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Medications to Avoid and 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 to 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 this form to keep with your Grab and Go Packet for all medical appointments and hospitalizations.



There are certain medications to avoid depending on what prescriptions you are taking to manage your Parkinson’s symptoms. This is especially true if you are taking an MAO-B Inhibitor.


MAO-B Inhibitors Monoamine Oxidase Type B (MAO-B) is an enzyme in our body that breaks down brain chemicals such as dopamine. MAO-B inhibitors block the effect of MAO-B to improve many motor symptoms of Parkinson’s disease. MAO-B inhibitors are commonly used in early therapy or in addition to other medications to help reduce ‘off” time and extend “on” time. Some studies indicate that MAO-B inhibitors slow the progress of PD by offering neuroprotection. MAO-B inhibitors are used to treat slowness, stiffness, tremor and on/off fluctuations. The most common side effects of MAO-B inhibitors, include: mild nausea, dry mouth, lightheadedness and constipation.


Pharmacists routinely warn about drug interactions with MAO-B inhibitors, including antidepressants. Prior to starting any MAO-B inhibitor, carefully review all medications, including over the counter medications with your physician for possible adverse reactions. It is also very important to provide information about MAO-B inhibitors to anesthesiologists prior to any surgeries. Some of the common generic and trade names for MAO-B Inhibitors include:

  • Selegiline – Eldepryl

  • Slegiline HCL Orally Disentegrating – Zelapar

  • Rasagiline – Zilect

  • Safinamide – Xadago

Most prescription antidepressants have a potential interaction with MAO-B inhibitors. Prescription antidepressants have been used safely in thousands of people with PD, but your prescribing physician may need to inform the pharmacy if they consider the benefits to outweigh the risks. Below are some medications that should be avoided or used with caution under a physician’s care if you are taking a MAO-B Inhibitor

  • Pain Medications: Meperidine, Tramadol, Methadone (Demerol, Ultram, Adolophine)

  • Antidepressants: Over the counter such as St. John’s Wort

  • Muscle Relaxants: Cyclobenzaprine or Flexeril

  • Cough Suppressants: that contain Dextromethorphan (Robitussin and other brands)

  • Decongestants: with Pseudoephedrine, Phenylephrine or Ephedrine (Sudafed, Vicks, Sinex, etc.)

  • Other Medications: Linezolid, Phenelzine, Tranylcypromine, Isocarboxazid

First generation antipsychotics are medications that block dopamine receptors in the brain, thus countering the desired effects of Parkinson’s medications and likely worsening Parkinson’s motor symptoms. These include:

  • Lurasidone

  • Asenapine

  • Olanzapine

  • Aripiprazole

  • Iloperidone

  • Cariprazine

  • Risperidone

  • Brexpiprazole

  • Ziprasidone

  • Paliperdone

  • Latuda

  • Sphris

  • Zyprexa

  • Abilify

  • Fanapt

  • Vraylar

  • Risperdal

  • Rexulti

  • Geodon

  • Invega

Antiemetics are medications often used to treat nausea by blocking dopamine receptors in the brain, thus countering the desired effects of Parkinson’s medications and possibly worsening Parkinson’s motor symptoms:

  • Prochlorperazine

  • Chlorpromazine

  • Promethazine

  • Metoclopramide

  • Droperidol

  • Compazine

  • Thorazine

  • Phenergan

  • Reglan

  • Inapsine

Treatments for hyperkinetic movements are used for a condition called tardive dyskinesia, which is different than carbidopa/levodopa – induced dyskinesia. These medications lower dopamine, possibly worsening Parkinson’s motor symptoms. They include:

  • Tetrabenazine

  • Valbenazine

  • Deutetrabenzine

  • Xenazine

  • Ingrezza

  • Austedo

Antihypertensives are medications used to reduce dopamine which possibly worsen Parkinson’s motor symptoms. They are:

  • Reserpine

  • Methyldopa

  • Serpalan

  • Aldomet

Amoxazpin is a TCA, but unlike other TCAs also blocks dopamine receptors, Phenelzine, isocarboxazid and tranylcypromine are nonselective MAO inhibitors and cannot be taken in conjunction with MAO-B inhibitors.


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


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.

Sources:

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.


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