Usage Usage episodes in levodopa for for levodopa therapy with therapy with therapy Combination Combination Indications for for Indications for Indications dyskinesia; “off” “off” dyskinesia; for “off” episodes “off” for levodopa-induced levodopa-induced Parkinson disease Parkinson carbidopa/levodopa carbidopa/levodopa Effects Effects dizziness insomnia, Dizziness, dry mouth, Dyskinesia, discoloration discoloration constipation, hallucination, confusion, leg confusion, pressure from from pressure Common SideCommon SideCommon hallucinations, of arrhythmias of urinary retention, urinary retention, paranoia, nausea, paranoia, (livedo reticularis), reticularis), (livedo seated to to seated standing, dizziness/low blooddizziness/low and potential effectand potential
once/day once/day Regimens Regimens 20–40 mg at bedtime 137–274 mg 137–274 Typical Treatment Treatment Typical Treatment Typical tablets capsules Dosages Dosages 20 or 40 mg20 or 68.5 or 137 mg 137 68.5 or
Amantadine ERAmantadine (Gocovri) capsules Medication (product Medication name in parentheses) Medication (product Medication name in parentheses) Istradefylline (Nourianz) Amantadine exercise and complementary therapies are important to living well with PD. well living to important are therapies and complementary exercise brand by category within each alphabetized are and listed alphabetically categories medications Note: in parenthesis. appears which name, A2A antagonists Adenosine related symptoms. There are many medications available to treat Parkinson’s motor Parkinson’s treat to available medications many are There symptoms. related common It is the disease. the effectsof that reverse yet none although symptoms, and doses — all at different medications these of variety a take to with PD people for remember Always symptoms. motor these to manage — day of times at different that and PD, combating for plan treatment the overall part of is only that medication There is no standard treatment for Parkinson’s disease (PD). Treatment for eachfor Treatment (PD). disease Parkinson’s for treatment is no standard There movement or symptoms, motor her on his or is based with Parkinson’s person Medications for Medications Symptoms Motor
living with Parkinson’s Usage Usage therapy, therapy, therapy, therapy, dyskinesia and tremor; and tremor; levodopa for for levodopa combination therapy with therapy therapy with therapy Monotherapy Monotherapy Monotherapy Monotherapy Monotherapy; Monotherapy; Indications for for Indications Indications for for Indications predominantly predominantly predominantly predominantly for tremor and tremor for for tremor and tremor for or combination or or combination or or combination or with or withoutwith or Monotherapy for for Monotherapy people; should be people; should be avoided in elderly avoided in elderly avoided levodopa-induced levodopa-induced slowness, stiffness,slowness, motor fluctuations. motor dystoniayounger in dystoniayounger in carbiodpa/levodopa carbiodpa/levodopa Effects Effects Dizziness, Dizziness, Confusion, Confusion, Confusion, Confusion, dry mouth, dry mouth, discoloration discoloration discoloration discoloration constipation, constipation, hallucination, hallucination, confusion, leg confusion, leg confusion, pressure from from pressure pressure from from pressure Common SideCommon Common SideCommon of arrhythmias of of arrhythmias of memory issues, memory issues, urinary retention urinary retention urinary retention, urinary retention, urinary retention, urinary retention, paranoia, nausea, paranoia, nausea, paranoia, hallucinations, dry hallucinations, dry (livedo reticularis), reticularis), (livedo (livedo reticularis), reticularis), (livedo seated to to seated standing, seated to to seated standing, dizziness/low blooddizziness/low dizziness/low blooddizziness/low and potential effectand potential and potential effectand potential mouth, blurryvision, mouth, blurryvision,
