Managing motor fluctuations in Parkinson's with medication

If your patient is struggling with on and off periods, we have two main ways to address their medications that can provide relief!

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

 On and off periods, or motor fluctuations, occur as Parkinson’s progresses and the patient’s levels of endogenous dopamine decline. Their medication dose won’t be able to keep them “on” until the time of their next dose and they will therefore notice the return of rigidity and slowing down. In this lesson, we share the two main ways to address motor fluctuations.

1. Increase their dopamine levels by

  • Increasing the dose of their carbidopa / levodopa or dopamine agonist
  • Increasing the frequency when they take levodopa 
  • Adding a dopamine agonist to levodopa

2. Extend the life of their dopamine 

  • Change their immediate-release levodopa to extended-release levodopa*

*Remember that the dose can’t be converted 1:1 because of the difference in bioavailability. They will need a higher dose of the ER levodopa.

  • Give a medication that delays the breakdown of dopamine or that modulates dopamine in the brain

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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