If Parkinson’s is affecting your daily life, whether it’s physically, mentally or socially, it’s worth considering treatment options. There are effective options to help with motor symptoms like tremor, stiffness, and slowness, as well as challenges such as constipation, dizziness, trouble sleeping, anxiety, and depression. Starting treatment sooner rather than later is recommended, as delaying it doesn’t provide any benefit. The medications commonly used are well-tested and generally well-tolerated.
The myth about delaying Parkinson’s medications likely stems from concerns about long-term side effects and the idea that treatments might lose effectiveness over time. For example, some people worry about developing dyskinesias (involuntary movements) after prolonged Levodopa use, or they believe that starting medications early may lead to diminishing returns as the condition progresses.
Additionally, some healthcare providers used to recommend waiting until symptoms significantly impacted daily life before initiating treatment, based on the outdated notion that early medication use wouldn’t provide long-term benefits.
However, research and expert consensus have shifted this perspective. Starting treatment earlier is now recognised as an important step in improving quality of life and managing symptoms effectively from the start. There’s no benefit to delaying medications; instead, timely treatment helps control symptoms, reduce discomfort, and maintain your daily life.
What are my treatment options?
The focus of treatment is improving your quality of life. This often involves a combination of lifestyle changes, medications to manage symptoms, alongside non-medical approaches like exercise and allied health therapies to support your overall wellbeing.
Remember, you’re not in this alone—your care team is there to help find the best options for your needs. Let’s break it down into simple terms so you can feel confident in understanding the options for treatment of motor symptoms.
The main types of Parkinson’s medications to treat motor symptoms
1. Dopamine Precursor (Levodopa)
Dopamine-producing cells in the brain die off in Parkinson’s, which leads to motor symptoms (just like a diabetic no longer produces insulin). Levodopa is the “gold standard” medication that helps by turning into dopamine once it reaches the brain. But there’s a catch—it needs neurons there to soak it up and it doesn’t last long in the body, so starting early and optimising your medication schedule is key: “Meds on time, every time.”
To make Levodopa more effective, it’s combined with a helper drug called a dopa decarboxylase inhibitor (DDI). This ensures more Levodopa reaches the brain. Common DDIs include Carbidopa (found in Kinson) and Benserazide (in Madopar). For example, Kinson 100/25 contains 100 mg of Levodopa and 25 mg of Carbidopa.
- What it treats: Levodopa is the most effective medication for managing motor symptoms, including tremor, rigidity, and slow movement. It’s often referred to as the “gold standard.”
- How it works: Levodopa converts into dopamine in the brain, replenishing the levels lost due to Parkinson’s… like insulin is replaced for people living with diabetes.
- Side effects: Common side effects include nausea, low blood pressure, and dizziness.
2. Dopamine Agonists (Dopamine Mimics)
Think of these drugs as imitators—they mimic dopamine by stimulating the same receptors in the brain. Common ones include Pramipexole (Sifrol) and Rotigotine patches (Neupro). They’re sometimes used in the early stages to delay starting Levodopa or alongside Levodopa to enhance its effect.
- What it treats: These drugs help improve motor symptoms and are sometimes used early to delay starting Levodopa or alongside Levodopa for enhanced motor control (tremor, stiffness, slowness). Dopamine agonists are also commonly used to effectively reduce the uncomfortable sensations and the urge to move the legs Restless Legs Syndrome (RLS).
- How they work: Dopamine agonists mimic dopamine by stimulating the brain’s dopamine receptors.
- Side effects: Possible side effects include fatigue, nausea, and hallucinations. They can also increase the risk of impulse-control disorders (e.g., hypersexuality, compulsive shopping, gambling, or eating). If these ICDs occur, tell your GP immediately and get an adjustment to your medications (n.b. never modify your drug regime without proper medical advice).
3. Inhibitors
- Monoamine Oxidase-B Inhibitors (MAO-B Inhibitors): These medications work by stopping an enzyme (monoamine oxidase-B) that breaks down dopamine in the brain. The result? More dopamine sticks around in your brain. Common options include Rasagiline (Azilect) and Safinamide (Xadago). They can improve motor symptoms and may be easier to tolerate than dopamine agonists.
- What it treats: MAO-B inhibitors can help manage motor symptoms and motor fluctuations. Some people prefer these for their potential to be better tolerated than other medications.
- How they work: These drugs block an enzyme that breaks down dopamine, increasing its availability in the brain.
- Side effects: Mild nausea, headaches, and insomnia are possible side effects. They may also interact with certain foods or medications.
- Catechol-O-methyltransferase (COMT) Inhibitors: COMT inhibitors stop dopamine from breaking down too quickly in the body, giving Levodopa a longer-lasting effect. Examples include Entacapone (Comtan) and Opicapone (Ongentys). Some medications, like Stalevo, even combine Levodopa, a DDI, and Entacapone all in one.
- What it treats: COMT inhibitors are used to enhance the effect of Levodopa and reduce motor fluctuations.
- How they work: These medications prevent the breakdown of dopamine in the body, extending Levodopa’s effectiveness.