1–2 mg 1–2 100 mg once/day once/day 0.5–2 mg 0.5–2 Regimens Regimens 129–322 mg 129–322 upon waking 2–3 times/day 2–3 2–3 times/day 2–3 times/day 2–3 Typical Treatment Treatment Typical Typical Treatment Treatment Typical elixir syrup tablets tablets tablets 100 mg Dosages Dosages 2 or 5 mg2 or 2 mg/5 ml mg tablets capsules orcapsules 50 mg/5 ml 0.5, 1, or 2 mg 1, or 0.5, 129, 193, or 258 193, or 129, Benztropine (Cogentin®) name in parentheses) name in parentheses) Trihexyphenidyl Artane®) (formerly Medication (product Medication (Symmetrel) Amantadine Amantadine ERAmantadine ER) (Osmolex tablets name in parentheses) name in parentheses) Medication (product Medication Anticholinergics
living with Parkinson’s Medications for Motor Symptoms Usage Usage levdopa) levdopa) fast-acting levodopa for for levodopa therapy with therapy with therapy with therapy Combination Combination Combination used without used without and should be Indications for for Indications Indications for for Indications “off” time (not “off” only injectable, only active by itself) active by for 90 minutes. for have have been tried PD medications Adjunct therapy Adjunct therapy be used after all be used after fluctuations (not fluctuations (not episodes. It is theepisodes. It is Note: Should onlyNote: discontinued if no if discontinued minutes and lastsminutes pharmacologically pharmacologically benefit in 3 weeks. in 3 benefit as needed for “off” “off” for as needed levodopa for motor for levodopa motor for levodopa dopaminergic drug. dopaminergic Starts working in 10working Starts loss Effects Effects urine, plusurine, plusurine, Dyskinesia, behaviors like like behaviors Common SideCommon Common SideCommon and confusion liver functions. liver enhancing sideenhancing enhancing side gambling; may blood pressure/ confusion, sleep confusion, medication dailymedication dizziness, weight for 3 days before before 3 days for constipation, lowconstipation, tests for checkingfor tests and discoloration, and discoloration, receive antinausea receive and confusion, plus and confusion, attacks, compulsive attacks, nausea, leg swelling starting medication effects of levodopa, effectsof effects of levodopa, effectsof Low blood pressure, blood pressure, Low Diarrhea, discolored discolored Diarrhea, Diarrhea, discolored Needs regular blood Needs regular risk of liver damage. liver of risk especially dyskinesia especially especially dyskinesia especially
hours. doses. 50 mg 100 mg between once/day Regimens Regimens “off” time. “off” 0.2–0.6 ml 0.2–0.6 4–8 times/ at bedtime every 2 hours every Requires test Requires as needed for No more thanNo more 5 doses per 245 doses per Do not exceed Do not Maximum 200 day (with each (with day Typically dosed Typically levodopa dose) levodopa mg 3 times/day 2 ml in 24 hours. up to up to 3 times/day Typical Treatment Treatment Typical Typical Treatment Treatment Typical tablets 200 mg capsules Dosages Dosages mg tablets 100 or 200100 or 25 or 50 mg25 or 10 mg/ml vial 10 mg/ml Apomorphine subcutaneous injections (Apokyn®) Medication (product Medication name in parentheses) Tolcapone (Tasmar®) Tolcapone (Ongentys) (Comtan®) Opicapone Medication (product Medication name in parentheses) Entacapone Dopamine Agonists COMT-Inhibitors
living with Parkinson’s Medications for Motor Symptoms Usage therapy for for therapy therapy for for therapy for therapy for therapy and tremor and tremor and tremor and tremor It is the onlyIt is intermittent intermittent approved for for approved treatment of treatment of treatment Monotherapy Monotherapy Monotherapy Monotherapy Monotherapy Monotherapy For the acute, For Indications for for Indications “off” episodes. “off” or combination or or combination or combination or combination or the on-demand “off” episodes in “off” sublingual therapy sublingual therapy slowness, stiffnessslowness, slowness, stiffnessslowness, stiffnessslowness, stiffnessslowness, Parkinson’s disease Parkinson’s Parkinson’s disease. Parkinson’s Effects gambling gambling gambling gambling sleepiness. medication. behaviors like like behaviors behaviors like like behaviors like behaviors like behaviors dizziness, and Common SideCommon Nausea, oral/ Nausea, tissue