Medication Choices - Why are certain medicines used?
Medications are tailored to the individual and will vary from patient to patient. The following outline reviews common thoughts or strategies that are used as PD changes over time.
For younger patients with mild symptoms or in the early stage of PD, delaying or minimizing the use of levodopa may be recommended. This is sometimes referred to as a levodopa sparing strategy. This strategy is used because levodopa is associated with wearing off problems and dyskinesia as the disease progresses. This is especially common when high doses of levodopa are taken. An example of a levodopa sparing strategy would be starting with a dopamine agonist, amantadine or MAOB inhibitor and adding levodopa when symptoms worsen or cause a loss of function. However this strategy is not for everyone. A patient’s age and presence of other problems such as confusion, hallucinations or balance problems help determine which medications should be used. For example, older patients who are at high risk for sedation, hallucinations or thinking and memory problems may do better when levodopa is chosen as initial treatment as low doses are usually effective when compared to the dopamine agonists that may require higher doses to obtain similar improvement in symptoms at the risk of more side effects.
Over time, multiple medications are used if symptoms become more challenging to control. Wearing off and dyskinesia typically cause a roller coaster experience as symptoms can improve, yet as the medication peaks too much movement (dyskinesia) can occur and then symptoms return before the next dose when the medication wears off. Dopamine agonists, COMT and MAOB inhibitors help extend the length of time that levodopa is effective in controlling symptoms and can allow for levodopa dose reduction to limit dyskinesia. Amantadine is the only medication available that may help both movement and reduce dyskinesia. Wearing off and dyskinesia can be improved by taking smaller doses of levodopa more frequently during the day and sometimes at night. Deep Brain Stimulation (DBS) can help reduce off, reduce dyskinesia and possibly reduce the amount of medication that is needed to control symptoms.
As PD changes over time, speech, posture, balance, and slowness can worsen. The brief inability to move, called freezing, can be a very serious problem. These symptoms may not respond well to additional medication. The importance of integrative care, rehabilitation, and alternative therapies such as speech therapy, physical therapy, occupational therapy, music therapy, and mind body therapy may be especially important to enhance safety and quality of life. These therapies are defined in Care Tips Section.