Section 03
Parkinson's Disease
Dopaminergic & Movement Therapies
37 AGENTS
Carbidopa-levodopa
SinemetDopamine precursor
- Forms
- IR: 10/100, 25/100, 25/250mg | CR: 25/100, 50/200mg | ODT: 10/100-25/250mg
- Dose
- TID-5x/day, titrate to effect
- MOA
- Levodopa→dopamine; carbidopa blocks peripheral breakdown
Foslevodopa-foscarbidopa
VyalevDopamine precursor · SC infusion
- Forms
- SC pump cartridge: 236mg/236mg per 10mL
- Dose
- 24-hr pump, individualized rate
- MOA
- Continuous levodopa/carbidopa delivery
Carbidopa-levodopa-entacapone
StalevoDopamine precursor + COMT inhibitor
- Forms
- Tab: ratios from 12.5/50/200 to 50/200/200mg
- Dose
- with each levodopa dose
- MOA
- Levodopa + peripheral COMT blockade
Levodopa inhalation powder
InbrijaDopamine precursor · inhaled
- Forms
- Inhaler: 42mg cartridge
- Dose
- up to 5x/day PRN OFF episodes
- MOA
- Rapid pulmonary levodopa absorption
Pramipexole
MirapexDopamine agonist
- Forms
- IR: 0.125, 0.25, 0.5, 0.75, 1, 1.5mg | ER: 0.375-4.5mg
- Dose
- Start 0.125mg TID, titrate weekly to 1.5-4.5mg/day
- MOA
- D2/D3 receptor agonism
Ropinirole
RequipDopamine agonist
- Forms
- IR: 0.25, 0.5, 1, 2, 3, 4, 5mg | XL: 2-12mg
- Dose
- Start 0.25mg TID, titrate weekly to 6-24mg/day
- MOA
- D2/D3 receptor agonism
Rotigotine
Neupro patchDopamine agonist · patch
- Forms
- Patch: 1, 2, 3, 4, 6, 8mg/24h
- Dose
- Start 2mg/24h, increase 2mg/24h weekly to 6-8mg/24h
- MOA
- D1-D3 receptor agonism
Apomorphine
Apokyn / OnapgoDopamine agonist · injectable
- Forms
- SC pen: 2, 3, 4mg/dose | pump: 10mg/mL
- Dose
- 2-6mg PRN rescue or continuous
- MOA
- D1/D2 receptor agonism
Bromocriptine
ParlodelDopamine agonist
- Forms
- Tab: 2.5mg | Cap: 5mg
- Dose
- up to 100mg/day divided
- MOA
- D2 receptor agonism
Selegiline
Eldepryl / ZelaparMAO-B inhibitor
- Forms
- Tab: 5mg | ODT: 1.25mg
- Dose
- 5mg BID
- MOA
- Irreversible MAO-B inhibition
Rasagiline
AzilectMAO-B inhibitor
- Forms
- Tab: 0.5, 1mg
- Dose
- Start 0.5mg/day, may increase to 1mg/day
- MOA
- Irreversible MAO-B inhibition
Safinamide
XadagoMAO-B inhibitor
- Forms
- Tab: 50, 100mg
- Dose
- 50-100mg once daily (adjunct)
- MOA
- Reversible MAO-B + Na+ channel blockade
Entacapone
ComtanCOMT inhibitor
- Forms
- Tab: 200mg
- Dose
- with each levodopa dose, max 8x/day
- MOA
- Peripheral COMT blockade, ↑levodopa availability
Opicapone
OngentysCOMT inhibitor
- Forms
- Cap: 25, 50mg
- Dose
- 50mg qHS
- MOA
- Peripheral COMT blockade
Istradefylline
NourianzAdenosine A2A antagonist
- Forms
- Tab: 20, 40mg
- Dose
- 20-40mg once daily (adjunct)
- MOA
- Blocks A2A receptors (adjunct to levodopa)
Amantadine
Gocovri ER / generic IRNMDA antagonist/dopaminergic
- Forms
