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Guidelines for the Use of Parkinsonian Drugs (in USA)

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NeuroPsychopharmacotherapy

Abstract

Levodopa is the most effective drug for treating the motor symptoms of Parkinson’s disease. It is usually combined with a dopa-decarboxylase inhibitor to extend its half-life increasing levodopa availability to the brain. In patients who are younger and present with milder symptoms, medications such as dopamine agonists, catechol-O-methyl transferase inhibitors, or monoamine oxidase B (MAO-B) inhibitor may be used initially. This can delay the onset of levodopa-related complications, including motor fluctuations and dyskinesia. A number of approaches can be used to improve motor fluctuations including modification of the levodopa preparations, improvement in delivery of levodopa, and addition of adjunctive medications. Options for adjunct treatment include dopamine agonist, catechol-O-methyl transferase inhibitor, MAO-B inhibitor, or adenosine A2A antagonist drugs. Some patients respond well to continuous subcutaneous apomorphine infusion. Anticholinergic drugs are most useful as monotherapy in younger patients with predominantly disturbing tremor. Amantadine is mainly used for reducing the severity of dyskinesia. Currently, no neuroprotective drug has been proven to delay the progression of Parkinson’s disease.

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Vo, T.N.N., Frei, K., Truong, D.D. (2022). Guidelines for the Use of Parkinsonian Drugs (in USA). 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_357

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