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Parkinson's disease - Management
What treatments will be used in secondary care for later Parkinson's disease?
- Treatment will usually consist of levodopa (with a dopa-decarboxylase inhibitor) together with adjuvant treatment to help manage motor fluctuations and dyskinesias.
- First-choice adjuvant treatment:
- Oral dopamine agonists (usually pramipexole, ropinirole, or rotigotine).
- Monoamine oxidase-B (MAO-B) inhibitors (selegiline or rasagiline).
- Catechol-O-methyl transferase (COMT) inhibitors (entacapone or tolcapone).
- Second-choice adjuvant treatment:
- Amantadine.
- Subcutaneous apomorphine infusions.
- Intermittent apomorphine injections.
- Modified-release levodopa or levodopa gel by enteral tube (Duodopa®) may be used, but should not be the drugs of first choice.
- Deep brain stimulation may also be considered.
[National Collaborating Centre for Chronic Conditions, 2006]
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