Treatment Options

Sinemet is a combination of two common medications used to treat Parkinson’s Disease: Carbidopa and Levodopa.

Levodopa is a substance that is converted into Dopamine in the brain. This is the most widely prescribed treatment for Parkinson’s. 

Carbidopa works by preventing the breakdown of levodopa in the bloodstream. This allows more levodopa to enter the brain. By helping more levodopa get into the brain so that less stays in the bloodstream, carbidopa can reduce some of levodopa’s side effects. The most common side effect of levodopa is nausea.

Carbidopa/levodopa (Sinemet) gets absorbed through the gut—mainly the small intestines.

Carbidopa/levodopa often helps with symptoms of Idiopathic Parkinson’s Disease – including slowness, and stiffness. Tremors can be resistant to levodopa.

It is available in different dosages and in short-acting and long-acting formulation.

Things to Know:

• Take carbidopa/levodopa 30 minutes to 1 hour prior to a meal or 1 to 2 hours after.
• Protein can adversely affect the absorption of carbidopa/levodopa.
• Taking carbidopa/levodopa with food is NOT harmful, but reduces absorption and efficacy of the medication.
• If you get an upset stomach, it is OK to take the medication with crackers or toast.
• Let your doctor and pharmacist know of any other medications you may take.
• The most common side effects include: nausea, dizziness, and hallucinations. Please let us know if these become bothersome. 
• If you experience dyskinesias (spontaneous, involuntary movements) that are bothersome, let the office know. You may need to decrease the dose. 

Rytary is a combination of two common medications used to treat Parkinson’s Disease: Carbidopa and Levodopa.

This medication is a truly extended release version of carbidopa/levodopa (Sinemet).

Rytary is released from the capsule filled with beads and is absorbed into your body similarly to that of regular carbidopa/levodopa (Sinemet). The Rytary stays in your body for about 4 to 5 hours.

Taking Rytary will avoid the peaks and valleys fluctuations that can be seen with taking immediate release carbidopa/levodopa.

You will start taking Rytary three times a day.

Because of the way Rytary is formulated, the dose of levodopa is higher than what you have received before.

Patients with early Parkinson’s disease experience a significant improvement in their ability to move and perform activities during the day.

Patients with advanced Parkinson’s disease experience significantly less “OFF” time and more “ON” time without troublesome dyskinesia during the day.

Things to know:

• Preferably, swallow the capsule whole—you can take Rytary with or without food.
• Do not chew, divide or crush Rytary.
• If you have difficulties swallowing—you can open the capsule and sprinkle it onto a small amount (1 – 2 tablespoons) of applesauce. Eat the entire contents of the applesauce and the contents of the Rytary capsule immediately.
• Side effects include: sleepiness, dizziness, abnormal dreams, dry mouth, low blood pressure, hallucinations, abnormal thoughts, or compulsive behaviors.
• Do NOT quickly lower your dose or change your dose or suddenly stop taking Rytary without calling the office first.

Stalevo is a combination of three common medications used to treat Parkinson’s Disease: Carbidopa and Levodopa (which are the active ingredients in Sinemet) and Entacapone (which is the active ingredient in Comtan).  Taking Stalevo will allow you to take one medication instead of two separate ones and may also help you to experience fewer signs and symptoms of wearing off.

Levodopa is a substance that is converted into Dopamine in the brain.  This is the most widely prescribed treatment for Parkinson’s. 

Carbidopa helps prevent levodopa from being broken down in the gut, liver, and other tissues.  This allows more levodopa to reach the brain and also helps prevent nausea and vomiting. 

Entacapone (Comtan) will enhance the action of Levodopa.

Stalevo is available in 3 separate dosage forms. We may only need this medication on an "as needed basis". Your provider will decide what's best for you.          

