Parkinson's Disease - Levadopa (L-dopa)

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Selegiline (Eldepryl) and Rasagiline (Azilect). Selegiline is a monoamine oxidase B (MAO-B) inhibitor that may have some mild benefit as an initial therapy. Rasagiline (Azilect) is another MAO-B inhibitor used for treatment of Parkinson’s.

Treatments for Off Time

Drug treatments for Parkinson disease do not consistently control symptoms. At certain points during the day, the beneficial effects of drugs wear off, and symptoms can return, including uncontrolled muscular motor function, difficulty walking, and loss of energy. The American Academy of Neurology (AAN) recommends the following drugs as best for controlling off time symptoms:

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• Entacapone (Comtan) belongs to a class of drugs called catechol-o-methyl transferase (COMT) inhibitors. COMT inhibitors help prolong the effects of levodopa by blocking an enzyme that breaks down dopamine.
• Rasagiline (Azilect) belongs to a class of drugs called monoamine oxidase (MAO) inhibitors. These drugs slow the breakdown of dopamine that occurs naturally in the brain and dopamine produced from levodopa.

Other dopamine agonists, such as ropinirole (Requip) and pramipexole (Mirapex), and the COMT inhibitor tolcapone (Tasmar) may also be helpful for treating off-time symptoms. Deep brain stimulation is a surgical treatment that may help improve motor fluctuations in some patients.

Treatments for Other Symptoms of Parkinson's

Conditions associated with non-motor impairment symptoms of Parkinson's disease may need a variety of treatments.

Depression. Antidepressants used for PD include tricyclics, particularly amitriptyline (Elavil). Some studies have found that selective serotonin-reuptake inhibitors (SSRIs) -- which include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) -- may worsen symptoms of Parkinson's. Doctors should monitor patients taking SSRIs.

Psychotic Side Effects. Studies indicate that clozapine (Clozaril) and quetiapine (Seroquel), antipsychotic drugs used to treat schizophrenia, may be the best drugs for treating psychosis in patients with Parkinson's disease. A similar drug, olanzapine (Zyprexa), should not be used for patients with PD because it can worsen psychotic symptoms.