Dopamine replacement in Parkinson's disease: initial therapy

Carbidopa / levodopa, dopamine agonists, or MAO-B inhibitors. What is the first-line therapy for Parkinson’s disease?

Kara J. Wyant, MD
Kara J. Wyant, MD
17th Dec 2023 • 1m read

Which medication should you start when symptoms become bothersome for your patient? In this lesson, we’ll review the different drugs that can be used for dopamine replacement, and provide recommendations for selecting the best drug for your patient.

Below is a quick review of the drugs based on class:

Exogenous dopamine (levodopa)

  • Carbidopa / levodopa*
  • Benserazide / levodopa*

*Remember that levodopa must be given with a dopa decarboxylase inhibitor to prevent the GI upset that occurs when levodopa is administered alone

Dopamine agonists: 

  • Ergot derived: bromocriptine, pergolide, cabergoline, liseride
  • Non-ergot derived: pramipexole, ropinirole, rotigotine, apomorphine

MAO-B inhibitors: 

  • Rasagiline, selegiline, safinamide (Only considered for mild PD symptoms)

Carbidopa / levodopa or dopamine agonists are considered first-line monotherapy and preference is often regionally based. They each have their benefits and side effects. Please see the video and handbook for more explanation but there is no difference in overall quality of life regardless of which is chosen.

Dive into this course as we cover pathophysiology, evaluate common motor and non-motor symptoms, learn how to initiate the best therapy, and more!

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