Other antiparkinsonian drugs

Dopamine-receptor agonists

e.g. pramipexole, ropinirole, and rotigotine. Dopamine-receptor agonist monotherapy causes fewer motor complications in long-term treatment compared with levodopa treatment, however, the improvement in overall motor performance is not as good. Dopamine-receptor agonists can be administerd as adjunct to co-beneldopa or co-careldopa to reduce 'end of dose' deterioration. Dopamine-receptor agonists plus levodopa can be prescribed for more advanced disease, but the levodopa dose must be reduced.

Subcutaneous injection of apomorphine hydrochloride is sometimes helpful in advanced disease, especially for patients experiencing unpredictable ‘off’ periods with levodopa treatment. Patients are able to self-administer the drug at the first sign of an ‘off’ episode. Use of other antiparkinsonian medications can sometimes be reduced once apomorphine treatment is established.

Monoamine-oxidase-B (MAOB) inhibitors

e.g. rasagiline and selegiline hydrochloride are irreversible MAOB inhibitors. Both of these drugs can be used alone and in combination with anti-Parkinsonian drugs. Early treatment with selegiline hydrochloride alone can delay the need for levodopa therapy. Rasagiline is useful in dealing with non-motor symptoms such as fatigue.