Tapering and Discontinuing DAs
➤ Clinicians should recommend tapering or discontinuation of DAs if
patients experience disabling medication-related adverse effects,
including ICDs, excessive daytime sleepiness, sudden-onset sleep,
cognitive impairment, or hallucinations (B).
➤ When DAs must be discontinued due to adverse effects, clinicians
should monitor patients for symptoms of dopamine agonist withdrawal
syndrome (DAWS) and, when possible, gradually decrease the dosage to
minimize symptoms (B).
Prescribing MAO-B inhibitors
➤ Clinicians should counsel patients with early PD on the greater
motor benefits of initial therapy with levodopa compared with MAO-B
inhibitors to inform treatment decisions (B).
➤ Clinicians may prescribe MAO-B inhibitors as the initial dopaminergic
therapy for mild motor symptoms in patients with early PD (C).
Treatment
Medications for Parkinson Disease
Agent – generic
Brand Mechanism of Action Dose
carbidopa and levodopa
RYTARY
dopamine precursor Individualize PO
rotigotine transdermal
system
Neupro
dopamine agonist 2 mg/24 hours
Max: 8 mg/24 hours
carbidopa and levodopa
Sinemet
dopamine precursor Individualize PO
carbidopa, levodopa,
and entacapone
Stalevo
dopamine precursor/
catechol-o-methyltransferase
(COMT) inhibitor
Individualize PO
entacapone
a
Comtan
COMT inhibitor 200 mg PO with each
levodopa and carbidopa
dose
selegiline
generic
monoamine oxidase type B
(MAO-B) inhibitor
5 mg bid PO
rasagiline
generic
MAO-B inhibitor 1 mg PO qd
ropinirole
Requip
non-ergoline dopamine
agonist
2 mg PO qd
Max: 24 mg/d
pramipexole
Mirapex
non-ergot dopamine agonist 0.375 mg PO qd
Max: 4.5 mg PO qd
a
Adjunctive to levodopa/carbidopa
