Pharmacotherapy for Parkinson's disease

Jack J. Chen, David M. Swope

Research output: Contribution to journalReview articlepeer-review

73 Scopus citations

Abstract

The available pharmacotherapies for Parkinson's disease address symptomatology because no agent has been demonstrated to provide definite neuroprotection against the disease. Choice of pharmacotherapy must include consideration of short-term benefits as well as long-term consequences. Patients with mild Parkinson's disease often function adequately without symptomatic treatment. However, recent data suggest that initiation of treatment with a well-tolerated agent (e.g., the monoamine oxidase [MAO]-B inhibitor rasagiline) in the absence of functional impairment is associated with improved long-term outcomes. Consideration should also be given to many patient-specific factors, including patient expectations, level of disability, employment status, functional as well as chronologic age, expected efficacy and tolerability of drugs, and response to previous Parkinson's disease therapies. Increasingly, initial monotherapy begins with a nondopaminergic agent or, if the patient is considered functionally young, a dopamine agonist. Since Parkinson's disease is a progressive disorder, adjustments to pharmacotherapy must be expected over time. When greater symptomatic relief is desired, or in the more frail elderly patient, levodopa therapy should be considered. If motor fluctuations develop, addition of a catechol-O-methyltransferase inhibitor or MAO-B inhibitor should be considered. For management of levodopa-induced dyskinesias, addition of amantadine is an option. Surgery may be considered when patients need additional symptomatic control or are experiencing severe motor complications despite pharmacologically optimized therapy.

Original languageEnglish
Pages (from-to)161S-173S
JournalPharmacotherapy
Volume27
Issue number12 II
DOIs
StatePublished - Dec 2007
Externally publishedYes

Keywords

  • Amantadine
  • Anticholinergics
  • COMT inhibitors
  • Catechol-O-methyltransferase
  • Dopamine
  • Levodopa
  • MAO-B inhibitors
  • Monoamine oxidase
  • Parkinson's disease
  • Pharmacotherapy

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