As a newly diagnosed Parkinson’s patient, you will most likely be taking some kind of prescribed medication regularly for the rest of your life. In fact, it’s fairly common for people with Parkinson’s to be on multiple medicines at any given time.

Because of this, it is absolutely vital that you understand what medications are commonly used to treat Parkinson’s, how they work, and what your options are. Many patients find that the right combination of medication and other types of treatments are a huge help in managing their symptoms and improving their quality of life.

On this page, we’re going to try to answer common questions about Parkinson’s medications in general. Other pages will cover specific medicines in greater detail.

Is there any medicine that will cure my Parkinson’s?

You probably already know this, but it’s worth reiterating. Short answer: nope. 

Currently, no medications exist that can stop or reverse the progression of Parkinson’s. While research is ongoing, no Parkinson’s drugs address the underlying loss of dopamine-producing cells in the brain that allow the disease to progress. Parkinson’s is a chronic, degenerative disorder, and all existing treatments are long-term.

That being said, several medications have been proven to help Parkinson’s patients improve their quality of life and manage their symptoms – especially motor issues like tremors, stiffness, and slowness of movement.

What medications are available for people with Parkinson’s?

There are a number of medications that doctors commonly prescribe to Parkinson’s patients. Your own regimen of medicine will depend on a number of factors, including your age, what stage of Parkinson’s you are in, and so on.

Here are some of the medications you should learn about:

Levodopa (L-DOPA) / Carbidopa

For Parkinson’s patients, levodopa is often the cornerstone of treatment, as it effectively addresses motor symptoms like tremors, stiffness, and slowness by converting into dopamine in the brain. 

However, experiences with levodopa can vary, and there are also challenges associated with its use. It’s often combined with carbidopa to prevent side effects like nausea and to ensure more of the drug reaches the brain. Carbidopa prevents early breakdown of Levodopa.

Dopamine Agonists

Typically, these provide an important alternative or complement to levodopa, especially in the early stages of Parkinson’s or in combination with other medications to manage motor symptoms. 

Dopamine agonists mimic dopamine by stimulating dopamine receptors in the brain, helping to control symptoms like tremors, stiffness, and slowness. They may be used alone or with Levodopa.

Common dopamine agonists include:

Pramipexole (Mirapex). Commonly used, with a risk of impulse control issues and drowsiness.

Ropinirole (Requip). Another widely used option, with similar side effects to pramipexole.

Rotigotine (Neupro patch). This is available as a transdermal patch that provides a steady release of medication over 24 hours. It is often used to reduce fluctuations in symptom control and avoid the digestive issues associated with oral medications.

Apomorphine (Apokyn). This is an injectable dopamine agonist used for quick relief of “off” episodes. It provides rapid symptom relief but requires an injection and can cause nausea.

MAO-B Inhibitors

Monoamine oxidase-B (MAO-B) inhibitors can provide modest improvement in symptoms and may be particularly useful in the early stages of Parkinson’s or as an add-on therapy in later stages. However, they are not a substitute for Levodopa and are often part of a broader treatment plan.

Common MAO-B inhibitors include:

Selegiline. One of the first MAO-B inhibitors used for Parkinson’s. It can be taken alone in early-stage Parkinson’s or in combination with Levodopa to reduce “wearing-off” periods. Zelapar is a dissolvable form of Selegiline that can be taken orally.

Rasagiline: A more modern MAO-B inhibitor than Selegiline, this medication is often used in early-stage Parkinson’s as monotherapy or added later to help reduce motor fluctuations when Levodopa is less effective. It’s known for being well-tolerated and is taken once daily.

Safinamide. This newer option not only inhibits MAO-B but also affects glutamate release. It is used in combination with Levodopa in patients who experience “off” episodes, helping to smooth out motor fluctuations.

COMT Inhibitors

Catechol-O-methyltransferase (COMT) inhibitors are not effective on their own and must be taken alongside Levodopa – they’re typically added when Levodopa becomes less effective. They help prolong the effect of levodopa by preventing its breakdown in the brain. 

COMT inhibitors are often prescribed to help manage the “wearing-off” effect of Levodopa, where symptoms return before the next dose is due. 

Here are some commonly used COMT inhibitors:

Entacapone (Comtan). This medicine is frequently used in combination with Levodopa/Carbidopa to extend the duration of its effects. It is available as a separate medication or can be combined in a single pill with Levodopa and Carbidopa (Stalevo).

Tolcapone (Tasmar). It’s more potent than entacapone, but less commonly used because it carries a risk of serious liver damage. If you start taking Tolcapone, you will need to undergo regular monitoring of your liver functions.

