Why do some doctors use as initial treatment levodopa and others dopaminergic agonists?
Initial drugs: Why do some doctors use as... - Cure Parkinson's
Initial drugs
There's no one obvious first choice.
Levodopa, with inhibitors carbidopa and entacapone, gives a better quality of symptom relief, but has a shorter half-life which is associated with earlier levodopa induced dyskinesia.
Agonists have a longer half-life. They are associated with a higher chance of compulsive behaviour. They are more expensive.
Some doctors will start young PwP on agonists and older ones on levodopa.
There's one other drug based option: a MAO-B inhibitor, e.g. rasagiline.
As far as I understand it, current thinking is that none of the above drugs either speed or slow the progression of the underlying disease.
John
Except MAO-B inhbitors. medicalxpress.com/news/2017...
I think John covered it pretty well. I know some of the thinking with C/L is that if you have idiopathic Parkinson's it will respond to that drug, thus supplying information. I was so relieved when the sinemet started working because then I knew I just had plain old Parkinson's. Sounds funny but I had been reading about all the worse things it could be.
Great question!
If you google Birmingham University PD meds trial you will gain an insight into this practice. My consultant entered me into this 10yr+ trial at our first meeting when he diagnosed me as having PD. The 4 drugs favoured by GPs &/or consultants on dx (in UK) were being randomly allocated to new patients to see which, if any, proved to be more effective.
I was given Sinemet, which my consultant would not normally have prescribed as I was considered Young Onset at 55yrs.
I took it for the minimum agreed time in the trial & I thought I was dying! I felt nauseous, had little balance, fainted, sat on the sofa & slept for hours.
When the due date arrived I was off Sinemet & slowly introduced to the agonist Ropinirole (Requip). As I settled down I continued to take Requip & 13 years on I still take 8mg slow release. After a number of other meds at various times in conjunction with Requip we finally reintroduced Sinemet a few years ago & this proved a winning partnership.
I wonder whether or not age at dx is a factor for younger patients?