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Understanding Various Medications Used to Treat Parkinson's Disease

Understanding Various Medications Used to Treat Parkinson's Disease

PD is a prevalent neurological condition that impacts a vast number of individuals globally. The disorder, which is continual and gradual, is marked by the decline of cells that generate dopamine in the brain.


Dopamine, a neurotransmitter that governs an individual's emotional and motion responses, is compromised in this ailment. PD is recognizable by several symptoms like quivering, rigidity, lethargy of movement, and challenges in equilibrium and coordination. Although PD does not have a cure at present, multiple medications are obtainable that can assist in regulating its effects.


Medications for Parkinson's Disease


There exist various groups of medications employed in treating PD, each possessing its own advantages and disadvantages. Below are the principal categories of medications for Parkinson’s treatment:


  1. Levodopa: Levodopa, an agent transformed into dopamine inside the brain, is the most potent medication for PD’s motor symptoms treatment, like lack of movement, stiffness, shaking, etc. It’s generally given alongside carbidopa, which halts levodopa from breakage before it enters the brain. This combo drug is also known as carbidopa-levodopa.
  2. Dopamine agonists: Dopamine agonists are drugs that act like dopamine within the brain. They are not as effective as levodopa but have fewer harmful effects. In early parkinson stage or late parkinson stage, dopamine agonists can be used alone or in combination with levodopa.
  3. MAO-B inhibitors: Medications that deter the operation of a compound called monoamine oxidase-B (MAO-B) are called MAO-B inhibitors. This enzyme degrades dopamine in the brain; hence, its obstruction by MAO-B inhibitors hikes dopamine levels. Typically, they’re used then in combination with levodopa.
  4. COMT inhibitors: Catechol-O-methyltransferase (COMT) inhibitors are drugs that impede the COMT enzyme. This enzyme degrades levodopa before reaching the brain. Therefore, these inhibitors increase levodopa transport to the brain by hindering the COMT enzyme activity. COMT inhibitors are usually given together with levodopa.
  5. Anticholinergics: Anticholinergics are medications that block the activity of a neurotransmitter called acetylcholine. This neurotransmitter is involved in regulating movement, and blocking its activity can help reduce tremors and stiffness. Anticholinergics are usually used in combination with levodopa or dopamine agonists.


Other Medication Classes for Parkinson's Disease


Although less commonly administered compared to levodopa and dopamine agonists, MAO-B inhibitors, COMT inhibitors, and anticholinergics can be efficacious for specific patients. MAO-B inhibitors, like rasagiline and selegiline, are generally blended with levodopa to lessen motor fluctuations and improve a patient's quality of life. Despite few side effects, patients must avoid foods and medications with tyramine, which can increase blood pressure. 


Extended levodopa effects and decreased motor fluctuations can be achieved with COMT inhibitors, like entacapone and tolcapone. Although beneficial, these inhibitors have adverse effects like diarrhoea and liver problems, with tolcapone linked to rare yet fatal liver disease


Tremors and stiffness can be treated with anticholinergics such as benztropine and trihexyphenidyl, which are typically paired with levodopa or dopamine agonists; nevertheless, they might lead to dry mouth, constipation, and confusion, predominantly in elderly patients.


Parkinson Plus Syndromes


Parkinson Plus syndromes are a group of ailments that are linked to PD, where they display a blend of motor and non-motor symptoms. These symptoms include dementia, autonomic dysfunction, and atypical parkinsonism. Parkinson Plus syndromes are more complex to remedy than typical PD, and their remedy frequently necessitates a mix of pharmacological and non-pharmacological therapies.  


The popular types of Parkinson's Disease Plus syndrome are progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD). MSA is characterised by autonomic dysfunction and motor symptoms, which are more rigorous than those of PD. PSP is characterised by balance and coordination problems, cognitive impairment, and issues with eye movements. On the other hand, CBD is distinguished by asymmetric movement problems, cognitive impairment, and sensory deficits.


Treating Parkinson Plus syndromes contrasts standard Parkinson’s treatment in various aspects. Levodopa has an inferior effect on Parkinson Plus syndromes, and dopamine agonists are mostly discouraged. Instead, treatments that target non-motor symptoms, such as antipsychotics and antidepressants, are usually recommended. Physical and occupational therapy can also be of benefit in dealing with symptoms and improving life quality.




To tackle the intricate neurological disorders, Parkinson's disease and Parkinson Plus syndromes, a holistic approach towards parkinson’s treatment is required. Alongside other approaches, medicines are fundamental in managing both motor and non-motor symptoms. For patients and their caretakers, comprehending various medication classes and their pros and cons is imperative. 


Close cooperation with healthcare providers to find the optimal treatment plan that suits individual needs is essential. Consistent monitoring of side effects and customising medications as necessary is also important. Additionally, patients should be cautious of impulse control disorders that may arise while using levodopa and dopamine agonists and must be monitored for the same.

Dr. Varun Kataria
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