Diagnosis & Symptoms

The diagnosis of Parkinson’s disease can be overwhelming causing fear, anxiety, anger, and disappointment for the individual and the entire family. Often times, the diagnosis is accompanied by little or no information about the disease, prognosis, or its management.

PFWPA is a clearinghouse for current, well vetted information and materials on PD. For newly diagnosed and those new to our region, we maintain an up to date list of medical, allied medical and allied health professionals with specific trainings, certifications and experience working with individuals and families impacted by Parkinson’s disease.

Introduction to Parkinson’s Disease

If you are newly diagnosed, you are not alone. The PFWPA is here to help. Rely on the resources and support of the Parkinsons community of providers, educators and exercise professionals. There are approximately 12,000 people living with Parkinson’s disease in our area. The FAQ section on Parkinson’s Disease section has a wealth of useful information many patients, family and supporters find helpful.

LINK TO FAQ

Medication Overview

Medications most often prescribed in managing the symptoms

There are a number of medications used to treat or manage the symptoms of Parkinson’s disease. Because there are many variations in the way the symptoms present themselves, differences in individual sensitivities to the medications and treatment philosophies between physicians, treatment regimens can widely vary from person to person. This section describes common medications in detail to help you understand the benefits of PD treatments.

Managing Motor Symptoms Associated with Parkinson’s Disease

Physicians can use different medications and combinations of approved medications based on the needs of each patient and physicians’ treatment philosophy. Considerations related to the choice of medications include efficacy for symptomatic control, side effects, safety, practicality, cost and sensitivities of their individual patients.

Although the dopamine deficiency causes the motor problems associated with PD, dopamine cannot cross the blood brain barrier (moving from the blood stream into the brain) and therefore it can’t be directly used as a medication to treat the disease. Levodopa is a precursor of the dopamine neurotransmitter and can be converted to dopamine once inside the brain. Carbidopa is added to decrease the amount of levodopa that is broken down before entering the brain.

Carbidopa/Levodopa: Levodopa is still considered the “gold standard” medication for PD with the broadest antiparkinsonian effects.

Available Forms:

  • Immediate release (generic form available)
  • Controlled/Extended release (generic form available)
  • Oral disintegration tablets (generic form available) (previously branded as Parcopa®)
  • Rytary™ (carbidopa/levodopa extended-release capsules) No generic form of this formulation available.
  • Duopa™ (Abbvie, Inc) Carbidopa/levodopa enteral suspension continuous infusion No generic form available.
  • Stalevo® (Novartis Pharmaceuticals Corp) (carbidopa/levodopa+entacapone tablets) No generic form available in 1 pill.
  • Inbrija® (Acorda Therapeutics) Inhaled levodopa powder used for “OFF” period in between doses of carbidopa/levodopa. No generic form available.

Dopamine agonists are drugs that stimulate the parts of the human brain that are influenced by dopamine. In effect, the brain is “tricked” into thinking it is receiving the dopamine it needs. Dopamine agonist therapy does not replace dopamine; it makes the existing dopamine more effective by binding to the same receptor sites on the neurons normally occupied by dopamine. Agonist stimulated neurons require less dopamine to complete the neural transmission.

Dopamine agonists can be taken alone (mono therapy) or in combination with medications containing levodopa (adjunctive therapy)

Available Forms:

  • Pramipexole (generic form available) (Mirapex®- Boehringer Ingelheim Pharmaceuticals, Inc.)
  • Extended- release Pramipexole (generic form available) (Mirapex ER® – Boehringer Ingelheim Pharmaceuticals, Inc.)
  • Ropinerole (generic form available) (Requip® – GlaxoSmithKline, GSK group)
  • Extended release Ropinerole (generic form available) (Requip XL® – GlaxoSmithKline)
  • Rotigotine Transdermal System (Neupro® – UCB, Inc.) No generic form available.
  • Apomorphine hydrocloride injection (Apokyn® – US World Meds, Inc.) No generic form available.1

Catecholamine-O-Methyltransferase (COMT) Inhibitor
These types of drugs block or inhibit the breakdown of levodopa or dopamine which in turn helps maintain dopamine levels in the motor neurons and are typically used to decrease “OFF” periods. These medications must be used in combination with levodopa.

  • Entacapone (generic form available) (Comtan® – Novartis Pharmaceuticals Corp.)
  • Tolcapone (Tasmar® – Bausch Health)
  • Carbidopa+levodopa+entacapone tablets (Stalevo® – Novartis Pharmaceuticals Corp.) No generic form available.

Monoamine Oxidase B (MOAB) Inhibitors

Monoamine Oxidase Type B (MAO-B) is an enzyme in our body that breaks down dopamine. By giving a medication that blocks the effect of MAO-B, more dopamine is available to be used by the brain. This can modestly improve many motor symptoms of PD. When used with other medications, MAO-B inhibitors may reduce “OFF” periods. Prolonged use may enhance release of dopamine. MAOB Inhibitors can be taken alone (mono- therapy) or in combination with medications containing levodopa (adjunctive therapy).

  • Rasagiline (generic form only) (previously branded as Azilect® – Teva Pharmaceuticals)
  • Selegiline HCL (generic form available) (Eldepryl® – Bausch Health)
  • Selegiline HCL Orally disintegrating (Zelepar® – Bausch Health)
  • Safinamide prescribed as adjunctive therapy with carbidopa/levodopa (Xadago® – US World Meds) No generic form available.

Amantadine

Immediate release amantadine is a mild agent used in early and advanced PD primarily to help tremor. It promotes the release of dopamine from nerve terminals, blocks its re-uptake and inhibits a glutamate receptor in the brain.

  • Amantadine HCL (generic form available) (Symmetrel® – Endo Pharmaceuticals Inc.)
  • Extended release amantadine for levodopa induced dyskinesia (Gocovri® – Adamas Pharmaceuticals) No generic form available.
  • Extended release amantadine for the treatment of Parkinson’s disease and for the treatment of drug-induced extrapyramidal reactions. (Osmlex ER™ – Vertical Pharmaceuticals) No generic form available.

Adenosine A2a Antagonists
Adenosine neurotransmitters act like a braking system slowing down movement. In PD, Adenosine A2a receptors become overactive, which can cause problems with movement.

  • Istradefylline (NOURIANZ™ – Kyowa Kirin Co.) No generic form available.
1. Medications used for “OFF” periods are often referred to as “rescue medications” for use when there is an unexpected or anticipated return of motor symptoms despite having taken other Parkinson’s medications as prescribed. Rescue medications are not a replacement for regular management medications.

Exercise

EXERCISE AND ACTIVITY are essential tools for managing motor and non-motor symptoms, providing motivation, encouragement and social engagement. There is mounting evidence that regular exercise can also help slow the progression of the disease. In addition to providing weekly exercise classes, PFWPA established the Parkinson’s Exercise and Activity Network (PEAN) to expand the number and variety of exercise programs in the region. Our vision is that every person diagnosed with PD in Western PA will have access to one of these evidence-based Parkinson’s specific classes.

EXERCISE SCHEDULE

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