Initial therapy for Parkinson's disease: levodopa vs. dopamine receptor agonists

J Neurol. 2002 Sep:249 Suppl 2:II25-9. doi: 10.1007/s00415-002-1205-3.

Abstract

Levodopa therapy is essential for patients in the advanced stages of Parkinson's disease. However, at early stages, DA agonist therapy has similar efficacy in the treatment of parkinsonism and a lower incidence of motor complications compared to levodopa therapy several years after the initiation of the therapy. The main factors causing motor complications have been speculated to be a severe reduction of dopaminergic nerve terminals because of disease progression, and a pulsatile stimulation of DA receptors using a drug with a short plasma half-life. DA agonists have longer plasma half-lifes than levodopa; therefore, they are expected to have a favorable effect on motor complications. Moreover, two clinical reports confirmed the potential neuroprotection by DA agonists. Although the patient's conditions should be considered in the selsction of a drug, DA agonist therapy is recommended as the initial therapy for Parkinson's disease.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Animals
  • Antiparkinson Agents / adverse effects
  • Antiparkinson Agents / therapeutic use*
  • Bromocriptine / adverse effects
  • Bromocriptine / therapeutic use
  • Contraindications
  • Disease Models, Animal
  • Disease Progression
  • Dopamine Agonists / adverse effects
  • Dopamine Agonists / therapeutic use*
  • Drug Therapy, Combination
  • Dyskinesia, Drug-Induced / etiology
  • Dyskinesia, Drug-Induced / prevention & control
  • Humans
  • Levodopa / adverse effects
  • Levodopa / pharmacokinetics
  • Levodopa / therapeutic use*
  • Parkinson Disease / drug therapy*
  • Receptors, Dopamine / drug effects*

Substances

  • Antiparkinson Agents
  • Dopamine Agonists
  • Receptors, Dopamine
  • Bromocriptine
  • Levodopa