Pharmacological management of Parkinson's disease.

Abstract

Parkinson's disease is an incurable neurodegenerative disease of the elderly. Although symptoms can be ameliorated by drugs, optimum management requires a multidisciplinary approach. Pharmacotherapy is usually initiated with levodopa using gradual dosage titration. Initial therapy with dopamine agonists such as cabergoline can be considered in younger patients. Cabergoline can also be used to reduce levodopa dosage in patients who develop dyskinesia. End-of-dose effects may require more frequent levodopa administration and the addition of a catechol-O-methyl transferase inhibitor such as entacapone. In mid-stage disease a degree of dyskinesia may be accepted in order to maintain movement capacity. Cabergoline can also be used for levodopa sparing. In advanced disease, fluctuations between on and off states become rapid and disabling. Levodopa dosage can be further refined with a liquid formulation and apomorphine may be used to overcome sudden off periods.