Guidelines for the Use of Parkinsonian Drugs in Canada
Drug therapies available for patients with Parkinson’s disease (PD) in Canada are similar to all other regions of the world where the primary focus is on dopamine replacement therapies predominantly with levodopa/carbidopa and levodopa/benserazide immediate release and controlled release levodopa/carbidopa. No other levodopa preparations are available. Dopamine agonists (DA), as monotherapy or adjunct therapy, are less commonly used due to the side effect profile. Longer-acting ropinirole and pramipexole, as well as apomorphine subcutaneous infusion pump therapy, are not available in Canada. For subjects with fluctuating symptoms, add-on therapies with monoamine oxidase B inhibitors (MAOB-I), rasagiline or selegiline, and the catechol-o-methyltransferase inhibitor (COMT-I), entacapone, are commonly used options. Other MAOB inhibitors and COMT-I are not easily available. Dyskinesia can be reduced with amantadine. There are no recommended drugs for disease modification available. For the many non-motor symptoms in PD, including neuropsychiatric symptoms, autonomic failure, pain, and sleep disorders, drugs used in non-PD areas available in Canada are used.
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