Table 1

Drugs used in the treatment of Parkinson’s disease and levodopa-related complications

Treatment, clinical implications and efficacy conclusions
ClassDrugDaily dose rangePotential side effects of drugTo prevent/delay disease progressionFor symptomatic monotherapyFor symptomatic adjunct therapy in early or stable PD patientsFor motor fluctuations
Dopamine agonistsPramipexole
Pramipexole (ER)
0.125–4.5 mg
0.375–4.5 mg
Drowsiness, nausea, vomiting, dizziness, leg swellingEfficacious; clinically usefulEfficacious; clinically usefulEfficacious; clinically useful
Ropinirole
Ropinirole (ER)
0.25–12 mg
2–24 mg
Drowsiness, nausea, vomiting, abdominal discomfort, dizziness, leg swellingLikely efficacious; possibly useful clinicallyEfficacious; clinically usefulEfficacious; clinically useful
Rotigotine
(patch)
2–8 mgPatch application site reactions (swelling, redness or itching), leg swelling, dizziness, drowsinessEfficacious; clinically usefulEfficacious; clinically usefulEfficacious; clinically useful
Apomorphine sublingual 10-100 mg/day3–30 mg (intermittent)
16–72 mg (continuous)
Drowsiness, dizziness, lightheadedness, nausea, sweatingEfficacious; clinically useful
Carbidopa/levodopaStandard levodopa formulation300–1000 mgDyskinesias, nausea, chest pain, cardiac irregularities, vomiting, dry mouthInsufficient evidence on efficacy; investigational implicationsEfficacious; clinically usefulEfficacious; clinically useful
Levodopa (ER)855–2205 mgDyskinesias, dizziness, nausea, vomiting, insomnia, headache, sweating, salivationEfficacious; clinically usefulEfficacious; clinically useful
Levodopa gel intestinal infusion600–1800 mgDizziness, nausea, vomiting, trouble sleeping, headache,Efficacious; clinically useful
Levodopa inhalation powder42–84 mgNausea, headache, cough, dyskinesiaEfficacious clinical usefulEfficacious rescue therapy
COMT inhibitorsEntacapone600–1600 mgDyskinesias, dizziness, nausea, vomiting, diarrhoea, hallucination, drowsiness, dry mouth, abdominal pain, urine becomes orangeNon-efficacious; clinically not usefulEfficacious; clinically useful
Tolcapone300–600 mgDyskinesia, dizziness, nausea, vomiting, diarrhoea, hallucination, drowsiness, urine becomes orangeNon-efficacious; clinically not usefulEfficacious; possibly useful clinically
Opicapone50 mgDyskinesiaEfficacious; possibly useful clinically
MAO‐B inhibitorsRasagiline1 mgDizziness, drowsiness, heartburn, nauseaInsufficient evidence on efficacy; investigational implicationsEfficacious; clinically usefulEfficacious; possibly clinically usefulEfficacious; clinically useful
Selegiline5 mgDizziness, drowsiness, nausea, weight lossInsufficient evidence on efficacy; investigational implicationsEfficacious; clinically usefulEfficacious; possibly clinically usefulEfficacious; clinically useful
Safinamide50–100 mgDizziness, drowsinessPossibly clinically usefulEfficacious; clinically useful
OthersAmantadine
Amantadine ER
100–300 mg
68.5–274 mg
Dizziness, hallucination, nausea, confusion, myoclonus, livedo reticularis, leg swelling,Likely efficacious; possibly useful clinicallyLikely efficacious; possibly useful clinicallyEfficacious for dyskinesias
Osmolex ER129–258 mgDry mouth, constipation, urinary retention, hair loss, potential exacerbations of heart failure
Istradefylline20–40 mgInvoluntary muscle movements, dizziness, constipation, nausea, hallucination, insomniaNonefficacious; clinically not usefulLikely efficacious; possibly useful clinically
Trihexyphenidyl2–8 mgCognitive impairment, dry mouth, blurring of vision, urinary retentionEfficacious for rest tremor
Botulinum toxin type A (ona- or incobotulinumtoxinA)10–100 U
Injected in FCR, FCU
Transient hand weaknessEfficacious 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.