Medication is an important part of your overall care. Choosing when to start medication for Parkinson's varies from person to person. Initially, Parkinson's symptoms may be mild and not interfere with daily routines. A good rule of thumb is to start medication when your Parkinson's symptoms become restricting or disruptive in some way.
Currently medication treatments are divided into Motor and Non-Motor symptom categories. You can find details about each of these categories by clicking on the links below:
Which medication is best for you depends on many factors, including your symptoms, age, time living with Parkinson's, and risk for side effects. Any of the available medications can be used early in the progression of Parkinson's depending on these factors.
Parkinson's symptoms may be mild for several years, requiring small doses of medication. During the first few years of treatment, controlling motor symptoms is also generally smooth, and missing a dose or two of medication may not even be noticeable. However, as the number of years with Parkinson's increases, fluctuations in the benefits of medication may emerge, and symptoms may begin to breakthrough before the next dose is due. During these "OFF" times, problems with gait, freezing, anxiety, speech, imbalance, tremor, stiffness, slowness, and posture can be very pronounced. You may start to feel like you are on a roller coaster when you feel good (ON) at times and worse (OFF) at other times.
If these symptoms occur, you and your physician can adjust your medications to reduce your OFF periods. These adjustments may include taking medication doses closer together, using longer-acting medications, such as dopamine agonists, or using carbidopa/levodopa boosters, such as MAO-B or COMT inhibitors. We break down each of these medications according to the appropriate motor or non-motor symptom categories.
As is the case with any medication, different people tolerate the same Parkinson's medications very differently. Some people experience medication side effects severe enough to warrant a change of course, while others experience few or no side effects. If you experience side effects with your medication, especially if the side effects interfere with your ability to go about your normal activities, discuss this with your physician as soon as possible. Your dosage might need to be adjusted, or your physician might choose a different medication or combination of drugs.
Treatment for Parkinson's is focused on achieving the most ON time and limiting OFF time as much as possible to give you the highest quality of life. However, as medications are increased, dyskinesias - involuntary, irregular jerking or wiggling movements - can become a problem. To treat dyskinesias, medication dosages may be reduced or changed completely.
Medications to Avoid or Use with Caution
It can be challenging to keep track of all your medications, especially if you're taking medications for both motor and non-motor symptoms. However, keeping an accurate, up-t0-date list of your medications decreases the likelihood of an unwanted medication interaction. Studies have found that one in three people with Parkinson's have been prescribed contraindicated drugs while they were hospitalized, which highlights the importance of always having an up-to-date list of medications available.
TIP: Download the below chart to keep with your Grab and Go Packet for all medical appointments and hospitalizations. Check back often to ensure you have the latest copies printed to share with your medical team.
Tips to Avoid Medication Interactions
Read all your medication labels carefully.
Inform your doctor if you had a new supplement or medication change for any of your medication dosages or usage. Your doctor should have a complete and current list of everything you are always taking.
Maintain a current list of your medications and dosages. This includes eye drops, skin lotions, and vitamins. Keep this with you and update it when you need to.
Memorize your food and drug allergies - include them in writing as well.
If you are struggling to remember your allergies or your medications, keep a list in your wallet or on your phone.
Review possible drug side effects. Most reactions occur when a new drug is started, but not always. Some reactions may be delayed, or they could occur when a new medication is added.
Use the same pharmacy for all of your medications if you can. This way, the pharmacist can monitor your medication list for any potential drug interactions and provide refills and advice as needed.
Medication Management Strategies
Medications are tailored to the individual and will vary from person to person, as no two people with Parkinson's will experience the same symptoms with the same severity. Mild symptoms in Parkinson's may not need to be treated. A tremor that doesn't interfere with activities may be more tolerable than the potential side effects of medication. For younger people with mild to moderate symptoms in the early stages of Parkinson's, a carbidopa/levodopa-sparing strategy may be recommended. A person's age and presence of other problems may determine which medications should be used. As Parkinson's changes over time, additional medications may need to be added or increased.
The importance of integrative care; rehabilitation therapies and targeted exercise are especially important to enhance safety and quality of life in all stages of PD. We take a deep dive into the most common medication management strategies by topic below - Click on each red button for more information.
Keeping an organized list of updated medications and having it available in case of an emergency or at every doctor's appointment is important. Whether you choose to keep this listing updated on your personal computer, phone, or old fashioned, pen and paper - it is important that you have the current list at hand in case you need it.
The PAA has developed a FREE template that you can use to model your own Medication Form, or you can download this form, print it, fill it out, and take with you to your appointments. Keeping it in an easy to grab and go binder can be very handy.
Hospitalization and Medications
Hospital stays for people with PD require special consideration, especially when it comes to medication. Before your hospital visit, make sure you have a complete, updated list of your medications, dosages, and the times of day that you take them. Keeping an accurate, up-to-date list decreases the likelihood of an unwanted medication interaction. Studies have found that one in three people with PD have been prescribed contraindicated drugs while they were hospitalized, which highlights the importance of always having an up-to-date list of medications available.
Be sure your hospital care team understands that all Parkinson's medications must be given on time. You and your care partner should strongly advocate on your behalf for this important point.
In addition to your list of medications, bring with you a list of your current symptoms. This will help your hospital care team recognize these symptoms, as they may not be familiar with such problems as dyskinesia, ON-OFF fluctuations, and freezing of gait. Be sure to let them know how your movement and abilities change during ON and OFF times. This also helps the hospital care team understand why it is so important for you to get your medications on time, every time.
When putting together a plan for hospitalization medication preparedness, consider the topics found on this page, Hospitalization Medication Preparedness:
Prescription Payment Assistance
Dealing with PD medications can be expensive. There are several different avenues for getting help with medication costs. Click on those options below to learn more.
Disclaimer: The information provided on this Parkinson Association of Alabama Resource Center is for awareness and educational purposes only about Parkinson's medications. The PAA does not endorse any specific brand or type of medication. All discussions about medication should be between you, your care partner and your medical teams.
Davis Phinney Foundation. Parkinson's Treatments and Therapies. Chapter 7 - Medication. Page 109, Pages 125-131. Every Victory Counts. "Manual." Sixth Edition, 2021.
Marie, Lianna. Medications to Avoid. Chapter 37, page 112. Managing Medication Side Effects. Chapter 33, pages 100-101. Betting the Most Out of Medications. Chapter 35, pages 105-106. The Complete Guide for People with Parkinson's Disease and Their Loved Ones. Purdue University Press, (C) 2022.