Treatment, clinical implications and efficacy conclusions | |||||||
Class | Drug | Daily dose range | Potential side effects of drug | To prevent/delay disease progression | For symptomatic monotherapy | For symptomatic adjunct therapy in early or stable PD patients | For motor fluctuations |
Dopamine agonists | Pramipexole Pramipexole (ER) | 0.125–4.5 mg 0.375–4.5 mg | Drowsiness, nausea, vomiting, dizziness, leg swelling | Efficacious; clinically useful | Efficacious; clinically useful | Efficacious; clinically useful | |
Ropinirole Ropinirole (ER) | 0.25–12 mg 2–24 mg | Drowsiness, nausea, vomiting, abdominal discomfort, dizziness, leg swelling | Likely efficacious; possibly useful clinically | Efficacious; clinically useful | Efficacious; clinically useful | ||
Rotigotine (patch) | 2–8 mg | Patch application site reactions (swelling, redness or itching), leg swelling, dizziness, drowsiness | Efficacious; clinically useful | Efficacious; clinically useful | Efficacious; clinically useful | ||
Apomorphine sublingual 10-100 mg/day | 3–30 mg (intermittent) 16–72 mg (continuous) | Drowsiness, dizziness, lightheadedness, nausea, sweating | Efficacious; clinically useful | ||||
Carbidopa/levodopa | Standard levodopa formulation | 300–1000 mg | Dyskinesias, nausea, chest pain, cardiac irregularities, vomiting, dry mouth | Insufficient evidence on efficacy; investigational implications | Efficacious; clinically useful | Efficacious; clinically useful | |
Levodopa (ER) | 855–2205 mg | Dyskinesias, dizziness, nausea, vomiting, insomnia, headache, sweating, salivation | Efficacious; clinically useful | Efficacious; clinically useful | |||
Levodopa gel intestinal infusion | 600–1800 mg | Dizziness, nausea, vomiting, trouble sleeping, headache, | Efficacious; clinically useful | ||||
Levodopa inhalation powder | 42–84 mg | Nausea, headache, cough, dyskinesia | Efficacious clinical useful | Efficacious rescue therapy | |||
COMT inhibitors | Entacapone | 600–1600 mg | Dyskinesias, dizziness, nausea, vomiting, diarrhoea, hallucination, drowsiness, dry mouth, abdominal pain, urine becomes orange | Non-efficacious; clinically not useful | Efficacious; clinically useful | ||
Tolcapone | 300–600 mg | Dyskinesia, dizziness, nausea, vomiting, diarrhoea, hallucination, drowsiness, urine becomes orange | Non-efficacious; clinically not useful | Efficacious; possibly useful clinically | |||
Opicapone | 50 mg | Dyskinesia | Efficacious; possibly useful clinically | ||||
MAO‐B inhibitors | Rasagiline | 1 mg | Dizziness, drowsiness, heartburn, nausea | Insufficient evidence on efficacy; investigational implications | Efficacious; clinically useful | Efficacious; possibly clinically useful | Efficacious; clinically useful |
Selegiline | 5 mg | Dizziness, drowsiness, nausea, weight loss | Insufficient evidence on efficacy; investigational implications | Efficacious; clinically useful | Efficacious; possibly clinically useful | Efficacious; clinically useful | |
Safinamide | 50–100 mg | Dizziness, drowsiness | Possibly clinically useful | Efficacious; clinically useful | |||
Others | Amantadine Amantadine ER | 100–300 mg 68.5–274 mg | Dizziness, hallucination, nausea, confusion, myoclonus, livedo reticularis, leg swelling, | Likely efficacious; possibly useful clinically | Likely efficacious; possibly useful clinically | Efficacious for dyskinesias | |
Osmolex ER | 129–258 mg | Dry mouth, constipation, urinary retention, hair loss, potential exacerbations of heart failure | |||||
Istradefylline | 20–40 mg | Involuntary muscle movements, dizziness, constipation, nausea, hallucination, insomnia | Nonefficacious; clinically not useful | Likely efficacious; possibly useful clinically | |||
Trihexyphenidyl | 2–8 mg | Cognitive impairment, dry mouth, blurring of vision, urinary retention | Efficacious for rest tremor | ||||
Botulinum toxin type A (ona- or incobotulinumtoxinA) | 10–100 U Injected in FCR, FCU | Transient hand weakness | Efficacious for rest and action tremor |
Recommendations based on Movement Disorders Society (MDS) evidence-based medicine (EBM) review update.63
COMT, catechol-O-methyl-transferase; ER, extended release; FCR, flexor carpi radialis; FCU, flexor carpi ulnaris; MAO-B, monoamine-oxidase type B; PD, Parkinson's disease; s.c., subcutaneous.