Drugs inhibiting metabolism of Dopamine - Parkinson's Disease ( Part 5 ) - CNS Pharmacology

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There are many pharmacologic options available for the treatment of Parkinson disease; regimens are tailored to the patient's age, symptoms, and symptom severity. While only symptomatic treatment is available at this point in time, drugs that may slow or reverse the course of the disease are currently being investigated. Since treatment of Parkinson disease at an early stage can significantly improve a patient's subjective well-being (honeymoon period), medical therapy should be initiated as soon as symptoms begin to interfere with the patient's daily life. For most patients, first-line treatment consists of levodopa (L-DOPA) or dopamine receptor agonists, e.g., ropinirole and pramipexole. Other drugs that are used to treat Parkinson disease include amantadine, MAO-B inhibitors, and COMT inhibitors.

Medical therapy
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Levodopa is the drug of choice for the symptomatic therapy of Parkinson disease.
Dopaminergic therapy should be considered at an early stage if motor symptoms begin to substantially affect a patient's activities of daily living. The age of 65 should be considered a general point of reference rather than a fixed limit for beginning levodopa therapy.
In the early phase of levodopa treatment, patients may experience a "honeymoon period" with relief of symptoms.
“On” (parkinsonism is relieved by the levodopa) and “off” (levodopa effect wears off, parkinsonism returns) episodes are another common phenomenon.

Dopamine agonist in patients under the age of 65

In patients under the age of 65, it is generally recommended that treatment begin with a dopamine agonist to delay the onset of motor complications before moving on to levodopa, even though levodopa is more potent and has fewer side effects.

Patients under the age of 65 with no significant comorbidities

First-line treatment
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Non-ergot dopamine agonists (e.g., pramipexole, ropinirole, apomorphine): as monotherapy or in combination with levodopa/carbidopa
MAO-B inhibitors (e.g., selegiline): may be used as a monotherapy or in combination with dopamine agonists or levodopa/carbidopa
COMT inhibitors (e.g., entacapone): in combination with levodopa/carbidopa

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