- Side effects: Side effects can include diarrhoea, orange urine discolouration, and abdominal discomfort.
5. Amantadine
Amantadine (Symmetrel or Amantamed) can help with involuntary movements (dyskinesias) caused by long-term Levodopa use. It’s usually used alongside other medications.
- What it treats: Amantadine is often prescribed to reduce dyskinesias (involuntary movements) caused by prolonged Levodopa use.
- How it works: It’s thought to increase dopamine release and block glutamate receptors to reduce motor symptoms.
- Side effects: Potential side effects include swelling in the legs, blurred vision, and confusion.
Acting early matters!
It’s important to start medication while you still have the most neurons available and working so there’s more of the to use the dopamine you mimic or replace. This allows you to optimise symptom relief and preserve your independence for as long as possible. Research has shown that delaying treatment can lead to a reduced quality of life and unnecessary suffering due to poorly managed symptoms (Hauser, 2009). Early treatment can improve mobility, reduce rigidity, and enhance overall wellbeing, giving you more opportunity to slow progression through exercise and maintain social connections.
Medication plans and progression
Every person with Parkinson’s is unique, and there is no single treatment plan that works for everyone. Your brain chemistry plays a big role in how you respond to medications, meaning the treatments that work for one person may not be right for you. That’s why regular medication reviews with your neurologist are so important.
How Often Should Medications Be Reviewed?
Parkinson’s medications should be reviewed every 6 to 12 months to make sure they are effectively managing symptoms and minimising side effects. However, if you notice new symptoms, worsening side effects, or changes in your daily function, you should see your neurologist sooner.
Adjusting Your Medication Over Time
Your neurologist should work with you to find the right medication and dosage as your symptoms change. Some people can stay on the same dose for years if it continues to work well, while others may need adjustments to keep symptoms under control. A medication review is a chance to talk about:
- What’s working well
- What’s not working
- Any changes that might help maintain or improve your quality of life
If you feel your current medication isn’t working or your symptoms have changed, don’t hesitate to speak up. Your neurologist can explore different options to help manage fatigue, stiffness, tremors, or other concerns.
Home Medication Review
You can also request a Home Medication Review through your GP. This allows a pharmacist to visit your home, review all medications, vitamins, and supplements you are taking, and check for any contraindications. They can also guide you on how best to manage and take your medications.
What Medications Might Be Used?
While Levodopa is often the first medication prescribed, some specialists may start with dopamine agonists instead. There is no standard roadmap for Parkinson’s treatment—every plan is tailored to your symptoms and needs, which may change over time. Your neurologist may add other medications as your condition evolves to help control symptoms more effectively.
The most important thing to remember is that flexibility is key. Parkinson’s is different for everyone, and your treatment plan should change with you. Be proactive, ask questions, and make sure your medications are helping you maintain the best possible quality of life.
Next steps
Managing Parkinson’s involves much more than just medications. In these early stages, focus on what you CAN control, such as:
- Building a strong care team of healthcare professionals (e.g., your GP, a neurologist, Parkinson’s Nurse and allied health specialists like physiotherapists and speech pathologists).
- Starting preventive activities, especially exercise and diet, which is proven to help with both motor and non-motor symptoms.
- Gradually educating family members can help increase understanding of the complexities of Parkinson’s and the fluctuations in symptoms you may experience.
- Future planning is recommended early to address legal (e.g. EPOA, ACD), financial, and digital arrangements.
Remember, you’re not alone in this journey. Parkinson’s medications help manage symptoms, but they’re most effective when combined with non-pharmacological approaches like exercise, diet, sleep, hydration and allied health therapies. Work closely with your care team to find the right balance for your loved one’s journey. Reach out to your local Parkinson’s state/territory organisation or other support networks for local guidance.
Remember, these notes are not meant to be a replacement for professional medical advice for your unique situation.
References:
Adapted with permission from Sunday, 20 April Australia & New Zealand Parkinson’s Group for the Carers (private Facebook group) post by Rex Adamson, care partner, NSW, Australia.
- Ahlskog, J. E. (2011). Does vigorous exercise have a neuroprotective effect in Parkinson disease? Neurology, 77(3), 288–294.
- Hauser, R. A. (2009). Early pharmacologic treatment in Parkinson’s disease. American Journal of Managed Care, 15 (7 Suppl), S187-S193.
- National Institute on Aging. (n.d.). Parkinson’s Disease: Medications. Retrieved from https://www.nia.nih.gov/
- Standaert, D. G., & Kordower, J. H. (2015). Current and future treatments of Parkinson’s disease. Annual Review of Pharmacology and Toxicology, 55, 227–240.
- Schapira, A. H. V., & Olanow, C. W. (2004). Drug therapy: Levodopa in the treatment of Parkinson’s disease. New England Journal of Medicine, 351(24), 2498–2508.
- Waller, S., Williams, L., Morales-Briceño, H., & Fung, V. S. C. (2021). Diagnosis and management of Parkinson’s disease. Australian Journal of General Practice, 50 (11).
