Treatment
➤ Clinicians should routinely monitor patients taking levodopa for their
motor response to treatment, and for the presence of dyskinesia, motor
fluctuations, ICDs, excessive daytime sleepiness, postural hypotension,
nausea, and hallucinations, to guide dosage titration over time (B).
➤ Clinicians should counsel patients taking levodopa that higher dosages
are more likely to cause dyskinesia (B).
➤ Clinicians should counsel patients that in later disease stages, taking
levodopa with meals may affect levodopa absorption and efficacy, but
this is usually not problematic at the time of levodopa initiation in early
PD (B).
Prescribing DAs
➤ Clinicians should inform the patient and caregiver (when present) of
important side effects of DAs before prescribing; this discussion should
specifically include ICDs, excessive daytime sleepiness, sudden-onset
sleep, nausea, postural hypotension, and hallucinations (B).
➤ Clinicians should screen patients for cognitive impairment, excessive
daytime sleepiness, sudden-onset sleep, hallucinations, orthostatic
hypotension, and the presence of risk factors for ICDs before prescribing
a DA (B).
➤ Clinicians should screen patients for the presence of adverse effects
related to DAs, including ICDs, excessive daytime sleepiness, sudden-
onset sleep, orthostatic hypotension, cognitive impairment, and
hallucinations repeatedly in follow-up of patients prescribed DAs (B).
➤ Clinicians should involve caregivers in assessments for ICDs, excessive
daytime sleepiness, sudden-onset sleep, orthostatic hypotension,
cognitive impairment, and hallucinations in patients with PD (B).
➤ Clinicians may screen patients for the presence of adverse effects
associated with DAs using questionnaires validated for this purpose,
including the Questionnaire for Impulsive-Compulsive Disorders in
Parkinson's Disease (QUIP) for ICDs, and the Epworth Sleepiness Scale
(ESS) for the assessment of impaired wakefulness (C).
➤ Clinicians should integrate patient preferences concerning formulation,
mode of administration, and cost when prescribing a DA (B).
➤ Clinicians should prescribe the lowest dose of DA required to provide
therapeutic benefit (B).
