What are clinical practice guidelines?

Clinical practice guidelines are documents for doctors and other medical professionals that make recommendations for best practices in the diagnosis and treatment of medical conditions. Guideline recommendations are based on a thorough review of available studies on the topic, as well as the expertise of the guideline authors.

What is Parkinson’s disease?

Parkinson’s disease is a neurologic disorder caused by a lack of dopamine in the brain. Parkinson’s disease can cause motor symptoms such as tremor, stiff muscles, slow movements, and dyskinesia (involuntary, erratic, writhing movements of the face, arms, legs, or trunk) and non-motor symptoms such as depression, anxiety, problems with memory and concentration, pain, fatigue, constipation, and sleep problems. Learn more about Parkinson’s disease.

What are dopaminergic medications?

Dopaminergic medications help replace dopamine in the brain. The medications reviewed in this guideline include levodopa, dopamine agonists, MAO-B inhibitors, and COMT-inhibitors.

What does the research say about medications for Parkinson’s disease?

This guideline reviewed the current research into the effectiveness and possible risks of the available dopaminergic medications to treat motor symptoms in the early stages of Parkinson’s disease. The analysis of the research found that initial treatment with levodopa is better at reducing motor symptoms than treatment with dopamine agonists or MAO-B inhibitors. It also found that levodopa is more likely than dopamine agonists to cause dyskinesia while dopamine agonists are more likely to cause impulse-control disorders such as compulsive gambling, eating, or sexual activity. The research found that patients are more likely to stop their treatment because of adverse effects when taking dopamine agonists than when taking levodopa.

What are the key takeaways from the guideline?

• The recommendations provide guidance on the risks and benefits of taking levodopa, dopamine agonists, and MAO-B inhibitors for your motor symptoms.
• Levodopa is usually the best first treatment for motor symptoms.
• Before starting treatment with dopamine agonists, you should talk to your doctor about potential adverse effects of the medication.

What else should I know about treating my Parkinson’s disease?

• Studies do not show an advantage in delaying medical or drug treatment for motor symptoms caused by Parkinson’s disease.
• Choosing to start a medication is a collaborative decision between you and your care team. The right medication for you will depend on your symptoms, age, and life circumstances.
• You are encouraged to discuss the potential costs, benefits, and adverse effects of your medication options with your clinician.

This practice guideline update was endorsed by the Parkinson’s Foundation.  Read the full guideline.