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Best medications for Parkinson’s

Senior women exercisingAccording to the Parkinson’s Disease Foundation, approximately 7 to 10 million people live with Parkinson’s disease. Naturally, patients and families want to learn more about the best medications and treatments for this life-changing illness. This article concerns medications that may help or control the poor motor symptoms associated with Parkinson’s. These symptoms can include tremor, slow movement, stiffness, difficulty with gait and posture, and a feeling of weakness.

Best medicine: Exercise

It is a fact that the patients who exercise do so much better than those who don’t. Recent research has suggested that even simple daily activities, such as routine housework, can provide benefit in motor symptoms. This should be paired with exercise, as well.

I believe that all patients with Parkinson’s disease should be involved in scheduled, safe exercise. It’s as good as any medication we can provide. 

Acceptable exercise includes (but is not limited to) walking, biking, swimming/water aerobics, dance, boxing, tai chi and yoga. Basically, any exercise the patient can do without straining or falling is a good one for that patient.

Carbidopa/levodopa (Sinemet)

Carbidopa/levodopa is the most effective and well-tolerated drug we have for controlling the motor symptoms that result from Parkinson’s. The brand name for this drug is Sinemet. A good argument can be made for starting with this medication if you have been diagnosed with Parkinson’s.

The medication often helps with:

  • Bradykinesia (slowness of movement)
  • Rigidity
  • Tremor while the person is at rest

It typically does not help with:

  • Balance/falls
  • Freezing
  • Non-motor symptoms such as depression, fatigue or memory problems

Taking the medication

There are two important things to note in taking Sinemet:

  • Take the medication at the same time every day.
  • It is best to take Sinemet during awake hours, though some patients find benefit taking a longer-acting dose before bed to help reduce symptoms overnight.

Facts about carbidopa/levodopa (Sinemet)

  • There is no harm (and instead, there is probably a real benefit) in starting the medication early as first-line treatment, if your symptoms are bothersome or limiting to you; there is no reason to delay if you have motor symptoms that you’d like to improve.
  • Early use of the medication does not result in worse long-term symptoms.
  • Use likely results in a longer period of better symptom control than the use of other medications.
  • It does not “wear off” the more it is used, though the disease progression itself may warrant higher doses over time.
  • It is significantly more cost-effective than other medications.

Adjunctive medications

These adjunctive medications are sometimes used in addition to carbidopa/levodopa (Sinemet) if necessary:

  • Dopamine agonist (pramipexole/ropinirole/rotigotine): But there is a greater chance for worsening cognition, hallucinations, disinhibited behavior, hypersexuality and sleep attacks.
  • MAOB-inhibitor (Selegiline/rasagiline): But it is expensive, and there is a risk of problems if the person is also on certain antidepressants.
  • Amantadine: Amantadine can improve dyskinesias (impaired movement) and may help slightly with tremor. However, it has similar side effects as carbidopa/levodopa or Sinemet, especially in the area of cognition, and is bad for patients with dementia.

Medications not recommended for Parkinson’s

Generally, anti-cholinergics (i.e., trihexyphenidyl, also known as Artane) are not recommended for the treatment of Parkinson’s because many side effects can arise. It should be used only as a last-resort treatment for rest tremor.

Upcoming

  • 8 more treatment options for Parkinson’s

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jonathan_SniderJonathan D. Snider, M.D., received his medical degree from the University of Michigan where he did a residency in Neurology. He is in the second year of a movement disorders fellowship. Dr. Snider has a strong interest in the treatment of movement disorders and in medical education.

 

 

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