As you may know, medications are the backbone of the Parkinson's treatment plan. But because the disease affects everyone differently, and each person's response to therapy will vary, there is no hard-and-fast rule about when you should begin taking medication and what to take first. Some doctors prescribe medication upon diagnosis. Others believe that drugs, especially levodopa, should be delayed as long as possible to avoid earlier onset of medication-related side effects.
Your involvement from the very start is important because you want to be sure your doctor is addressing your individual needs. When your doctor writes a new prescription, or makes a change to an existing one, take the opportunity to ask for an explanation. If her response goes something like, "I always start my Parkinson's patients on X dosage of Y, a dopamine agonist," you might want to consider switching to a movement disorders specialist, a neurologist who has had special training in Parkinson's disease and other movement disorders.
Taking a closer look at your options
Since the drug levodopa (L-dopa for short) was synthesized in the 1960s, levodopa in combination with carbidopa (brand name Sinemet), has been the gold standard for treating the symptoms of Parkinson's. However, after several years of taking this medication some people experience dyskinesias, or involuntary writhing movements. This is sometimes referred to as levodopa-induced dyskinesias or "LIDS." The fear of these side effects has led many clinicians and patients to avoid levodopa-carbidopa for as long as possible.
But some experts do not believe this "levodopa phobia" is warranted (risk factors for LIDS include younger age at onset, duration of treatment and a higher levodopa dose). In short, they say that levodopa can be considered as a potential first-line therapy in all age groups---although caution should be exercised in younger patients. In most cases, the dosage will start low then increase slowly, often in combination with other medications, to adjust to a person's changing condition.
Other first-line medications that can be used to control Parkinson's symptoms include drugs known as dopamine agonists and monamine oxidase inhibitors. Dopamine agonists provide relief by mimicking the action of dopamine within the brain, and monamine oxidase inhibitors help maintain motor control by slowing the breakdown of dopamine within the brain. These drugs can help younger patients buy some time before starting levodopa-carbidopa.
For an in-depth explanation of all medications used to treat both motor and non motor symptoms of Parkinson's disease medications, download a copy of NPF's Parkinson's Disease Medications Manual.
Timing is everything
When it comes to Parkinson's medications, timing is critical. That is why it is so important to take all prescription drugs exactly as directed. Levodopa-carbidopa, in particular, must be taken in precise, consistent dosages throughout the day in order to control symptoms. The goal is to maintain a steady supply of the medicine in your bloodstream. When medication is not taken on time, "freezing" and other sudden and debilitating motor symptoms can occur.
Keeping a drug diary
You will need to report back to your doctor about how your body is responding to the medication you are taking. A good way to do this is by keeping a drug diary. This can be done simply, with a notebook and a pencil. Take this diary with you to every doctor visit. Here is what to record:
Warning signs. Write down any new experience, from a headache to mild diarrhea to hives to anaphylactic shock. Ask your care partner to jot down any side effects he or she notices.
Changes to your meds. Whenever your doctor adds or withdraws a medication or changes a dose, enter that information into your diary.
A list of medicines. Keep an updated list of everything you are taking, including supplements, along with specific dosages.
Avoiding negative interactions
Be aware that some medicines can have a negative effect on your condition. That is why it is important to familiarize yourself with all the medications that people with Parkinson's should avoid. Having this information on hand can help prevent dangerous interactions and other problems.
As you can see the answer to the medication question can be long and and tricky. Work with your physician to make sure you are taking the medications that are right for you.
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