Hey Guys ,
Anyone got a simple break down on the order of treatment for Parkinson disease .. I cant seem to get my head around what medications to use at each stage of the disease and with specific symptoms . Thanks
I'm going through UWorld for Step 3 now, and they say you
start with
dopamine receptor agonists (e.g., ropinerole, pramipexole).
They then say levodopa (they didn't say levodopa/carbidopa) is
more effective than dopamine agonists but is notably not used first because it's associated with degradation of remaining dopaminergic cells in the substantia nigra and worsening of symptoms long term. So levodopa we try to reserve for last. Its use is also associated with dyskinesia.
They said in exceptional circumstances in patients over age 65 levodopa can be used first, but the rule of thumb is dopamine receptor agonists first.
This particular UW question didn't say anything about amantadine, but I recall MTBs saying something about how it's the best drug for halting progression of the disease.
And catechol-o-methyltransferase inhibitors are never used alone but as augmentation therapy.
Benztropine is just for Tx of cholinergic side-effects (i.e., it's anti-).
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So my basic understanding is dopamine agonists first. Levodopa try to use last.
