Parkinson's Disease

Care & Treatment

Although there is no cure for Parkinson’s disease, there are a number of medications and other treatments that can improve symptoms and quality of life.  Your healthcare provider will work with you to find the best combination of treatments for your symptoms.

Medications

The decision to start medications for Parkinson’s disease is usually based on how severe the symptoms are, how much the symptoms interfere with a person’s daily life, and the whether a person has a preference about using medications.

The most effective treatment for Parkinson’s disease is levodopa-carbidopa, two medications that are combined in a single pill. This combination of medicines helps to replace the dopamine that a person’s neurons are no longer producing. Levodopa-carbidopa is most helpful for bradykinesia. Symptoms of tremor and rigidity can also be improved with this medication, but postural instability (the medical term for balance problems) are less likely to improve. Common side effects include nausea, sleepiness, a drop in blood pressure, and headache. This medication may also cause confusion and hallucinations. It is important to avoid eating high-protein meals at the same time you take the levodopa-carbidopa pills. This can reduce the absorption of the medication. Make sure to eat your protein in between the doses.

With long-term use (usually over 5-10 years) of levodopa-carbidopa, other complications commonly occur. These include uncontrolled, involuntary movements (called “dyskinesias”). Another long-term complication of this medication is the “wearing off” or “on-off” effect, when the medication wears off before the next dose.

Other medications for motor symptoms of Parkinson’s disease include:

  • Monoamine oxidase B (MAO B) Inhibitors. These medications help raise levels of dopamine in the brain by blocking its breakdown. MAO B inhibitors can be taken alone or in combination with medications for Parkinson’s disease. Side effects of MAO B inhibitors can include nausea, headache, sleep problems, and confusion.
  • Dopamine Agonists. These medications work by stimulating the response to dopamine in the brain. Side effects can include sleepiness, swelling in the legs and feet, nausea, a drop in blood pressure, and hallucinations. Less common but more serious side effects can include problems with impulse control (such as compulsive gambling, eating, or shopping) or sudden “sleep attacks.”
  • Catechol-O-methyl transferase (COMT) inhibitors. These medicines are used to help prolong and enhance the effect of levodopa-carbidopa. These medications are mainly used for people who have "wearing off" periods before their next dose of levodopa-carbidopa. The most common side effects of COMT inhibitors are  dyskinesias, hallucinations, confusion, nausea, diarrhea, orange discoloration of the urine, and a drop in blood pressure with standing. 
  • Anticholinergics. These medications are sometimes used for patients with more advanced Parkinson’s disease, especially with tremor. However, these medications are avoided in older adults because of common side effects such as difficulty with urinating and passing stool, confusion, memory problems, and falls.
  • Amantadine. This medication is an antiviral drug developed to prevent influenza, but it was found to improve mild motor symptoms in people with Parkinson disease. It is rarely used in older adults because of side effects such as confusion and hallucinations. 
Never change or stop taking your medication without first checking with your healthcare provider.

Surgery

People who are no longer getting relief from medications or experience serious side effects from medications may benefit from surgery known as deep brain stimulation (DBS).  During the surgery, a surgeon places wires into a part of the brain that helps control movement. The wires are attached to a small device, similar to a pacemaker, that is implanted under the skin near the collarbone. The device sends electrical signals to the brain to reduce abnormal movements.

Treatment of Non-Motor Symptoms

Medications and other interventions can be used to treat some of the common non-motor symptoms of Parkinson’s disease.

  • Depression can be treated effectively with medication.
  • Sleep problems can be treated by improving sleep habits, and by addressing other causes of disrupted sleep, such as pain or frequent urination.
  • Dementia symptoms may improve with medications. Some of the medications approved to treat dementia in people with Alzheimer’s disease also are approved to treat dementia in Parkinson’s disease.
  • Hallucinations can sometimes be treated by decreasing the dose of one or more of the medications used to treat motor symptoms of Parkinson's disease. Other medications called antipsychotics can sometimes be used if the symptoms are very bothersome.

Last Updated October 2020