Parkinson’s medication
Dopaminergic Medications (First-Line Treatment)
Levodopa with Decarboxylase Inhibitor (e.g., Co-Careldopa, Co-Beneldopa) Absolute Contraindications
- Narrow-angle glaucoma
- Severe psychosis
Main Side Effects
- Nausea, vomiting
- Dyskinesias (involuntary movements)
- Postural hypotension
- Hallucinations or confusion (in older adults)
Main Interactions
- Antipsychotics (reduce efficacy)
- Non-selective MAOIs (risk of hypertensive crisis)
Main Monitoring Requirements
- Monitor symptom improvement and side effects
Pregnancy & Breastfeeding
- Avoid unless benefits outweigh risks, limited data available
Dopamine Agonists (e.g., Pramipexole, Ropinirole, Rotigotine)
Absolute Contraindications
- Severe psychosis
- Hypersensitivity to dopamine agonists
Main Side Effects
- Nausea, vomiting
- Impulse control disorders (e.g., gambling, hypersexuality)
- Sleep attacks and excessive daytime sleepiness
- Hallucinations, confusion
Main Interactions
- CNS depressants (e.g., alcohol, sedatives) – increased sedation
- Antipsychotics (reduce efficacy)
Main Monitoring Requirements
- Monitor for impulse control issues
- Symptom control and side effects
Pregnancy & Breastfeeding
- Avoid unless benefits outweigh risks, limited safety data
Monoamine Oxidase-B (MAO-B) Inhibitors (e.g., Selegiline, Rasagiline)
Absolute Contraindications
- Concomitant use with SSRIs, TCAs, or other serotonergic drugs (risk of serotonin syndrome)
- Active peptic ulcer disease
Main Side Effects
- Nausea, dry mouth
- Headache, dizziness
- Rare: Hypertension
Main Interactions
- Serotonergic drugs (risk of serotonin syndrome)
- Sympathomimetics (e.g., decongestants) – risk of hypertensive crisis
Main Monitoring Requirements
- •Blood pressure if hypertensive risk
- Symptom improvement
Pregnancy & Breastfeeding
- Avoid, limited safety data available
Catechol-O-Methyltransferase (COMT) Inhibitors (e.g., Entacapone,Tolcapone)
Absolute Contraindications
- Severe hepatic impairment
- History of neuroleptic malignant syndrome
Main Side Effects
- Diarrhoea, nausea
- Urine discoloration (orange, brown)
- Rare: Liver toxicity (especially Tolcapone)
Main Interactions
- Levodopa (used in combination to prolong its effect)
- MAOIs (risk of toxicity)
Main Monitoring Requirements
- Liver function (with Tolcapone)
- Symptom improvement
Pregnancy & Breastfeeding
- Avoid unless benefits outweigh risks
Anticholinergics (e.g., Procyclidine, Trihexyphenidyl)
Absolute Contraindications
- Glaucoma
- Prostatic hypertrophy
Main Side Effects
- Dry mouth, constipation
- Blurred vision
- Confusion, especially in older adults
Main Interactions
- CNS depressants (additive sedation)
Main Monitoring Requirements
- Monitor for side effects and symptom control
Pregnancy & Breastfeeding
- Avoid unless benefits outweigh risks
Amantadine (Used for Dyskinesias in Advanced Parkinson’s)
Absolute Contraindications
- Severe renal impairment
- Untreated angle-closure glaucoma
Main Side Effects
- Nausea, dizziness
- Livedo reticularis (mottled skin)
- Rare: Hallucinations
Main Interactions
- CNS depressants (increased sedation)
- Anticholinergics (additive cognitive effects)
Main Monitoring Requirements
- Renal function
- Symptom improvement
Pregnancy & Breastfeeding
- Avoid, insufficient safety data
Key Considerations for Parkinson’s Treatment
Combination Therapy: Often necessary as the disease progresses, typically combining levodopa with dopamine agonists or MAO-B inhibitors.
Side Effects: Many Parkinson’s medications cause neuropsychiatric side effects like hallucinations, which require close monitoring.
On-Off Phenomenon: With long-term use of Levodopa, patients may experience motor fluctuations; adjunctive therapies like COMT inhibitors can help.