Medicines for Parkinson's disease

Medicines do not prevent Parkinson's but they aim to improve your daily functioning. Medicines are usually started when symptoms disrupt your daily life.

Everybody's experience of Parkinson's is different and your healthcare team will work with you to find the best treatments for your particular symptoms. Depending on your symptoms and responses to medicines, you may need to try a combination of medicines, and your medicines may change over time as your symptoms change.

On this page you will find information about:

What are the main medicines for Parkinson's?

There are many different types of medicines for Parkinson's. Most work by topping up or mimicking the effect of dopamine, a chemical in your brain that helps control movement. In Parkinson's, brain cells that produce dopamine stop working properly and are lost slowly over time. Read more about Parkinson's.

(Parkinsons's UK, 2017)

Medicine
Levodopa

Levodopa is converted into dopamine in your body. It is the first line of treatment medication.

  • Levodopa is always combined with another medicine (either benserazide or carbidopa) to prevent levodopa from changing to dopamine in the bloodstream before it reaches the brain.
  • This means that more levodopa can enter your brain, causing less side effects from dopamine, such as nausea and vomiting. Levodopa treatment is started at a low dose and increased in small steps.
  • When a person takes levodopa, their Parkinson’s symptoms will improve. But these symptoms can sometimes return before the next dose of medication is due, causing their condition to fluctuate. This can be called ‘wearing off’. 
  • Let your doctor know if you notice this happening. They may make adjustments to your medicines.   
  • Read more about levodopa + carbidopa and levodopa  and benserazide. 
Dopamine agonists
  • These work in a similar way to dopamine to improve movement symptoms.  Read more about ropinirole and pramipexole.
COMT inhibitors
  • Entacapone and tolcapone prolong the effects of levodopa by preventing the breakdown of the medication in your brain. They have to be taken at the same time as levodopa, otherwise they will be ineffective.
  • Read more about entacapone and tolcapone.
 Selegiline
  • Selegiline prevents the breakdown of dopamine in your brain by blocking the enzyme type MAO-B.
  • It may be suitable for people who have mild symptoms.
  • Selegiline is a stimulant and should be taken in the morning so it doesn’t disturb sleep.
Amantadine (Symmetrel®)
  • Amantadine is used to control tremor and stiff muscles. It’s thought to increase dopamine in the brain.
  • Amantadine is a weak dopamine agonist and is usually used with levodopa.

Tips for taking Parkinson’s medicines

Timing is important

It is important to take your Parkinson’s medicines on time, every time. Not taking your medicines at the right time can lead to your symptoms becoming worse, and it can take some time for this to be put right again. For best results, take medicines at the same time each day. If you are going to be changing your routine, such as going on holiday or going into hospital, talk to your doctor or pharmacist so you can plan your medicine schedule.

Keep a medicine and symptoms diary

Keeping a diary is a helpful way of monitoring your condition and keeping track of your medicines. A diary can be a useful way of letting your doctor know what problems you’re experiencing, the changes in your condition from day to day or over a period of time, and how well your medication is controlling your symptoms. It can also help remind you of things you want to discuss during your appointment that you may otherwise forget. You can also use it to record any embarrassing issues that you want help with but find difficult to ask about. Examples of diaries:

Side effects – talk to your doctor or pharmacist 

If you get side effects from your Parkinson's medicines, tell your doctor or pharmacist. Common side effects include nausea (feeling sick), light-headedness, leg swelling and sleep problems. Also let them know if you think your medicines are causing confusion, hallucinations or involuntary movements. Some people have an unusual desire to gamble or engage in other obsessive behaviors. Your doctor may adjust the amount of medicine you take or you may be given another type. Do not stop taking your Parkinson’s medicines until you are advised to do so.

Swallowing problems

Swallowing difficulty can occur at any stage of Parkinson's. This can be a problem when taking your medicines. Tell your doctor or pharmacist if you have problems swallowing your medicines. They may recommend seeing a speech language therapist. Some medicines should not be broken or crushed. Ask your pharmacist for advice. Read more about difficulty swallowing medicines. 

Medicines to avoid

Some medicines can bring on Parkinson’s-like symptoms or react with Parkinson’s medicines and should be avoided unless they’re recommended by a specialist. Always check with your pharmacist before starting any new medicines, including over the counter medicines and herbal supplements.

Learn more

Medication used in the treatment of Parkinson's Parkinson's New Zealand
Parkinson's and complementary therapies Parkinson's New Zealand

Reference

  1. The management of Parkinson’s disease: which treatments to start and when? BPAC, NZ, 2014
  2. Parkinson's disease New Zealand Formulary
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 24 Mar 2019