A number of other medications can be used alone or in combination with levodopa or a dopamine agonist to improve movement for people with Parkinson's disease. These medications do not stimulate dopamine receptors but affect the movement control center by other means. Although a number of medications are used by doctors, the most commonly used medications are
- anticholinergic medications
Amantadine was initially developed as an antiviral medication for treatment of influenza. By coincidence it was found to help with symptoms of early and advanced Parkinson's disease. It may be used alone or in combination with levodopa or dopamine agonists. Amantadine reduces symptoms of fatigue and tremor in some people with early Parkinson's disease. However, for some, this benefit is short-lived. More recently, amantadine has been found helpful for people with advanced Parkinson's disease who experience dyskinesias.
Formulation: Amantadine (Symmetrel®) as 100 mg capsules or in liquid form that may be convenient for treating an individual who does not tolerate a full 100 mg dose or a person with swallowing problems.
Side effects may include difficulty concentrating, confusion, insomnia, nightmares, agitation, headache, and hallucinations. Amantadine may cause leg swelling as well mottled skin (livedo reticularis), often on the legs.
Anticholinergic medications are the oldest class of medications available for Parkinson's disease. They may reduce tremor or rigidity but appear to have little effect on slowness of movement and imbalance. They can be taken alone or in combination with levodopa. These drugs are rarely used in elderly patients or those with cognitive problems, because increased confusion can be one of their side effects.
Specific Anticholinergics and their Preparations include:
- Biperiden HCL (Akineton®): 2 mg tablets
- Benztropine mesylate (Cogentin®): 0.5 mg, 1 mg, 2 mg tablets
- Trihexyphenidyl (Artane®): 2 mg and 5 mg tablets as well as liquid form
Side effects may include dry mouth, blurred vision, sedation, delirium, hallucination, constipation, and difficulty urinating.
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