Gocovri (amandine) prevents cells from recycling dopamine. Opicapone works by preventing a different enzyme, catechol-O-methyltransferase (COMT), from breaking down dopamine. Xadago (safinamide) inhibits monoamine oxidase, an enzyme that normally breaks down dopamine. There are three therapies work to extend the effectiveness of levodopa by maintaining increased dopamine concentrations in the brain. Thus, many emerging therapies are designed to make the treatment more effective and reduce the side effects. Emerging and experimental therapeuticsĪlmost all patients with severe Parkinson’s who take levodopa or levodopa-carbidopa will, over time, experience motor fluctuations and dyskinesias. However, he believes that because every patient is different, the timing, choice, and dosage of therapy must be individualized according to the needs of each particular patient. Therefore, delaying the use of the therapy, particularly for patients with increased functional disability, is not backed by currently available scientific data, he said. “There is no doubt that delaying levodopa therapy by using dopamine agonists early may delay the onset of levodopa-related motor complications,” Jankovic said.Īlthough levodopa has some potential for side effects in vitro (or in the laboratory), Jankovic said there is no evidence that this translates to patients. Instead of helping the brain produce more of the dopamine it lacks, these treatments directly stimulate the receptors that dopamine would normally act on.Ī 2009 study, which compared pramipexole with levodopa in patients who had not yet been treated with levodopa, found that 50% of those on pramipexole experienced dyskinesia, compared with 68.4% of the levodopa patients. Jankovic “strongly discouraged” the use of these products for “many, many reasons,” chief among them that some supplements contain levodopa at inconsistent doses.Īn alternative for patients and neurologists concerned about starting levodopa too early are dopamine agonists such as Mirapex (pramipexole), Requip (ropinirole), Dostinex (cabergoline), and Permax (pergolide). Some patients may turn to natural supplements, such as bacopa extract or mucuna pruriens. When patients first start to experience symptoms severe enough to require treatment, they and their doctors may be reluctant to start levodopa or levodopa-carbidopa - the most commonly used treatment for Parkinson’s symptoms - for fear they will develop motor complications such as dyskinesias.
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