swelling, daily for 3 days for daily and numbness, before starting before soft tissue painsoft confusion, sleep confusion, confusion, sleep confusion, sleep confusion, sleep confusion, pharyngeal soft oral/pharyngeal oral/pharyngeal May receive anti- receive May and discoloration, and discoloration, and discoloration, and discoloration, and discoloration, and discoloration, nausea medication attacks, compulsive attacks, attacks, compulsive attacks, compulsive attacks, compulsive attacks, nausea, leg swelling nausea, leg swelling nausea, leg swelling nausea, leg swelling Low blood pressure, blood pressure, Low blood pressure, Low blood pressure, Low Low blood pressure, blood pressure, Low
strips. 9–24 mg 9–24 8–24 mg 8–24 once/day once/day Regimens 1.5–4.5 mg 1.5–4.5 mg These filmsThese than on top. are similar in similar are placed underplaced least 2 hours. (3 times/day) (3 times/day) (3 the tongue the tongue as doses per day, day, doses per appearance to appearance However, these However, total daily dose daily total dose daily total One 10 mg film One 10 mg separated by at by separated are placed under placed are needed, five to up breath freshening freshening breath the tongue the tongue rather Typical Treatment Treatment Typical tablets Dosages 10, 15, 20, 10, 0.125, 0.25, 0.125, mg tablets 3, 4, 5 mg or 25, or 30 mg25, or 0.25, 0.5, 1, 2, 0.5, 0.25, 0.5, 0.75, 1, or 0.75, 0.5, 2, 4, 12 6, 8, or 1.5 mg tablets 2.25, 3, 3.75, or2.25, 3, 3.75, 4.5 mg tablets sublingual film 0.375, 0.75, 1.5, 0.75, 0.375,
Ropinirole XL Ropinirole XL™) (Requip® Ropinirole (Requip®) Ropinirole Pramipexole ER Pramipexole ER®) (Mirapex Pramipexole Pramipexole (Mirapex®) Apomorphine hydrochloride (KYNMOBI™) name in parentheses) name in parentheses) Medication (product Medication
living with Parkinson’s Medications for Motor Symptoms Usage Usage impaired of motorof with other in patients carbidopa/ therapy for for therapy therapy for for therapy therapy for for therapy and tremor and tremor. fluctuations Monotherapy Monotherapy Monotherapy Monotherapy Monotherapy medication inmedication Indications for for Indications for Indications with advanced if swallowing is swallowing if or combination or or combination or or combination or Monotherapy or Monotherapy interchangeable interchangeable and tremor; skinand tremor; and tremor, plus and tremor, mouth especially patch delivery an delivery patch of Rytary are not Rytary of are For the treatment the treatment For slowness, stiffnessslowness, slowness, stiffnessslowness, stiffnessslowness, slowness, stiffnessslowness, Note that Note dosages levodopa products. levodopa Parkinson’s disease Parkinson’s adjunct therapy for for adjunct therapy need for dissolvable need for advantage for some for advantage rashes Effects Effects dyskinesia dyskinesia dyskinesia dyskinesia behaviors like like behaviors Common SideCommon SideCommon confusion, sleep confusion, and discoloration, and discoloration, gambling plus skin nausea, confusion, nausea, confusion, nausea, confusion, nausea, confusion, nausea, confusion, nausea, confusion, nausea, confusion, attacks, compulsive attacks, nausea, leg swellingnausea, Low blood pressure, blood pressure, Low Low blood pressure, blood pressure, Low blood pressure, Low Low blood pressure, pressure, blood Low blood pressure, Low
times) times) 4–8 mg 16 hours once/day Regimens Regimens daily dose daily levodopa total levodopa Up to 2000 mgto Up levodopa total/ levodopa levodopa total/ levodopa day (divided 3–4 (divided day day (divided 3–4 (divided day 855–2340 mg of 855–2340 150–1000 mg of 150–1000 150–1000 mg of 150–1000 of levodopa over levodopa of Typical Treatment Treatment Typical Treatment Typical
tablets tablets 10/100, 10/100, capsules Dosages Dosages 23.75/95, mg patch 36.25/145, 25/100, or 25/100, 25/100, or 25/100, 25/250 mg 25/250 mg 48.75/195, or 48.75/195, 61.25/245 mg61.25/245 1, 2, 3, 4, 6, or 8 1, 2, 3, 4, 8 6, or 4.86/20 ml per Carbidopa/levodopa Carbidopa/levodopa immediate-release (Sinemet) tablets Carbidopa/levodopa Carbidopa/levodopa extended-release (Rytary) capsules Carbidopa/levodopa Carbidopa/levodopa disintegrating orally (Parcopa) tablets surgically implanted surgically in smalltube intestine Medication (product Medication name in parentheses) Carbidopa/levodopa Suspension enteral (Duopa) via name in parentheses) name in parentheses) (Neupro) Rotigotine Medication (product Medication Levodopa
