Parkinson's Disease Medications
Once we learn we have Parkinson’s disease, there are an overwhelming number of thoughts and questions that we have. Arguably, the most important question is, “What can I do about it?”
An important part of your care team will be your Movement Disorder Specialist and/or general neurologist. They will talk with you about various medication options. There are several different medications that can be used to manage symptoms for Parkinson’s disease, but none have been proven to slow the progression of the disease on their own.
At the bottom of this page are the experiences of others with PD about whether or not to start medications.
I look at medications as an important tool that allow me to continue to be active and to exercise to the absolute best of my ability. With medication, I am able to run and bike and swim in greater amounts without feeling as stiff and sore afterwards. I am able to move better, and it decreases my tremor.
Parkinson’s medicationwork by a variety of ways, and many have side effects. It can be challenging at first to figure out which medication or combination of medications will work for you and have you feeling your best.
You play a critical role in this, because you will need to be able to communicate effectively with your doctor about how each medication affects you, if it is wearing off and if and when you are experiencing any side effects. Depending on this your doctor may want to increase a dosage, or if there are severe side effects either decrease the dose or try something else completely. If you aren’t able to tolerate a higher dose on one medicaiton, your doctor may choose to add a second medication with a slightly different mechanism of action.
I will start with a very basic overview of the different types of medications. If you want to learn more, I suggest, The New Parkinson’s Disease Treatment book.
Carbidopa/Levodopa also known as Sinemet
This is the most common and the oldest mediation to manage Parkinson’s disease. Levodopa is an amino acid (building blocks of proteins) that is able to cross the blood brain barrier. Once it reaches the brain it is converted by an enzyme into dopamine.
This helps to replace some of the dopamine that is no longer being made. Sinemet is generally taken 3 times per day. There are other formulations that are longer acting such as Rytary, or faster acting such as Inbrija. There are other formulations as well, but work by the same mechanism but delivered in different ways.
Dopamine Agonists
This class of medications act by crossing into the brain and binding to dopamine receptors. These medications have a longer duration of action, but for most people have more side effects.
Side effects to the dopamine agonists can include behavioral changes, such as developing a gambling addiction, excessive shopping, increased permiscuity or compulsive behavior. It is important that the care partner is aware of these potential side effects so that they can be recognized and the medication can be stopped before the destructive behavior causes serious harm.
A benefit of the dopamine agonists is that the medication only needs to be taken once per day. The common dopamine agonists used in the management of Parkinson’s disease are: requip, mirapex, and neupro.
Amantadine
The mechanism of this medication is not completely understood. It is thought to increase the amount of dopamine released from cells and possibly reduce its reuptake.
Amantadine also has some anti-viral properties and used to be prescribed as an anti-viral. There are better more effective medications for that now, so it is no longer used for that, but I like to think of it as having the potential side effect of not getting sick as often.
One side effect that I have experienced with amantadine is mottled appearing skin. I have not found anything that reduces this other than stopping the medication. It is at its worst when I am a little bit cold.
Medications for Anxiety and Depression
Anxiety and depression are common symptoms of Parkinson’s Disease and one that seems to be under treated. It is not a sign of weakness to acknowledge and seek treatment for these symptoms. See this link for more on this.
There are a few classes of anti-depressants. The most common are the Selective Serotonin Reuptake Inhibitors (SSRIs). These are drugs like prozac, lexapro, celesta and zoloft. SSRIs can take several weeks before noticing a difference in mood, and often those close to the person taking the medication notice that the person taking the medications is feeling better before the person themselves may notice.
Wellbutrin is the only medication in the Norepinephrine and dopamine reuptake inhibitor class of drugs. Interestingly this medication is FDA approved for depression, seasonal affective disorder and smoking cessation. In my primary care doc days, I had several patients successfully stop smoking with the help of Wellbutrin.
Wellbutrin is not generally indicated in the treatment of anxiety. I take this medication and it has helped me with anxiety. I hypothesize its because my anxiety is caused by a lack of dopamine and Wellbutrin’s mechanism of action keeps more dopamine available for use in the brain.
Monamine-Oxidase Inhibitors. These are medications like resegeline and rosagiline. I include this with the anti-depressants because they will likely help with depression, but are most often prescribed to PD patients, because they help with motor symptoms and there is some evidence that they may be neuro-protective.
