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Definition and Classification of Parkinsonian Drugs

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NeuroPsychopharmacotherapy

Abstract

Antiparkinsonian drugs can be classified as dopaminergic and non-dopaminergic drugs. Dopaminergic drugs include levodopa, dopamine agonists, monoamine oxidase B inhibitors, catechol-O-methyltransferase inhibitors, and zonisamide. Non-dopaminergic drugs include the anticholinergics, amantadine HCl, adenosine A2A inhibitors, and L-threo-dops. Among them, levodopa with a peripheral dopa decarboxylase inhibitor appears to be most effective. If a patient is under the age of 50 years, one should try a non-ergot dopamine agonist first. A severe wearing off and dyskinesia may result, if you use levodopa in young onset Parkinson’s disease patients. Monoamine oxidase inhibitors and catechol-O-methyltransferase inhibitors may aggravate dyskinesia induced by levodopa. Dopamine agonists and adenosine receptor antagonists also may aggravate dyskinesia. One of the major problems of levodopa is wearing off and dyskinesia. They set in 2–6 years of the initiation of levodopa treatment. Initially, the improvement from levodopa is smooth despite two to three times of drug intake in a day. This is mainly due to the remaining nigral dopaminergic neurons. But as the treatment goes on, the remaining dopaminergic neurons go away. Then the serotonergic neurons and glia in the basal ganglia seem to the place for levodopa to dopamine conversion. Thus, wearing-off results. When dopamine released to the synaptic cleft is too much, dyskinesia may result. Even though the wearing off and dyskinesia set in, levodopa is the most effective drug for Parkinson’s disease.

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Authors and Affiliations

  1. Juntendo University School of Medicine, Tokyo, Japan

    Yoshikuni Mizuno

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  1. Yoshikuni Mizuno
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Correspondence to Yoshikuni Mizuno .

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Editors and Affiliations

  1. Clinic and Policlinic for Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany

    Peter Riederer

  2. Institute of Psychological Medicine (IPM), Soyen, Germany

    Gerd Laux

  3. Centre for Research Promotion and Support, Fujita Health University, Toyoake, Aichi, Japan

    Toshiharu Nagatsu

  4. Center Translational Res Neurol Diseases, Dalian Med Uni Shanghai Inst Health Sc Center Translational Res Neurol Diseases, Dalian, China

    Weidong Le

  5. Würzburg, Germany

    Christian Riederer

Section Editor information

  1. Fujita Health University School of Medicine, Toyoake, Aichi, Japan

    Toshiharu Nagatsu

  2. Institute of Environmental Medicine, Nagoya University, Nagoya, Aichi, Japan

    Toshiharu Nagatsu

  3. Department of Physiological Chemistry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan

    Akira Nakashima

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Mizuno, Y. (2022). Definition and Classification of Parkinsonian Drugs. In: Riederer, P., Laux, G., Nagatsu, T., Le, W., Riederer, C. (eds) NeuroPsychopharmacotherapy. Springer, Cham. https://doi.org/10.1007/978-3-030-62059-2_213

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  • DOI: https://doi.org/10.1007/978-3-030-62059-2_213

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