Opicapone (Ongentys). This is a newer COMT inhibitor. It is a once-daily medication that helps extend the effect of Levodopa. It is typically well-tolerated and can be an alternative to entacapone.

Anticholinergics and Amantadine

These are less commonly used but can help with tremors and other specific symptoms.

What kinds of things does Parkinson’s medication help with?

This was touched on above, but essentially the available medication can help you manage the symptoms of the disease – both motor and non-motor issues.

Here are some more specifics:

Reduced Motor Symptoms

Medications like Levodopa/Carbidopa are highly effective at reducing tremors, muscle stiffness, and slowness of movement (bradykinesia). Dopamine agonists have also proven quite successful at allowing people to maintain movement during the early stages of the disease. And Amantadine is sometimes prescribed to help manage the involuntary movements associated with dyskinesia.

This helps with

• Daily activities like walking, writing, and dressing.
• Balance and coordination.
• Independence.

Fewer (and Shorter) “Off” Periods

As Parkinson’s progresses, the effects of medications can wear off before the next dose, leading to “off” periods when symptoms return. Drugs like COMT inhibitors and MAO-B inhibitors can help extend the duration of Levodopa’s effects.

This helps with

• Reducing the fluctuations between “on” and “off” periods, which can prove difficult to navigate, and
• Minimizing “off” periods, where you’re feeling worse, altogether.

Less Non-Motor Symptoms

While popular culture has mostly focused on the more attention-getting motor symptoms associated with Parkinson’s, such as tremors, many patients quickly discover that the non-motor symptoms are just as bad – if not worse. These include depression, reduced cognitive functioning, sleep disturbances, and general fatigue, among others. MAO-B inhibitors, amantadine, and dopamine agonists have proven particularly effective in alleviating these problems.

This helps with

• The ability to mentally function at work and in doing everyday tasks.
• Emotional wellbeing.

Symptom Progression

While no existing medications stop the progression of Parkinson’s, they can delay the worsening of symptoms.

This helps with

• Allowing you to function better for a longer period of time.

What side effects should I watch for?

There are a number of possible side effects attached to Parkinson’s medications. Unsurprisingly, these vary depending on the type of medication and dosage you’re on. 

As with all things related to your day-to-day experience of Parkinson’s, it is incredibly important to track the specific side effects you notice – what happens, when it happens, how often it happens, how severe it is, and so on. This kind of record is vital to enable your medical team to make appropriate adjustments to your care. 

Below are the some of the side effects associated with different types of Parkinson’s drugs:

Blurred Vision

Anticholinergics can cause this due to the medication’s effect on your eye muscles.

Confusion, Delusions, and Hallucinations

These are more common in older patients or those with cognitive issues, but they have been linked to several Parkinson’s drugs, including Levodopa, dopamine agonists, MAO-B inhibitors, Amantadine, and Anticholinergics. 

Constipation

Slower bowel movements is an unfortunate side effect of anticholinergics.

Diarrhea

A common side effect of COMT inhibitors, particularly with Entacapone.

Dizziness and Lightheadedness

Levodopa and Amantadine can cause these issues – especially when you stand up.

Drowsiness and Sudden Sleep Attacks

Dopamine agonists can cause you to feel unusually drowsy, or suddenly fall asleep during activities like driving.

Dry Mouth

This is a very common side effect of anticholinergics.

Dyskinesia

These involuntary, erratic movements usually occur after long-term use or higher doses of Levodopa. COMT inhibitors can exacerbate dyskinesia since they enhance Levodopa’s effects.

Headaches

Some patients who take MAO-B inhibitors report mild to moderate headaches.

Impulse Control Disorders

Compulsive behaviors like gambling, excessive shopping or eating, and hypersexuality have been known to result from dopamine agonists in some cases.

Injection Site Reactions

Swelling, redness, or irritation may occur where the injection of Apomorphine is given.

Insomnia

Associated with Amantadine and MAO-B inhibitors – especially Selegiline, which can interfere with sleep if taken too late in the day.

Liver Issues

Tolcapone can cause liver damage, so it requires regular monitoring.

Low blood pressure

This can result from Levodopa and Apomorphine.

Nausea and Vomiting

Common when starting Levodopa/Carbidopa, dopamine agonists, and MAO-B inhibitors. With Apomorphine, it can be so severe that this medication is often taken alongside an anti-nausea drug.

Purple Mottling of the Skin

Though rare, this side effect can be caused by Amantadine.

Serotonin Syndrome

When combined with certain antidepressants, MAO-B inhibitors come with a rare but serious risk of serotonin syndrome, which causes agitation, rapid heart rate, and confusion.

