𝐏𝐚𝐫𝐤𝐢𝐧𝐬𝐨𝐧’𝐬 𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭 𝐇𝐚𝐬 𝐂𝐡𝐚𝐧𝐠𝐞𝐝: 𝐖𝐡𝐲 𝐃𝐨𝐜𝐭𝐨𝐫𝐬 𝐀𝐫𝐞 𝐔𝐬𝐢𝐧𝐠 𝐋𝐞𝐯𝐨𝐝𝐨𝐩𝐚 𝐄𝐚𝐫𝐥𝐢𝐞𝐫

For many years, people newly diagnosed with Parkinson’s disease (PD) were often started on a dopamine agonist rather than levodopa. Today, that approach has changed. For many patients—particularly adults over age 60—carbidopa/levodopa (Sinemet) is now the preferred first treatment when Parkinson’s symptoms begin to interfere with daily life.

PD causes symptoms such as slowness, stiffness and tremor because the brain gradually loses cells that produce dopamine. Levodopa is converted into dopamine in the brain and is generally the most effective medication for improving these movement symptoms.

In the past, doctors sometimes delayed levodopa because of concerns that long-term treatment would lead to dyskinesias, or involuntary extra movements, and fluctuations in how well the medication worked. There was also a belief that starting levodopa early might cause it to “stop working” sooner.

Because of these concerns, younger patients in particular were often started on dopamine agonists such as Mirapex, Requip, or Neupro. These medications stimulate dopamine receptors directly and can improve PD symptoms without using levodopa.

We now know that levodopa does not simply “wear out” because someone starts taking it early. Motor fluctuations and dyskinesias appear to be strongly related to the progression of PD itself, as well as the dose and duration of levodopa exposure. Importantly, levodopa generally provides better improvement in movement symptoms than dopamine agonists.

Dopamine agonist are now known to have side effects, such as sleepiness, dizziness, leg swelling, hallucinations, confusion and impulse control disorders.

Currently, carbidopa/levodopa is the preferred initial medication when movement symptoms require treatment. Dopamine agonists still have an important role, but their potential side effects are considered more carefully than they were in the past.

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