Parkinson’s medications

Levodopaphobia refers to the fear or reluctance to start or continue levodopa treatment, a cornerstone medication for managing Parkinson’s. It can significantly impact quality of life.

Causes of Levodopaphobia

• Many people with Parkinson’s worry about potential side effects of levodopa, such as dyskinesias (involuntary movements), which are more common with long-term use (Thanvi et al., 2007).
• Some believe that levodopa becomes less effective over time, leading to a reluctance to start treatment early.
• People with YOPD may wish to postpone levodopa use, fearing they will “run out of options” later in life.

Impact on people living with young onset Parkinson’s

For those with YOPD, levodopaphobia can be particularly challenging. Younger people often face unique life-stage pressures, such as managing careers, raising families, and maintaining social activities. Avoiding levodopa can lead to poorly managed symptoms, which may interfere with these responsibilities and reduce participation in things that make their life enjoyable and increase wellbeing.

Addressing Levodopaphobia

• Providing accurate information about levodopa’s benefits and addressing misconceptions can help alleviate fears.
• Tailoring medication regimens to individual needs and concerns can improve adherence and outcomes.
• Connecting with your care team, support groups, and participating in conferences put on by trusted organisations like Parkinson’s Australia can provide reassurance and guidance.

1. Dopamine Precursor (Levodopa)

Dopamine-producing cells in the brain die off in Parkinson’s, which leads to motor symptoms (just like a diabetic no longer produces insulin). Levodopa is the “gold standard” medication that helps by turning into dopamine once it reaches the brain. But there’s a catch—it needs neurons there to soak it up and it doesn’t last long in the body, so starting early and optimising your medication schedule is key: “Meds on time, every time.”

To make Levodopa more effective, it’s combined with a helper drug called a dopa decarboxylase inhibitor (DDI). This ensures more Levodopa reaches the brain. Common DDIs include Carbidopa (found in Kinson) and Benserazide (in Madopar). For example, Kinson 125 contains 100 mg of Levodopa and 25 mg of Carbidopa.

• What it treats: Levodopa is the most effective medication for managing motor symptoms, including tremor, rigidity, and slow movement. It’s often referred to as the “gold standard.”
• How it works: Levodopa converts into dopamine in the brain, replenishing the levels lost due to Parkinson’s; like insulin is replaced for people living with diabetes.
• Side effects: Common side effects include nausea, low blood pressure, and dizziness. Long-term use may cause dyskinesias (involuntary movements).

2. Dopamine Agonists (Dopamine Mimics)

Think of these drugs as imitators—they mimic dopamine by stimulating the same receptors in the brain. Common ones include Pramipexole (Sifrol) and Rotigotine patches (Neupro). They’re sometimes used in the early stages to delay starting Levodopa or alongside Levodopa to enhance its effect.

• What it treats: These drugs help improve motor symptoms and are sometimes used early to delay starting Levodopa or alongside Levodopa for enhanced motor control (tremor, stiffness, slowness). Dopamine agonists are also commonly used to effectively reduce the uncomfortable sensations and the urge to move the legs Restless Legs Syndrome (RLS).
• How they work: Dopamine agonists mimic dopamine by stimulating the brain’s dopamine receptors.
• Side effects: Possible side effects include fatigue, nausea, and hallucinations. They can also increase the risk of impulse-control disorders (e.g., hypersexuality, compulsive shopping, gambling, or eating). If these ICDs occur, tell your GP immediately and get an adjustment to your medications.

3. Inhibitors

• Monoamine Oxidase-B Inhibitors (MAO-B Inhibitors): These medications work by stopping an enzyme (monoamine oxidase-B) that breaks down dopamine. The result? More dopamine sticks around in your brain. Common options include Rasagiline (Azilect) and Safinamide (Xadago). They can improve motor symptoms and may be easier to tolerate than dopamine agonists.
  • What it treats: MAO-B inhibitors can help manage motor symptoms and motor fluctuations. Some people prefer these for their potential to be better tolerated than other medications.
  • How they work: These drugs block an enzyme that breaks down dopamine, increasing its availability in the brain.
  • Side effects: Mild nausea, headaches, and insomnia are possible side effects. They may also interact with certain foods or medications.
• Catechol-O-methyltransferase (COMT) Inhibitors: COMT inhibitors stop dopamine from breaking down too quickly in the body, giving Levodopa a longer-lasting effect. Examples include Entacapone (Comtan) and Opicapone (Ongentys). Some medications, like Stalevo, even combine Levodopa, a DDI, and Entacapone all in one.
  • What it treats: COMT inhibitors are used to enhance the effect of Levodopa and reduce motor fluctuations.
  • How they work: These medications prevent the breakdown of dopamine in the body, extending Levodopa’s effectiveness.
  • Side effects: Side effects can include diarrhoea, orange urine discolouration, and abdominal discomfort.

5. Amantadine

Amantadine (Symmetrel or Amantamed) can help with involuntary movements (dyskinesias) caused by long-term Levodopa use. It’s usually used alongside other medications.

• What it treats: Amantadine is often prescribed to reduce dyskinesias (involuntary movements) caused by prolonged Levodopa use.
• How it works: It’s thought to increase dopamine release and block glutamate receptors to reduce motor symptoms.
• Side effects: Potential side effects include swelling in the legs, blurred vision, and confusion.