Parkinson's Disease - Medications

Side Effects. Side effects are similar to those of anticholinergic drugs and also may include swollen ankles and mottled skin. It can also cause visual hallucinations. Overdose can cause serious and even life-threatening toxicity. Patients with Parkinson's should not withdraw from this drug abruptly. In rare instances, it can cause acute delirium or a life-threatening condition called neuroleptic malignant syndrome. Pregnant or nursing women should not use this drug.

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Investigative Agents

Dopamine Agonists. A rotigotine transdermal patch (Neupro) is showing promise in late-stage (Phase III) trials. Piribedil (Trivastal) is also progressing in clinical trials.

Monoamine Oxidase B (MAO-B) Inhibitors. Rasagiline (Agilect) has demonstrated effectiveness as a single-drug treatment for early-stage Parkinson?s disease. Recent research indicates that when used in combination with levodopa, rasagiline may also be useful for treating advanced Parkinson?s. Another MAO-B inhibitor, safinamide, improved motor function in a trial of patients with moderately severe Parkinson?s disease.

Cholinesterase Inhibitors. The Alzheimer?s drug rivastigmine (Exelon) is being investigated for treatment of dementia in Parkinson?s patients. Initial results show moderate improvement but side effects include nausea, vomiting, and tremors.

Coenzyme Q10 (Ubiquinone). Coenzyme Q10 (also called ubiquinone) is an antioxidant that is being studied for Parkinson's disease. This enzyme is important for cellular energy, which may be impaired in PD. In one study, patients who took coenzyme Q10 experienced slower decline in daily activities and mental and motor skills compared to patients on placebo. This is available as a supplement in health food stores, but such products are not necessarily those used in clinical studies. Patients should check with their physician about taking it.

Budipine and Other Glutamate Blockers. A number of experimental drugs are being investigated for Parkinson's disease because they block the actions of glutamate, an amino acid that is a particularly potent nerve cell killer. Some of these drugs block a receptor group to glutamate called N-methyl-D-aspartate (NMDA). Investigative NMDA antagonists include remacemide, memantine, riluzole, and budipine. Budipine is of particular interest. It not only blocks NMDA, but it increases levels of two enzymes involved in the production of dopamine. Studies suggest that it reduces tremor in PD and it proving to be beneficial in combination with levodopa.