Prescription Medications

Although there are general guidelines that doctors use to choose a treatment regimen, each person with Parkinson’s disease (PD) must be individually evaluated to determine which drug or combination of medications is best for them. For some, a “first choice” drug might be a form of levodopa, and for others, an initial prescription may be given for one of the dopamine agonists, an MAO inhibitor, or an anticholinergic.

The choice of medication depends on many variables including your symptoms, other existing health issues (and the medications being used to treat them) and age. Dosages vary greatly depending on a person’s needs and metabolism.

Since most Parkinson’s symptoms are caused by a lack of dopamine in the brain, many Parkinson’s drugs are aimed at either temporarily replenishing dopamine or mimicking the action of dopamine. These types of drugs are called dopaminergic medications. They generally help reduce muscle rigidity, improve speed and coordination of movement, and lessen tremor.

Always remember that medication is only part of the overall treatment plan for combatting PD. Talk to your doctor about available medications, but don’t forget exercise and complementary therapies.

Generic vs. Branded Drugs

Currently, there are multiple pharmaceutical companies that manufacture a generic formulation of carbidopa-levodopa, dopamine agonists, monoamine oxidase inhibitors, and anticholinergics. The U.S. Food and Drug Administration (FDA) requires that generic drugs show a similar risk and benefit to the branded drug prior to market approval, but in rare cases this standard is not high enough.

A review supported by the Parkinson’s Foundation reports evidence that if you are in more advanced stages of the disease, switching from branded drugs to generic, or from one generic to another, may have somewhat variable effects. The authors, including Parkinson’s Foundation National Medical Advisor Michael S. Okun, MD, believe that the standards for approving generic drugs for PD may not be strict enough to demonstrate that the generic alternatives are equally effective.

Work with your doctor to develop a tailored treatment plan. Using generic drugs will likely provide a cost savings. Infrequently, a person living with PD may require brand medication.

If you make the switch, follow these tips:

• Report to your physician on the effectiveness of the drugs.
• Carefully keep a diary of any side effects.
• Record dose adjustments made by your physicians (higher or lower).
• Try to stay with a single drug manufacturer for your generic medications. You may need to ask your pharmacist to special order for you.

When attempts to tailor drug therapy with a generic drug have been unsuccessful, have your doctor appeal to the insurance company for a branded drug. It is important to include details of the various adverse side effects with the generic medication in your appeal letter.

Page reviewed by Dr. Chauncey Spears, Clinical Assistant Professor at the University of Michigan and Dr. Amelia Heston, Movement Disorder Fellow at the University of Michigan