Drug treatment is the main method used to control the symptoms of Parkinson's.
Parkinson's symptoms happen when levels of a chemical messenger in your brain, called dopamine, become too low.
Drug treatments aim to increase the level of dopamine that reaches the brain and stimulate the parts of the brain where dopamine works.
Current medications can help to manage Parkinson's symptoms, but we don’t yet have any treatments that can cure, slow, stop or reverse the progression of Parkinson’s. This means the condition continues to progress as do the symptoms and side effects of taking more medication.
Drug Treatments are specific to you
Every person with Parkinson’s has a different experience of the condition so your specialist or Parkinson’s nurse will work with you to find the treatment that is best for you as an individual.
Finding the best drug, dose and timing may take some time and will need some changes along the way. Because the symptoms of Parkinson’s change over time, your medication may have to change, too.
Drugs for Parkinson's are often started at low doses and increased gradually, stepping up the doses, the frequency, or adding new drugs until your symptoms are as controlled as possible. If your symptoms are mild, you might decide with your specialist to wait to start drug treatment until your symptoms increase.
It is important not to make any changes to your medication without talking to your specialist or Parkinson’s nurse first.
How Parkinson's drugs work
Dopamine is a chemical messenger made in the brain. The symptoms of Parkinson's appear when dopamine levels become too low.
This is because many of the cells in your brain that produce dopamine have died or are dying.
Most drug treatments work by:
- increasing the amount of dopamine in the brain
- acting as a substitute for dopamine by stimulating the parts of the brain where dopamine works
- blocking the action of other factors (enzymes) that break down dopamine
Tips for managing your Parkinson's drugs
Understanding your Parkinson's drugs
- Ask your specialist, Parkinson’s nurse or pharmacist questions if there's anything you don’t understand. They won’t mind. You can also ask for written information.
- Make sure you know what to do if you miss a dose.
- Everyone with Parkinson's is different so don't assume your dose or timing should be the same as someone else with the condition.
Sharing decisions with your health professionals about your Parkinson's drug treatment
- Always talk to your specialist or Parkinson's nurse about any other conditions you have, or if you think you could be pregnant.
- Tell your specialist or Parkinson’s nurse straight away if you experience any side effects from the drugs you take to treat Parkinson’s, but don’t stop taking or change the dose or timing of your Parkinson’s drugs until you have spoken to your health professional as this can be dangerous (see dopamine agonist withdrawal syndrome information).
- Talk with your specialist or Parkinson’s nurse about how your treatment is working for you. Keep a diary or chart when your specialist or Parkinson’s nurse starts you on a new drug, changes your drugs or adjusts the dose or frequency. Record the dose and time you took the drug and what happened to your symptoms. This information can you decide together on how the drug is working for you.
Managing your Parkinson's drugs
- Keep a record of all the medications you are taking for Parkinson’s and any other conditions and what time you take each drug.
- You may want to wear medic alert jewellery or carry our medication card to help people know that you have Parkinson's and what medication you take in an emergency situation.
A pill timer is a box that you can store your Parkinson’s drugs in to remind you when to take each dose. They are useful if you have to take lots of different tablets or if you have trouble remembering to take your medication.
There are many different types and sizes of pill timer. Some have sections for different times of day, so you can store all of your Parkinson’s drugs for one day. Others are big enough to hold your tablets for a whole week, with sections for each day. Some weekly pill timers are also split into times of day.
Pill timers vary in cost, depending on the type and who it is made by. An occupational therapist or pharmacist can help you to choose the right option. The Disabled Living Foundation, an organisation that provides information on a range of equipment for disabled and older people, can also advise you on options available.
Managing Parkinson's medication while in hospital
Make sure that hospital staff understand you have Parkinson's and need your medication on time when you're staying in hospital.
Some hospitals will allow you to look after your own medication, so that you can self-administer your medication outside of the usual drugs round.
Our Get It On Time resources can help you to educate and remind staff about the importance of getting medication on time.
Side effects of Parkinson's drugs
All prescribed drugs can have potential side effects, including those used to treat Parkinson's. Some things you think are symptoms of Parkinson's may actually be side effects of medication.
Impulsive and compulsive behaviour
This is behaviour like gambling, becoming a ‘shopaholic’, binge eating or focusing on sexual feelings and thoughts. This behaviour can have a huge impact on people’s lives, so if you think this is happening to you or the person you are caring for, tell your GP, specialist or Parkinson’s nurse straight away.
Names of Parkinson's drugs
Sometimes, the same Parkinson's drug goes by a number of different names – even if the ingredients are the same and they do the same job.
Unbranded and branded drugs
All types of drug have a common or generic name. Every drug that has the same active ingredient will have this name, no matter who it is made by.
Many medications used to treat Parkinson’s are available under their generic name.
Some drugs will also have a brand name, decided by the company who makes it. For example co-beneldopa is an unbranded or generic name of a levodopa drug. Roche, one of the companies that makes co-beneldopa, sells it under the brand name Madopar.
The active ingredient of the unbranded drug is the same as the branded version and lots of people won’t have any problems using the generic medication. But some people may find they respond a bit differently to different versions. If you have any concerns, discuss these with your specialist or Parkinson’s nurse.
Other Parkinson's drugs you may be prescribed
People with Parkinson’s can have symptoms that aren’t connected to movement problems. These include anxiety, pain and constipation. Parkinson’s drugs are not always used to treat these types of symptoms. These symptoms may be treated with drugs that aren't specific to Parkinson's and are the same used for everyone with that health issue.
Parkinson’s drugs can interact with the drugs used for other conditions. The different drugs can make each other weaker or stronger. Your specialist or pharmacist can advise on this.
Herbal or complementary treatments, for example St John’s Wort, may also affect your Parkinson’s drugs. So always check with your specialist, Parkinson's nurse of pharmacist before taking alternative medicines.
Drugs to avoid
Some drugs can bring on Parkinson’s-like symptoms or react badly with Parkinson’s drugs and should be avoided unless they’re recommended by a specialist. These are some (but not all) of the drugs to avoid in Parkinson’s:
- chlorpromazine (Largactil)
- fluphenazine (Modecate)
- perphenazine (Fentazin/Triptafen)
- trifluoperazine (Stelazine)
- flupenthixol (Fluanxol/Depixol)
- haloperidol (Serenace/Haldol)
- metoclopramide (Maxalon)
- prochlorperazine (Stemetil)
Decongestants or cold remedies can affect some Parkinson’s medications. Always check with your pharmacist which one is safest to use.
Domperidone (Motilium) is the anti-sickness drug of choice to prevent and treat nausea and vomiting caused by levodopa.
Domperidone can cause heart rhythm problems (arrhythmia) in some people over the age of 60. If you are prescribed this medication, your specialist, Parkinson’s nurse or pharmacist should talk to you about how to recognise signs of irregular heart rhythms.
Other anti-sickness drugs that are generally considered useful include cyclizine (Valoid) and 5-HT3 receptor antagonists like ondansetron.