Parkinson's Disease

Question 1

What are the first line treatment for PD?

Answer 1

• Levodopa, which is usually given with a dopa decarboxylase inhibitor, as co-beneldopa or co-careldopa.
  Levodopa is usually offered to people in the early stages of Parkinson’s disease whose motor symptoms impact on their quality of life.
  Levodopa typically provides more improvement in motor symptoms and daily functioning, fewer adverse effects such as excessive sleepiness, hallucinations, and impulse control disorders, but may cause more motor complications than other drug classes.
• Oral monoamine oxidase-B (MAO-B) inhibitors (selegiline, rasagiline, or safinamide) — do not cause an interaction after consumption of tyramine-rich foods.
  These typically provide less improvement in motor symptoms and daily functioning, fewer motor complications, and fewer adverse effects such as excessive sleepiness, hallucinations, and impulse control disorders than other drug classes.
• Oral dopamine agonists, such as pramipexole or ropinirole; or transdermal dopamine agonist, such as rotigotine.
  These typically provide less improvement in motor symptoms and daily functioning, fewer motor complications

Question 2

What three MAO-B inhibtors do not cause an interaction after consumption of tyramine-rich foods?

Answer 2

selegiline, rasagiline, or safinamide

Question 3

What parkinson’s medication causes more adverse effects such as excessive sleepiness, hallucinations, and impulse control disorders than other drug classes.

Answer 3

Oral dopamine agonists, such as pramipexole or ropinirole; or transdermal dopamine agonist, such as rotigotine.

Question 4

What parkinson’s medication should not be used as first line treatment due to the risk of cardiac fibrosis with long-term use and need for additional monitoring?

Answer 4

Ergot-derived dopamine agonists such as cabergoline and pergolide