4.1 Identify medication used to manage Parkinson’s disease

This guide will help you answer 4.1 Identify medication used to manage Parkinson’s disease.

Parkinson’s disease is a long-term condition that affects the brain. It damages nerve cells in an area called the substantia nigra, which reduces dopamine levels. Dopamine is a chemical that helps control body movement. Low dopamine causes the symptoms of Parkinson’s such as tremors, stiffness, and slow movement.
Medication does not cure Parkinson’s but it can help manage the symptoms and improve quality of life. There are several main types of drugs which work in different ways.

Levodopa

Levodopa is the most common and effective medicine for Parkinson’s. The brain turns levodopa into dopamine. This helps replace the missing dopamine and reduces movement problems.

Levodopa is often combined with another drug known as carbidopa or benserazide. These medicines stop levodopa from breaking down before it reaches the brain. This combination means a lower dose can be used and side effects are reduced.

Common types:

• Co-careldopa (levodopa with carbidopa) – brand names such as Sinemet and Half Sinemet
• Co-beneldopa (levodopa with benserazide) – brand names such as Madopar

Main effects:

• Improves control of movements
• Reduces stiffness and tremors
• Makes it easier to carry out daily activities

Possible side effects:

• Feeling sick
• Low blood pressure when standing
• Confusion or hallucinations in some people
• Involuntary movements (dyskinesia) after long-term use

Dopamine Agonists

Dopamine agonists copy the action of dopamine in the brain. They do not change into dopamine but act on the same receptors. They can be used alone in early stages or alongside levodopa later.

Common types:

• Pramipexole
• Ropinirole
• Rotigotine (available as a skin patch)
• Apomorphine (given as injection or infusion in advanced Parkinson’s)

Main effects:

• Control symptoms, especially in early disease
• Can be used to smooth out “on-off” fluctuations with levodopa

Possible side effects:

• Sleepiness or sudden sleep attacks
• Hallucinations
• Swelling in the legs
• Impulse control problems (such as gambling, overeating or increased sexual urges)

Impulse control problems are an important side effect to watch for and report. The risk may be higher with dopamine agonists than other Parkinson’s drugs.

MAO-B Inhibitors

Monoamine oxidase type B (MAO-B) inhibitors block an enzyme in the brain that breaks down dopamine. This helps dopamine last longer in the brain. It can be used on its own in early Parkinson’s or with other medicines to improve control.

Common types:

• Selegiline
• Rasagiline
• Safinamide

Main effects:

• Extend the action of dopamine
• Reduce motor symptoms
• May allow lower doses of levodopa

Possible side effects:

• Nausea
• Headaches
• Insomnia if taken late in the day

COMT Inhibitors

Catechol-O-methyltransferase (COMT) inhibitors block another enzyme that breaks down levodopa. This helps levodopa stay active for longer. These drugs are not used alone but work alongside levodopa to prolong its effect.

Common types:

• Entacapone
• Tolcapone (less common due to risk of liver damage)
• Opicapone

Main effects:

• Help levodopa work for longer periods
• Reduce “off” times when levodopa stops working

Possible side effects:

• Diarrhoea
• Orange or brown urine
• Increased levodopa side effects such as dyskinesia

Anticholinergic Medicines

Anticholinergic medicines block the activity of acetylcholine, a chemical in the brain that can become overactive when dopamine is low. This helps improve the balance of brain chemicals.

These drugs are more effective for tremor than other symptoms and tend to be used less often now, especially in older adults, due to side effects.

Common types:

• Procyclidine
• Trihexyphenidyl (benzhexol)
• Orphenadrine

Main effects:

• Reduce tremor
• Reduce muscle stiffness

Possible side effects:

• Dry mouth
• Blurred vision
• Constipation
• Confusion (more common in older people)

Amantadine

Amantadine is another medicine sometimes used for Parkinson’s. It is not as strong as other treatments but can help with tiredness, movement problems and dyskinesia (involuntary movements caused by levodopa).

Main effects:

• Reduces dyskinesia
• Provides mild control of symptoms

Possible side effects:

• Mottled skin appearance (livedo reticularis)
• Swelling in the legs
• Insomnia

Supporting Medications for Parkinson’s Symptoms

Besides the main types used to replace or mimic dopamine, doctors may prescribe other drugs to help manage specific problems linked with Parkinson’s.

