treat or diagnose your own or another person's medical condition and never ignore medical advice or delay seeking it because of something in this document. Health professionals should rely on their own expertise and enquiries when providing medical advice or treatment. To the fullest extent permitted by law, NPS disclaims all liability (including without limitation for negligence) for any loss, damage, or injury resulting from reliance on, or use of this information. Any references to brands should not be taken as an endorsement by NPS.
Fact Sheet Medicines for Parkinson's disease

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