Деякі поширені пероральні протипаркінсонічні препарати
Medication | Average Daily Dose and Maximum Dose When Applicable | Major Adverse Effects |
|---|---|---|
Dopamine precursors | ||
Carbidopa/levodopa 10/100, 25/100, or 25/250 mg (immediate-release or dissolvable) | 1–3 tablets of 25/100 mg 4 times a day | 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) | 1 or 2 tablets of 50/200 mg at bedtime | |
Antiviral medication | ||
Amantadine | 100 mg 2 times a day | Confusion, urinary retention, leg edema, elevated intraocular pressure, livedo reticularis Rarely, with discontinuation or a decrease in dose: Neuroleptic malignant syndrome |
Dopamine agonists | ||
Apomorphine | 2 to 6 mg subcutaneously or 10–30 mg sublingually | 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 site |
Pramipexole | 0.5–1 mg 3 times a day Maximum dose: 4.5 mg/day Extended-release formulation: Can be dosed once or twice a day | |
Ropinirole | 3–4 mg 3 times a day Maximum dose: 24 mg a day Extended-release formulation: Can be dosed once a day | |
Rotigotine | 4, 6, or 8 mg a day in a patch applied daily | |
Anticholinergic medications* | ||
Benztropine | 1 mg 2 times a day–2 mg 3 times a day | Drowsiness, dry mouth, urinary retention, constipation, blurred vision Particularly in older adults: Confusion, delirium, impaired thermoregulation due to decreased sweating |
Trihexyphenidyl | 2–5 mg 3 times a day | |
Monoamine oxidase type B (MAO-B) inhibitors | ||
Rasagiline | 1 mg once a day | Nausea, insomnia, somnolence, edema |
Selegiline† | 5 mg 2 times a day, given with breakfast and lunch | Possible potentiation of nausea, insomnia, confusion, and dyskinesias when given with levodopa |
Catechol O-methyltransferase (COMT) inhibitors | ||
Entacapone‡ | 200 mg with each dose of levodopa Maximum dose: 200 mg 8 times a day | Due to increased bioavailability of levodopa: Dyskinesias, nausea, confusion, hallucinations Unrelated to levodopa: Back pain, diarrhea, changes in color of urine With tolcapone, risk of liver toxicity (rare) |
Opicapone | 50 mg at bedtime | |
Tolcapone | 100–200 mg 3 times a day | |
* 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. | ||
† Selegiline is also available in a formulation designed for buccal absorption. | ||
‡ Entacapone is also available in a triple combination tablet (carbidopa, levodopa, and entacapone). | ||