The choice of drugs depends on a risk/benefit evaluation based on:
- The ability to improve motor disability (better with levodopa)
- The risk of motor complications (more common in younger patients; delayed by agonists)
- The risk of neuropsychiatric complications (more common in older and cognitively impaired patients; greater with agonists)
Medications for the treatment of de novo patients
MAO-B inhibitors (Level A)
|
| Dopamine agonists
Initial treatment with an agonist can be recommended in younger patients (GPP).
Note that ergot derivatives are not recommended as first-line medication because of the risk of fibrotic reactions. |
| Levodopa
Levodopa is the most effective symptomatic drug (Level A).
Note that controlled-release formulations or adding entacapone is not effective in the delay of motor complications (Level A). |
Anticholinergics (Level B)
|
| Amantadine (Level B)* |
*Not available in Ireland
Download algorithm in pdf:
Practical recommendations for the adjustment of initial therapy in patients without motor complications – EFNS/MDS-ES guidelines [adapted]
Level A – effective
Level B – probably effective
Level C – possibly effective
GPP – good practice point
Rehabilitation: A recommendation cannot be made because of the lack of evidence in early-stage disease.
Reference: [Adapted from]. Ferreira J.J. et al. Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson’s disease. European Journal of Neurology. European Journal of Neurology 2013, 20: 5-15. MIMS Copyright®