Examples:

• Medicines for depression, as low mood is common
• Drugs for constipation, which Parkinson’s can cause
• Sleep aids if insomnia becomes troublesome
• Blood pressure medicines for low standing blood pressure

These medicines do not treat the root cause but make everyday life easier by tackling separate symptoms.

Routes and Methods of Taking Parkinson’s Medicines

Most Parkinson’s medicines are taken by mouth as tablets or capsules. Some options use other delivery methods.

Examples:

• Skin patches (rotigotine) for steady drug release
• Injections (apomorphine) for quick symptom relief
• Liquid forms for people with swallowing problems
• Intestinal gel (levodopa-carbidopa intestinal gel) given through a tube directly into the small intestine in advanced cases

These methods allow better absorption or smoother symptom control when tablets are less effective.

Combining Medicines

Parkinson’s often changes over time. The same treatment may not work as well after several years. Many people start with one medicine and later need a combination.

Common combinations:

• Levodopa with a dopamine agonist
• Levodopa with a MAO-B inhibitor or COMT inhibitor
• Triple therapy with levodopa, MAO-B inhibitor, and COMT inhibitor in advanced disease

Combining medicines can improve movement control and reduce “off” times. Side effects can also increase, so treatment needs regular review by a specialist.

Regular Review and Monitoring

Parkinson’s treatment requires frequent monitoring for:

• Symptom control
• Side effects
• Changes in daily functioning
• On/off patterns with levodopa

Doctors may adjust doses or timing. Some side effects such as hallucinations, low blood pressure, or impulse control changes can appear after starting or increasing medicine. These need reporting without delay.

Liver function tests may be needed for some drugs like tolcapone. Heart checks might be done for certain dopamine agonists.

Role of the Health and Social Care Worker

Although only doctors and pharmacists prescribe and change doses, health and social care workers play a big role in managing medication for people with Parkinson’s.

Key responsibilities:

• Supporting correct timing of medicines (important for symptom control)
• Monitoring and recording effects
• Observing for side effects
• Reporting concerns to healthcare professionals
• Helping with swallowing difficulties if medicines are in tablet form
• Encouraging people to follow their prescribed plan

Some workers may help arrange prescriptions, store medicines safely, and explain to family members how and when they should be taken.

Importance of Timing

Levodopa and other medicines for Parkinson’s need to be taken at the correct time every day. Missing or delaying a dose can worsen symptoms quickly. Some people may become “frozen” and unable to move if doses are late.

Health and social care staff should:

• Know each person’s medicine schedule
• Give support to take them on time
• Avoid mixing doses with protein-rich meals unless advised by a doctor, as protein can reduce levodopa absorbtion

Interactions with Other Medicines

Some medicines can interfere with Parkinson’s drugs. For example:

• Certain anti-sickness medicines like metoclopramide can worsen symptoms
• Some antidepressants may cause dangerous reactions with MAO-B inhibitors
• High doses of vitamin B6 can reduce the effect of levodopa if taken without a dopa decarboxylase inhibitor

Care staff should always alert doctors or pharmacists before a person starts a new medicine.

Non-Medication Support

Although medicines are the main treatment for symptoms, other approaches can help overall management:

• Physiotherapy for mobility and balance
• Speech therapy for voice and swallowing
• Occupational therapy for daily tasks
• Dietary advice to reduce constipation and maintain energy

These do not replace medicines but work alongside them for better outcomes.

Final Thoughts

Parkinson’s disease affects each person differently, so medication plans must be individual. Medicines aim to boost or mimic dopamine and improve movement control. There are several different classes, each with a distinct way of working and a unique set of potential side effects.
Levodopa remains the most effective, but other drugs such as dopamine agonists, MAO-B inhibitors, COMT inhibitors, and amantadine are often used. The right combination depends on the stage of the condition, the person’s age, overall health, and the side effects they can tolerate.

Support from health and social care workers is a key part of treatment success. Accurate timing, careful monitoring, and clear communication with healthcare professionals make a big difference to daily quality of life.
By knowing the names, effects, and risks of each medicine, and understanding the importance of consistent routines, you can give meaningful and practical help to anyone living with Parkinson’s.