Medications to help with Excessive daytime sleepiness
People with PD in general have more fatigue, in addition a common side effect to the dopamine agonists can be excessive daytime sleepiness. I was having a terrible time with this, and freaked out after I fell asleep at a red light on my way home from work one afternoon, and woke up to cars driving around me, thinking that maybe my car wouldn’t start…
Discontinuing or decreasing the dose of the dopamine agonist and adding something else is something you could ask your MDS about… In my case we did this, and we also added Nuvigil.
Nuvigil is FDA cleared for shift workers, people with excessive daytime sleepiness because of sleep apnea and narcolepsy. It is also a dopamine reuptake inhibitor, so will also increase the amount of dopamine available in the brain. It is Schedule IV, meaning there is a low risk of abuse or dependence.
I like it because I feel alert, but not jittery like I do when I over do caffeine, and it doesn’t negatively impact my sleep like caffeine can.
Sleep
I attempt to tackle this in the section on disordered sleep. It is critical that we get good sleep, and before starting medications to help sleep ensure you have tried all the principles of good sleep hygiene as discussed here.
The section on sleep also has some things other’s with PD have found helpful to improve their sleep.
Vitamins and Supplements
This is a huge topic. To keep it simple, probably a good idea to take a multi-vitamin.
Vitamin D: There is some evidence that low Vitamin D levels can lead to an increased risk of falls. Vitamin D may also decrease cognitive decline. You may find this article interesting.
People with PD also tend to have lower Vitamin B levels. This study suggests that taking Vitamin B may improve movement and cognition in people with Parkinson’s disease.
I know many have tried all kinds of other supplements. If you would like to share what you take, why you take it and your experiences with it, please include in comments section below.
Things to consider if taking other medications
Statins for cholesterol management: Some of the statins have been shown to cause cogntive impairment. If your physician recommends that you take a statin, rosuvastatin (Crestor) would be the preferred option. This medication is not able to cross the blood brain barrier, so should have no effect on cognition.
What was your experience in deciding to start medications?
What would you say to someone recently diagnosed with Parkinson’s Disease about the decision to start medications? Answers from members of the Parkinson’s Fight Club.
Kanon Broussard
I say to consider what would allow you to live a more fulfilling lifestyle at this moment. Are your symptoms negatively effecting you in a manner that you are neglecting your physical and emotional health and/or those close to you such has family and friends or job? If this is the case, it may be time to consider medication.
If side effects of medication are influencing your decision, ask your physician about alternative first line medications
Deb Fuller Bettencourt
If I had understood that starting meds doesn’t mean you’ll progress earlier or that the meds don’t do anything but give you relief I would have avoided many crying drives home from uncomfortable social events.
Gunilla Beard
I think of the medication (carbidopa/levodopa) almost like a supplement. My body is deficient so I need to add dopamine. The medication really helps me exercise more, which is scientifically proven to slow down the progress of the disease. I say do not hesitate to start medication. And ask your neurologist if you can experiment with your dosage since everyone is different and every day is different. I take more if I’ll do something challenging and less if I have a relaxing day. I also find an extended release pill at bedtime helps me sleep really well, so don’t hesitate to medicate at night. Sleep is important.
Trish McLoughlin
I delayed a couple of months and was becoming quite disabled: significant tremor in both legs, did not feel safe driving, weakness in hands and arms causing difficulty with handwriting, playing my musical instrument, buttons, trimming my nails etc. C/L made a dramatic difference…feels like I got my life back. I have read that there is research saying no benefit in delaying medication and no harm in starting. Dr Laurie Mischley likens the use of Levadopa for Parkinson’s to the use of insulin for someone who is diabetic. Makes sense to me.
Stephanie Cooley
Do plenty of reserch on natural alternative treatments. Weigh up the for and against. Im 2 years in had it for 5. No pd meds. Just natural, with plenty of exersise. And positivity. Im better than when diagnosed. Use it or loose it is my mantra. I eat well and sleep well. The longer i can stay drug free the better.
Thomas Braun
I was diagnosed in early 2021. I am not on any medication other than Gabapentin, to reduce pain. I have no tremors, just some changes in my gait. I just began Pt to help with my slow walking. My MDS has is not 100% I have PD as I don’t check all the boxes. No tremors DatScan was inconclusive, I do have some Dopamine.
I do exercise every day, balance is pretty good, no recent falls. I am happy with my progress and very little change in my PD issues.
I do want to begin running once again but o am afraid of falling, my previous falls have happened when running, I am hoping PT corrects this.
Stuart Davey
Start when you’re ready, I was under medicated for about 4 years and it sucked, big time. Still not quite right, but I’m close to the sweet spot now.
