Key Points
➤ The treatment options for the alleviation of motor symptoms in the
early stages of Parkinson disease (PD) are based on the enhancement
of dopaminergic tone with levodopa, monoamine oxidase inhibitors,
dopamine agonists (DAs), or a combination thereof.
➤ The choice of initial treatment is influenced by the potential for
neuropsychiatric adverse effects associated with DAs and dyskinesia and
motor fluctuations associated with levodopa.
Treatment
Levodopa vs. DAs vs. MAO-B inhibitors
➤ Clinicians should counsel patients with early PD on the benefits and risks
of initial therapy with levodopa, DAs, and MAO-B inhibitors based on the
individual patient's disease characteristics to inform treatment decisions
(B).
➤ In patients with early PD who seek treatment for motor symptoms,
clinicians should recommend levodopa as the initial preferential
dopaminergic therapy (B).
➤ Clinicians may prescribe DAs as the initial dopaminergic therapy to
improve motor symptoms in select early PD in patients <60 years who are
at higher risk for the development of dyskinesia (C).
➤ Clinicians should not prescribe DAs to patients with early-stage PD at
higher risk of medication-related adverse effects, including individuals
>70 years-of-age, patients with a history of impulse control disorders
(ICDs), and patients with pre-existing cognitive impairment, excessive
daytime sleepiness, or hallucinations (B).
Prescribing levodopa
➤ Clinicians should initially prescribe immediate-release levodopa rather
than controlled-release levodopa or levodopa/carbidopa/entacapone in
patients with early PD (B).
➤ In patients with early PD, clinicians should prescribe the lowest
effective dose of levodopa (i.e., the lowest dose that provides adequate
symptomatic benefit) to minimize the risk of dyskinesia and other adverse
effects (B).
