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Other Medications

A number of other antiparkinsonian medications can be used alone or in combination with levodopa or a dopamine agonist in patients with Parkinson's disease. These medications do not stimulate dopamine receptors but alter basal ganglia neurotransmission by affecting other receptors. The most commonly used medications are amantadine and anticholinergic medications.

Amantadine

Amantadine may be used alone or in combination with levodopa or dopamine agonists. It reduces symptoms of fatigue and tremor in certain patients with early Parkinson's disease, but benefit may be short-lived. More recently, amantadine has been found helpful for people with advanced Parkinson's disease who experience levodopa-induced dyskinesias.

Preparations:

  • Amantadine (Symmetrel®) as 100 mg capsules, tablets, or in liquid form that may be convenient for an individual who does not tolerate a full 100-mg dose or has dysphagia.

Side effects include difficulty concentrating, confusion, insomnia, nightmares, agitation, headache, hallucinations, edema and livedo reticularis.

Anticholinergic Agents

Anticholinergicmedications may reduce tremor or rigidity but have little effect on bradykinesia and imbalance. They can be taken alone or in combination with levodopa. They are rarely used in elderly patients or those with cognitive problems, because increased confusion is a side effect.

Specific anticholinergic medications 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.