Swelling (Edema)

Swelling in the legs or ankles is a common issue for those taking dopamine agonists or Amantadine.

Urinary Retention

Some people who take anticholinergics report difficulty emptying their bladder.

Urine Discoloration

Though it is completely harmless, Entacapone can turn your urine a reddish-brown color.

“Wearing-off” Effect

Over time, the effects of Levodopa can wear off before the next dose, causing symptoms to return.

It’s essential to monitor for these side effects and discuss them with your healthcare provider. Your doctor can often adjust the dosage or switch medications to minimize adverse effects while helping you maintain control of your symptoms.

How often will I have to take medication for Parkinson’s?

The frequency of Parkinson’s medication depends on the specific drug or drugs you’re prescribed, what stage the disease is in, and how well your symptoms are controlled. 

Regardless of how often you are taking medications, though, timing plays a big role in managing Parkinson’s symptoms effectively. It is vital that you take them at consistent times each day if you want to maintain as much control over your symptoms as possible. Always follow your doctor’s instructions on how and when to take your medications.

As the disease progresses, you may need to take medications more frequently. This is particularly true of Levodopa due to “wearing-off” periods where the effects of the drug don’t last as long. Moreover, your doctor may adjust your dosing schedule at any point to keep your symptoms stable.

Below is a general guide based on common Parkinson’s medications. Keep in mind that none of this should be taken as medical advice. Parkinson’s is different for everyone, and you should always consult your physician regarding the specifics of any treatment – especially medication.

Levodopa/Carbidopa

• Usually taken 3-4 times a day.
• As the disease progresses, you may need to take it more frequently (every 4-6 hours) to manage “wearing-off” symptoms, where the effects fade before the next dose.
• Extended-release versions may only need to be taken 2-3 times a day.

Dopamine Agonists

• Immediate-release forms are typically taken 2-3 times a day.
• Extended-release versions can be taken once a day.

MAO-B Inhibitors

• Usually taken once daily.
• Some forms (like Selegiline) may be taken twice daily in specific cases.

COMT Inhibitors

• Entacapone is usually taken with each dose of Levodopa, often 3-4 times a day.
• Opicapone is taken once daily, usually at bedtime.

Amantadine

• Immediate-release forms are typically taken 2-3 times daily.
• Extended-release versions are typically taken once daily, often at night.

How often will my doctor adjust my medication regimen?

Don’t wait for your doctor to suggest adjustments. While we don’t necessarily recommend making adjustments on your own, it is crucial that you actively manage your disease in order to receive the best care. 

This means maintaining a journal of your daily experiences with Parkinson’s, and asking questions and bringing up issues with your doctor rather than waiting for them. And if you do make adjustments to your medication on your own, make sure to record this in your journal as well, noting the changes and what results you noticed.

With all of that out of the way, the frequency with which your medication regimen will change depends on a number of factors, including how your symptoms progress and how well your current medications are managing those symptoms. 

Here are some key factors that influence how often your medicines might be adjusted:

How the Disease Is Progressing

In the early stages of Parkinson’s, a stable dose of medication might work well for a long time – anywhere from months to years. However, as the disease progresses, it is far more common for symptoms to become more difficult to control. At this point, treatment changes may happen more frequently – sometimes every few months – to keep your symptoms under control.

Increased Motor Fluctuations

Over time, you may suffer “wearing-off” periods or develop dyskinesia (involuntary movements) from long-term Levodopa use. If this happens, your doctor might adjust the timing, dosage, or add other medications like COMT inhibitors or MAO-B inhibitors to smooth out these fluctuations.

If You’re Experiencing Side Effects

If you develop side effects such as nausea, dizziness, or hallucinations from your medication, your treatment may need to be adjusted. This could involve lowering the dose, changing the type of medication, or adding drugs to manage these issues.

Significant Changes to Symptoms

Your doctor will likely schedule regular follow-ups every 3-6 months to evaluate how well your treatment is working. If your symptoms change drastically, treatment adjustments may be needed more frequently.

Availability of New Medications or Treatments

Finally, a positive one! As new drugs or treatment options become available, your doctor might recommend switching or adding these to your regimen. 

In general, your treatment will be regularly tailored based on how your symptoms evolve and how you respond to your medications. If numerous medications fail at controlling your symptoms over time, your doctor may even discuss advanced surgical treatments like deep brain stimulation (DBS). This can lead to a change in your treatment approach altogether.

Bottom line? Close communication with your doctor is the best way to ensure your treatment plan adapts to your needs over time.