Pharmacologic options for managing Parkinson's disease

Current therapy for idiopathic Parkinson's disease (IPD) is mainly symptomatic with the focus on individualizing therapy for early and advanced stage disease. The most effective drug for both early and advanced IPD is levodopa. For patients with mild disease and minimal disability, monotherapy with anticholinergic agents, amantadine, selegiline, or dopamine agonists (eg, bromocriptine and pergolide) may be useful. Advanced disease is usually associated with levodopainduced complications, such as motor fluctuations and dyskinesias, which may be alleviated by adjusting levodopa dosing or by adding a dopamine agonist. Although no drug has been unequivocally proven to be neuroprotective in IPD, selegiline, amantadine, bromocriptine, and pergolide may play some role in delaying the progression of disease.