How Parkinson's drugs work
Your drugs do one or more of the following:
- increase the amount of dopamine in the brain
- act as a dopamine substitute, stimulating the parts of the brain where dopamine works
- block the action of other factors (enzymes) that break down dopamine
At diagnosis, you and your specialist will make a decision about whether to start treatment straight away or wait until your symptoms cause you more problems. Usually you will be advised to start medication. You will be given specific times to take it which you should stick to.
You will be prescribed levodopa, dopamine agonist or a MAO-B inhibitor. Which medication you take depends on how much your symptoms affect you and other factors such as, your age and your lifestyle. Most people find they tolerate their treatment well and will return to clinic after six to eight weeks to review their response. This is when your specialist or Parkinson’s nurse will increase or decrease the doses, the frequency, or add new drugs until your symptoms are as controlled as possible.
Before leaving the clinic you should get the contact details of your Parkinson’s nurse or the number of the clinic in case you have any problems with side effects.
Every person with Parkinson’s has a different experience of the condition so your specialist, Parkinson’s nurse or pharmacist will work with you to find the best combination of treatment that is best for you as an individual.
Finding the best drug, dose and timing won’t happen straight away. Your treatment regime will usually need adapting as your Parkinson’s symptoms change over time.
Planning a medication routine is something that should be a joint decision between you and your healthcare professionals. If you are prescribed medication, make sure you ask about what you are taking, when to take it, and any side effects.
Your specialist or Parkinson’s nurse should explain things clearly and write down anything important.
Like any drugs, Parkinson’s drugs can have side effects. This means that some things you may think are Parkinson’s symptoms could be side effects of your medication.
Below we have listed some side effects that are important to be aware of. We have also included specific side effects information within each drugs class section.
Impulsive and compulsive behaviours
People who experience impulsive and compulsive behaviours can’t resist the temptation to carry out
an activity – often one that gives immediate reward or pleasure.
Behaviours may involve gambling, becoming a ‘shopaholic’, binge eating or focusing on sexual feelings and thoughts. This can have a huge impact on people’s lives including family and friends.
Not everyone who takes Parkinson’s medication will experience impulsive and compulsive behaviours, so these side effects should not put you off taking your medication to control your symptoms.
If you have a history of behaving impulsively you should mention this to your GP, specialist or Parkinson’s nurse.
Asking your specialist to make changes to your medication regime or adjusting the doses that you take is the easiest way to control impulsive and compulsive behaviours. So, if you or the person you care for is experiencing this side effect, tell your healthcare professional as soon as possible before it creates large problems.
If you are not able to get through to your healthcare professional straight away, you can call our Parkinson’s UK helpline on 0808 800 0303.
We have advice that can help you manage impulsive and compulsive behaviours as well as information on what behaviour to look out for.
Hallucinations and delusions
Hallucinations and delusions can also have a huge impact on daily life.
A hallucination is when you see, hear or feel things that aren’t there. Delusions are unusual thoughts, beliefs or worries that aren’t based on reality.
They can happen with any Parkinson’s medication but are more common with dopamine agonists. Not everyone will experience this side effect and it is more common in the later stages of Parkinson’s.
It’s natural to be worried about them but ask your doctor for clear information about hallucinations and delusions before starting your medication if you have any concerns.
Talking about hallucinations and delusions with your healthcare professional will mean they can adjust your medication regime to help reduce their impact.
Some Parkinson’s drugs can make you very sleepy. Sometimes this happens suddenly and without warning. Make sure you know what safety precautions you need to take – if you can drive, for example.
Sometimes it can be hard to know whether your sleep problems are part of the condition or whether they are a side effect of your Parkinson’s medication. It’s important to talk to your healthcare professionals to find out the cause of these problems.
Blood pressure changes
Some Parkinson’s drugs can make your blood pressure fall very quickly, causing you to feel dizzy or faint. Increasing the amount of liquid you drink can help. Your specialist or Parkinson’s nurse will be able to prescribe medication to ease this side effect and give you other tips, so speak to them for more advice.
Names of Parkinson’s drugs
Drugs for Parkinson’s can be divided into three categories.
On our website, we have listed drugs in the following order to help you see each category clearly.
- The class or type of drug, for example levodopa.
- The generic (unbranded) name, such as co-beneldopa, which will include the active ingredients of the drug. For example, co-beneldopa is a combination of levodopa and benserazide.
- The brand name. For example, Madopar is the name that the pharmaceutical company, Roche, uses to sell co-beneldopa.
Your specialist will decide whether to prescribe you branded or generic versions of your medication. It usually depends on which area of the country you are in or what is most common to prescribe in that area. Once there are no longer any legal rights to the brand name any company can make generic (unbranded) versions of a drug.
The active ingredient of a generic drug is always the same as the branded version and lots of people won’t have any problems using the generic medication.
In the UK, a generic or branded medicine needs a licence and there is a strict process for this. This means that the quality of a generic or branded version of the same medicine will be the same, and they will also act in the same way.
If you find that you respond a bit differently to generic medication, discuss this with your specialist or Parkinson’s nurse.
The brand name will usually be the most visible name on your packet of medication. The generic name is usually written in small print.
It is useful to keep the packaging for your medication. This will help you to remember what you are taking. You can also record the name and strength of your medication and carry this list with you for when you need it. This will be particularly useful in an emergency as it will help medical professionals to understand what medication you take.
Modified release, controlled release and prolonged release medication
You may see that your medication is written as modified release. It can also be written as controlled release (CR) or prolonged release (PR). All of these labels mean the same thing but drug companies can choose which one to use with their drug.
These types of medication are made to release your treatment slowly to help you have more even control of your symptoms throughout the day.
Tips and experiences to help you manage your medication
When you take your Parkinson's medication it's important to:
- get it on time
- keep a record of what you take
- know how other treatment could interact with it
Your Parkinson's drug treatment
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. Taking dopamine as a drug doesn’t work because it cannot cross the blood brain barrier. To get around this, doctors use other medication that can act in a similar way.
Find out more about the drugs you take for Parkinson's below.
Each heading shows the class of Parkinson's drug, for example levodopa or dopamine agonists. The bullet points show the unbranded name first and then the brand name in bold. For example, the drug company Roche, use the brand name Madopar to sell co-careldopa medication.
- pramipexole (Mirapexin, Pipexus, Glepark, Oprymea, Zentiva)
- ropinirole (Adartrel, Ralnea, Requip, Spiroco, Ipinnia, Raponer, Ropilynz)
- rotigotine (Neupro)
- apomorphine (Apo-go, Dacepton)
- entacapone (Comtess)
- co-careldopa and entacapone (Stalevo/Sastravi, Stanek, Tasmar)
- opicapone (Ongentys)
- procyclidine (Kemadrin)
- trihexyphenidyl or benzhexol