In this section we take a look at some of the most common medications used for Parkinson’s . Bear in mind that each person with Parkinson’s will have an individual medication regimen, based on his or her age, physical state, level of Parkinson's and so on, so no two patients medication regime will be the same and the following information is a generalized guide to treatments.
Levodopa is converted to dopamine in the brain, making it the best thing to replacing the missing chemical. It has been the main treatment for Parkinson’s for the past 40 years and is delivered in different ways depending on symptoms. In its oral tablet form it is combined with either carbidopa or benserazide and carbidopa/entacapone so that more of it reaches the brain.
It is easy to take, has a strong effect throughout all stages of Parkinson’s on both stiffness and slowness but over time, the amount taken will probably need to be increased because of Parkinson's progression. Levodopa is considered the ‘Gold Standard’. However it has little effect on imbalance.
It is usually divided into three or four daily doses and it is important if you are taking levodopa medication that it is taken at the same time every day, allowing 30 to 40 minutes prior to meals or 90 minutes after meals. This is due to the disruption in absorption caused by consuming protein along with levodopa medication. You also need to take plenty of fluids to help flush the levodopa down to the jejunum were it is absorbed.
Oral levodopa medications currently available include
*active ingredients of the medication
These have a similar effect to levodopa and trick the brain into thinking it is getting dopamine, but the effect is not as strong. However, they are less likely to cause ‘on/off’ effects or dyskinesia when taken alone. They are useful in early Parkinson’s and as an add-on later.
Oral dopamine agonists currently available include
These work by preventing the breakdown of levodopa before it gets to the brain or by preventing the breakdown of dopamine in the brain, allowing a longer and smoothers supply of dopamine.
Types of enzymes inhibitors include:
- COMT inhibitors :Entacapone* and Tolcapone* (entacapone combined with levodopa is also available as one tablet)
- MAO-B Inhibitors : Selegiline* and rasagiline*
- Other medication include amantadine* and anticholinergics*. These medications are usually used in the treatment of tremor or dyskinesia.
*active ingredients of the medication
Depending on the progression of your Parkinson’s, there may be a point when treatment with than oral medications should be considered as part of your care.
In the following section we will go through options currently available, but all three advanced therapies may not be suitable for everyone.
Apomorphine* is a dopamine agonist. It can be administered via a sub-cutaneous pen device (under the skin) which when injected can bring you out of an ‘off’ phase of Parkinson’s. Another form of administration is via a pump which delivers small amounts constantly through waking hours with an option for an occasional boost if required. Despite its name, apomorphine* does not contain morphine and does not have any addictive properties.
Levodopa/Carbidopa* Intestinal Gel
Levodopa/carbidopa* intestinal gel contains a combination of levodopa and carbidopa monohydrate. Unlike the oral forms of levodopa, the Levodopa/carbidopa* intestinal gel ensures a small dose of the drug is delivered continuously during the day-time through a portable pump. This means that the level of the medicines in your blood can be more constant and may also lower some of the movement side effects.
Treatment involves a procedure of passing a small tube through your abdomen into a selected part of your small intestine. The tube is then connected to a portable pump that you wear during the day that gives levodopa/carbidopa* directly into your small intestine. You will disconnect the pump when you go to be but you will have tablets available to manage troublesome nighttime symptoms if you need them.
Surgery – Deep Brain Stimulation
This is brain surgery where electrode wires are positioned in the brain and connected to a stimulator which delivers pre-programmed steady pulses of low voltage current that seems to restore normal movement – to varying degrees.
Deep Brain Stimulation is not available yet in Ireland so all potential candidates are referred by their Parkinson’s specialist to the UK or Northern Ireland where assessment, surgery and follow up care will be carried out.