Author Credentials

Conrad Musey BS Vikram Shivkumar MD




Parkinson’s Disease is the second most common neurodegenerative disorder in the aging population. It is associated with progressive loss of nigrostriatal dopaminergic neurons. Parkinsonism is a clinical syndrome that consists of motor and non-motor symptoms. It has been well described that many if not all of these deficits are associated with abnormalities related to the neurotransmitter Dopamine. This review is intended for primary care physicians who often establish the diagnosis and initiate Parkinson’s treatments. One challenge faced by the primary care physician is to decide the appropriate medication and starting dose. Often medications are used at very low doses or incorrect dosing schedules This review aims to summarize these medications, their potential side effects and the rationale for medication choices.

Conflict(s) of Interest


References with DOI

1. Gao LL, Wu T. The study of brain functional connectivity in Parkinson's disease. Transl Neurodegener. 2016;5:18. https://doi.org/10.1186/s40035-016-0066-0

2. Nishijima H, Tomiyama M. What mechanisms are responsible for the reuptake of levodopa-derived dopamine in parkinsonian striatum? Front Neurosci. 2016;10:575. https://doi.org/10.3389/fnins.2016.00575

3. Leaver K, Poston KL. Do CSF biomarkers predict progression to cognitive impairment in Parkinson's disease patients? A systematic review. Neuropsychol Rev. 2015;25(4):411-23. https://doi.org/10.1007/s11065-015-9307-8

4. Holmes K et al. How long is the wait to see a specialist in Parkinson’s disease in the United States? (S19.003). Neurology. 2016;86(16 Supplement).

5. Goetz CG. The history of Parkinson's disease: early clinical descriptions and neurological therapies. Cold Spring Harb Perspect Med. 2011;1(1):a008862. https://doi.org/10.1101/cshperspect.a008862

6. Smith Yet al. Parkinson's disease therapeutics: new developments and challenges since the introduction of levodopa. Neuropsychopharmacology. 2012;37(1):213-46. https://doi.org/10.1038/npp.2011.212

7. Dhall R, Kreitzman DL. Advances in levodopa therapy for Parkinson disease: Review of RYTARY (carbidopa and levodopa) clinical efficacy and safety. Neurology. 2016;86(14 Suppl 1):S13-24. https://doi.org/10.1212/wnl.0000000000002510

8. Hsu A et al. Comparison of the pharmacokinetics of an oral extended-release capsule formulation of carbidopa-levodopa (IPX066) with immediate-release carbidopa-levodopa (Sinemet®), sustained-release carbidopa-levodopa (Sinemet® CR), and carbidopa-levodopa-entacapone (Stalevo®). J Clin Pharmacol. 2015;55(9):995-1003. https://doi.org/10.1002/jcph.514

9. Ferrazzoli D et al. Dopamine replacement therapy, learning and reward prediction in Parkinson's disease: implications for rehabilitation. Front Behav Neurosci. 2016;10:121. https://doi.org/10.3389/fnbeh.2016.00121

10. Brodell DW et al. Carbidopa/levodopa dose elevation and safety concerns in Parkinson's patients: a crosssectional and cohort design. BMJ Open. 2012; 2(6). https://doi.org/10.1136/bmjopen-2012-001971

11. Nashatizadeh MM, Lyons KE, Pahwa R. A review of ropinirole prolonged release in Parkinson's disease. Clin Interv Aging. 2009;4:179-86. https://doi.org/10.2147/cia.s3358

12. Fernandez HH. 2015 update on Parkinson disease. Cleve Clin J Med. 2015;82(9):563-8. https://doi.org/10.3949/ccjm.82gr.15004

13. Alonso Canovas A et al. Dopaminergic agonists in Parkinson's disease. Neurologia. 2014;29(4):230-41.

14. Ossig C, Reichmann H. Treatment of Parkinson's disease in the advanced stage. J Neural Transm (Vienna). 2013;120(4):523-9.

15. Ribaric S. The pharmacological properties and therapeutic use of apomorphine. Molecules. 2012;17(5): 5289-309. https://doi.org/10.3390/molecules17055289

16. Factor SA. Literature review: intermittent subcutaneous apomorphine therapy in Parkinson's disease. Neurology. 2004;62(6 Suppl 4):S12-7. https://doi.org/10.1212/wnl.62.6_suppl_4.s12

17. Finberg JP, Rabey JM. Inhibitors of MAO-A and MAO-B in psychiatry and neurology. Front Pharmacol. 2016;7:340. https://doi.org/10.3389/fphar.2016.00340

18. Riederer P, Laux G. MAO-inhibitors in Parkinson's disease. Exp Neurobiol. 2011;20(1):1-17. https://doi.org/10.5607/en.2011.20.1.1

19. Leegwater-Kim J, Bortan E. The role of rasagiline in the treatment of Parkinson's disease. Clin Interv Aging. 2010;5:149-56.

20. Chong BS, Mersfelder TL. Entacapone. Ann Pharmacother. 2000;34(9):1056-65.

21. Truong DD. Tolcapone: review of its pharmacology and use as adjunctive therapy in patients with Parkinson's disease. Clin Interv Aging. 2009;4:109-13. https://doi.org/10.2147/cia.s3787

22. Waters CH et al. Long-term treatment with extended-release carbidopa-levodopa (IPX066) in early and advanced Parkinson's disease: A 9-month open-label extension trial. CNS Drugs. 2015;29(4): 341-50. https://doi.org/10.1007/s40263-015-0242-2

23. Pahwa R et al. Randomized trial of IPX066, carbidopa/levodopa extended release, in early Parkinson's disease. Parkinsonism Relat Disord. 2014;20(2):142-8. https://doi.org/10.1016/j.parkreldis.2013.08.017