living with Parkinson’s Medications for Motor Symptoms Usage Usage (benefit of (benefit therapy for for therapy and tremor entacapone) therapy with therapy levodopa, for for levodopa, Combination Replacement Replacement Monotherapy Monotherapy Monotherapy; Monotherapy; Indications for for Indications Indications for for Indications for carbidopa/ for or combination or or combination or with or withoutwith or therapy used as therapy needed for “off” “off” needed for oral Carbidopa/ oral episodes. Starts minutes and lastminutes working in 10–30 in 10–30 working up to 60 minutes.to up Must be used with Must be used motor flucuations. motor slowness, stiffnessslowness, motor fluctuationsmotor levodopa or Dupoa. or levodopa carbiodpa/levodopa carbiodpa/levodopa cough classes Effects Effects dyskinesia dyskinesia, possible rare possible rare entacapone) urine (due to urine (due plus diarrhea Common SideCommon Common SideCommon monotherapy) and discolored and discolored dyskinesia plusdyskinesia and other drug and other interaction with interaction lightheadedness, anti-depressants anti-depressants constipation; mayconstipation; nausea, confusion, confusion, nausea, nausea, confusion, nausea, confusion, worsen dyskinesia;worsen Nausea, dry mouth, Low blood pressure, pressure, blood Low blood pressure, Low blood pressure, Low (Insomnia unlikely in (Insomnia unlikely
84 mg 1.0 mg1.0 once/day Regimens Regimens daily need daily as needed daily need. daily of levodopa of (2 capsules) (2 capsules) depending ondepending depending on 150–1600 mg 150–1600 divided doses, of levodopa in levodopa of 400–1600 mg 400–1600 Max Max 8 tab/day. total daily dose, daily total inhaled by mouth inhaled by up to 5 times/day up to 5 times/day Typical Treatment Treatment Typical Typical Treatment Treatment Typical
or tablets tablets capsule Dosages Dosages 25/100 or 42 mg per mg tablets 50/200 mg50/200 25/100/200, 50/200/200 50/200/200 0.5 or 1.0 mg 1.0 or 0.5 12.5/50/200, 37.5/150/200, 37.5/150/200, 18.75/75/200, 31.25/125/200, Rasagiline (Azilect®) Rasagiline Medication (product Medication name in parentheses) LEVODOPA LEVODOPA INHALATION (Inbrija) via inhaler [see COMT- [see inhibitors] Carbidopa/ levodopa/ tablets entacapone (Stalevo) name in parentheses) name in parentheses) Carbidopa/levodopa controlled-release (Sinemet tablets CR*) Medication (product Medication *Sinemet CR is no longer being produced, but the generic forms continue to be available. to continue forms generic the but being produced, CR is no longer *Sinemet Inhibitors MAO-B
living with Parkinson’s Medications for Motor Symptoms living with Parkinson’sliving with Medication (product Typical Treatment Common Side Indications for Dosages name in parentheses) Regimens Effects Usage Nausea, dry mouth, lightheadedness, Monotherapy for constipation; may 5 mg slowness, stiffness worsen dyskinesia; Selegiline (l-deprenyl, twice/day and tremor; 5 mg tablets insomnia; possible Eldepryl) (with breakfast combination rare interaction and lunch) therapy for motor with anti- fluctuations depressants and other drug classes Medications for Motor S Combination 10 mg therapy to Safinamide (Xadago) 10 mg tablets Same as above once/day carbidopa/levodopa for “off” episodes Monotherapy; or combination Nausea, dry mouth, therapy with lightheadedness, carbiodpa/ constipation; may levodopa with or Selegiline HCL worsen dyskinesia; 1.25 or 2.5 mg 1.25–2.5 mg without motor orally disintegrating insomnia; possible tablets once/day flucuations; plus y m pto m s (Zelapar) rare interaction need for disolvable with anti- medication in depressants and mouth especially other drug classes if swallowing is impaired
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