Things to Know:

• Take Stalevo 30 minutes to 1 hour prior to a meal or 1 to 2 hours after. If you get an upset stomach, it is OK to take the medication with crackers or toast.  Protein can adversely affect the function of Stalevo.
• Let your doctor and pharmacist know of any other medications you may take.
• Do not crush or break Stalevo in half.
• The most common side affects you may experience include: diarrhea, dark urine, nausea, dizziness, drowsiness, and insomnia.  Please let us know if these become very bothersome.
• If you experience dyskinesias (spontaneous, involuntary movements), let the office know.  You may need to decrease the dose. 

Amantadine belongs to a class of medications known antivirals.  It is unclear as to how it works, but Amantadine reduces symptoms of fatigue and tremor in some people with early Parkinson’s disease. It can also help with dyskinetic movements.  The older you get, the less likely you are to be placed on Amantadine.

Things to Know:

• You must have good functioning kidneys to take Amantadine.
• There are few side effects in younger persons. Older persons are more likely to experience constipation, confusion, and hallucinations.
• This medication is usually taken at breakfast and lunch daily

MAO-B inhibitors act by slowing down the breakdown of dopamine in the brain, prolonging the action of dopamine and improving Parkinson’s disease symptoms such as slow movements and rigidity. 

Selegiline (Eldepryl) and Rasagiline (Azilect) offer mild symptomatic benefit, primarily in patients with early disease.

In more advanced Parkinson’s disease, it may be used in combination with carbidopa/levodopa (Sinemet).

Things to Know:

• Side effects are infrequent. The most common side effects of Selegiline are: nausea, dry, mouth, dizziness, fatigue, constipation, insomnia and benign cardiac arrhythmias. Inform your physician if these symptoms are severe and do not go away.
• Rise slowly from a lying or sitting position because Selegiline may cause a drop in blood pressure upon standing (orthostatic hypotension). This is especially important when starting the medication.
• Insomnia can be prevented by taking your last dose of Selegiline several hours before bedtime.
• If an upset stomach (nausea) occurs, try taking food or milk with the medication.
• Azilect and Selegiline are selective MAO inhibitors (MAO-B) and inhibit breakdown of dopamine, but not serotonin. The concern with Azilect and Selegeline and most drugs is serotonin syndrome, but as these do not affect serotonin, there is no worry that buildup of serotonin will occur; especially with low doses. Most of the warnings about Azilect are in regards to this, which is essentially a non-issue that was left on the warning labels due to the older MAO-I. 
• Other drug interactions can occur with Cipro (Ciprofloxacin), Demerol (Meperidine), Ultram (Tramadol), Inapsine (Droperidol), Flexeril (Cyclobenzaprine), and halothane. 
• Call the office or speak with your pharmacist if you are concerned about drug interactions. Often, we just half the dose or give every other day when medications are temporary.

Ropinirol (Requip), Primapexole (Mirapex) and Neupro (Rotigotine) are dopamine agonists which work by mimicking the effects of natural dopamine. These medications decrease tremors, stiffness and slow movements.

Dopamine agonists directly stimulate the receptors in nerves in the brain that normally would be stimulated by dopamine. Unlike levodopa, a dopamine agonist is not changed (converted) into dopamine when it enters the body, but it behaves like dopamine.

These medications can be used in early stages of Parkinson’s disease.

They also can be used in combination with Sinemet (carbidopa/levodopa) in late Parkinson’s disease.

Things to Know:

• Rise slowly from a sitting position. These medications may cause a drop in blood pressure upon standing.
• Sleepiness, drowsiness or sedation may be observed. Do not drive or perform activities that require mental alertness until stabilized on the medication. Avoid drinking alcohol while taking this medication. 
• Dopamine agonists may cause hallucinations or confusion. Let us know if this occurs. You may need a reduction in dosage.
• Nausea and vomiting may be side effects of this medication. You can take this medication with food to decrease nausea. 
• You may notice swelling of your legs. Please notify us if this occurs.
• If you experience dyskinesias (spontaneous, involuntary movements), let us know. You may need to decrease the dose. 
• Taking this medication may increase impulsive or compulsive behaviors. Examples include gambling, hypersexuality, binge eating, compulsive shopping, and punding (repetitive, aimless activity).  Let the office know immediately if you experience these symptoms.