Some Commonly Used Oral Antiparkinsonian Medications

Some Commonly Used Oral Antiparkinsonian Medications
Medication	Major Adverse Effects
Dopamine precursors
Carbidopa/levodopa 10/100, 25/100, or 25/250 mg (immediate-release or dissolvable)Carbidopa/levodopa 10/100, 25/100, or 25/250 mg (immediate-release or dissolvable)	Central: Drowsiness, confusion, orthostatic hypotension, psychotic disturbances, nightmares, dyskinesia Peripheral: Nausea, anorexia, flushing abdominal cramping, constipation, palpitations With sudden discontinuation: Neuroleptic malignant syndrome
Carbidopa/levodopa 25/100 or 50/200 mg (controlled-release; recommended only for nighttime [not daytime] symptoms)Carbidopa/levodopa 25/100 or 50/200 mg (controlled-release; recommended only for nighttime [not daytime] symptoms)
Antiviral medication
AmantadineAmantadine	Confusion, urinary retention, leg edema, elevated intraocular pressure, livedo reticularis Rarely, with discontinuation or a decrease in dose: Neuroleptic malignant syndrome
Dopamine agonists
ApomorphineApomorphine	Nausea, vomiting, light-headedness (due to orthostatic hypotension), hallucinations, impulse control disorder (gambling, buying, excessive eating, collecting) With the rotigotine patch only, redness, itching, and swelling in the legs and at the application siteWith the rotigotine patch only, redness, itching, and swelling in the legs and at the application site
PramipexolePramipexole
RopiniroleRopinirole
Rotigotine (transdermal)Rotigotine (transdermal)
Monoamine oxidase type B (MAO-B) inhibitors
RasagilineRasagiline	Nausea, insomnia, somnolence, edema
SelegilineSelegiline	Possible potentiation of nausea, insomnia, confusion, and dyskinesias when given with levodopa
Anticholinergic medications†
BenztropineBenztropine	Drowsiness, dry mouth, urinary retention, constipation, blurred vision Particularly in older adults: Confusion, delirium, impaired thermoregulation due to decreased sweating
TrihexyphenidylTrihexyphenidyl
Catechol O-methyltransferase (COMT) inhibitors
Entacapone‡Entacapone‡	Due to increased bioavailability of levodopaDue to increased bioavailability of levodopa: Dyskinesias, nausea, confusion, hallucinations Unrelated to levodopaUnrelated to levodopa: Back pain, diarrhea, changes in color of urine With tolcapone, risk of liver toxicity (rare)With tolcapone, risk of liver toxicity (rare)
OpicaponeOpicapone
TolcaponeTolcapone
* Selegiline is also available in a formulation designed for buccal absorption. * Selegiline is also available in a formulation designed for buccal absorption.
† Anticholinergic medications should preferably not be used in older adults. Because these medications have adverse effects and because recent findings suggest that these medications may increase tau pathology and neurodegeneration, their use should be limited.
‡ Entacapone is also available in a triple combination tablet (carbidopa, levodopa, and entacapone).‡ Entacapone is also available in a triple combination tablet (carbidopa, levodopa, and entacapone).

* Selegiline is also available in a formulation designed for buccal absorption. * Selegiline is also available in a formulation designed for buccal absorption.

† Anticholinergic medications should preferably not be used in older adults. Because these medications have adverse effects and because recent findings suggest that these medications may increase tau pathology and neurodegeneration, their use should be limited.

‡ Entacapone is also available in a triple combination tablet (carbidopa, levodopa, and entacapone).‡ Entacapone is also available in a triple combination tablet (carbidopa, levodopa, and entacapone).

In these topics

Parkinson Disease