Treating early Parkinson disease
The preferred first-line therapy for Parkinson disease is levodopa. Dopamine agonists may be used as first-line therapy in exceptional circumstances (eg rotigotine for a patient who can't swallow, pramipexole for a patient who strongly prefers once-daily dosing).
With all antiparkinson drugs, start at a low dose and increase gradually over days or weeks—this reduces the risk of adverse effects and improves concordance with therapy. A clear response can take 2 to 3 weeks.
Use:
1 levodopa+benserazide 50+12.5 mg orally, 3 times daily, increasing to 100+25 mg 3 times daily over 1 to 2 weeks Parkinson disease levodopa + benserazide
OR
1 levodopa+carbidopa 50+12.5 mg orally, 3 times daily, increasing to 100+25 mg 3 times daily over 1 to 2 weeks Parkinson disease levodopa + carbidopa
OR
2 pramipexole 0.125 mg orally, 3 times daily, slowly titrating to effect, to a maximum of 1.5 mg 3 times daily Parkinson disease pramipexole
OR
2 pramipexole modified-release 0.375 mg orally, once daily, slowly titrating to effect, to a maximum of 4.5 mg once daily pramipexole
OR
2 rotigotine 2 mg transdermally, once daily applied for 24 hours, increasing by 2 mg every week until an effective dose is reached, to a maximum of 8 mg once daily. Parkinson disease rotigotine
All antiparkinson drugs can cause nausea, but tolerance to this adverse effect usually develops rapidly. Taking doses with food can help. Avoid metoclopramide, prochlorperazine and other centrally acting dopamine-blocking antiemetics, because they often make parkinsonism worse.
When nausea is a problem, treat with a short course of domperidone. Use:
domperidone 10 mg orally, 3 times daily for up to 7 days, then stop1. nausea due to antiparkinson drug domperidone