- ER: 68.5, 137mg | IR: 100mg cap, 50mg/5mL
- Dose
- 137-274mg qHS (ER)
- MOA
- NMDA blockade + dopamine release
Trihexyphenidyl
ArtaneAnticholinergic
- Forms
- Tab: 2, 5mg | Elixir: 2mg/5mL
- Dose
- 1-15mg/day divided
- MOA
- Muscarinic receptor blockade
Benztropine
CogentinAnticholinergic
- Forms
- Tab: 0.5, 1, 2mg | IV/IM: 1mg/mL
- Dose
- 0.5-6mg/day divided
- MOA
- Muscarinic receptor blockade
Tetrabenazine
XenazineVMAT2 inhibitor
- Forms
- Tab: 12.5, 25mg
- Dose
- titrate to 25-75mg/day
- MOA
- Depletes presynaptic dopamine/serotonin/NE
Deutetrabenazine
AustedoVMAT2 inhibitor
- Forms
- Tab: 6, 9, 12, 18, 24mg
- Dose
- titrate to 12-48mg/day divided
- MOA
- Depletes presynaptic monoamines
Valbenazine
IngrezzaVMAT2 inhibitor
- Forms
- Cap: 40, 60, 80mg
- Dose
- 40-80mg once daily
- MOA
- Depletes presynaptic dopamine
Pimavanserin
NuplazidAtypical antipsychotic
- Forms
- Tab: 34mg | Cap: 10mg
- Dose
- 34mg once daily (PD psychosis)
- MOA
- 5-HT2A inverse agonist
Droxidopa
NortheraNorepinephrine precursor
- Forms
- Cap: 100, 200, 300mg
- Dose
- 100-600mg TID (orthostatic hTN)
- MOA
- Converted peripherally to norepinephrine
Carbidopa
LodosynDOPA decarboxylase inhibitor
- Forms
- Tab: 25mg
- Dose
- 25mg with each levodopa dose (target 70-100mg/day; max 200mg/day)
- MOA
- Blocks peripheral levodopa-to-dopamine conversion
Carbidopa-levodopa ER
RytaryDopamine precursor · ER
- Forms
- ER cap: 23.75/95, 36.25/145, 48.75/195, 61.25/245mg
- Dose
- Start 23.75/95mg TID x3 days, then 36.25/145mg TID; titrate to effect
- MOA
- Extended-release levodopa/carbidopa
Carbidopa-levodopa enteral suspension
DuopaDopamine precursor · enteral infusion
- Forms
- Susp: 4.63/20mg per mL (100mL cassette)
- Dose
- 16-hr intrajejunal infusion via PEG-J pump; individualized morning bolus + continuous rate
- MOA
- Continuous levodopa/carbidopa delivery
Clozapine
ClozarilAtypical antipsychotic
- Forms
- Tab: 25, 50, 100, 200mg | ODT: 12.5, 25, 100, 150, 200mg | Susp: 50mg/mL
- Dose
- PD psychosis (off-label): 6.25-50mg qHS; ANC monitoring required
- MOA
- 5-HT2A/D4 antagonism with low D2 affinity
Quetiapine
SeroquelAtypical antipsychotic
- Forms
- Tab: 25, 50, 100, 200, 300, 400mg | XR: 50-400mg
- Dose
- PD psychosis (off-label): 12.5-100mg qHS
- MOA
- 5-HT2A/D2 antagonism
Midodrine
ProAmatineAlpha-1 agonist
- Forms
- Tab: 2.5, 5, 10mg
- Dose
- 2.5-10mg TID daytime (last dose at least 4h before bed)
- MOA
- Peripheral vasoconstriction (orthostatic hTN)
Fludrocortisone
FlorinefMineralocorticoid
- Forms
- Tab: 0.1mg
- Dose
- 0.1-0.3mg/day (off-label, neurogenic orthostatic hTN)
- MOA
- ↑Na+ retention and plasma volume
Tavapadon
JuvmoD1/D5 dopamine partial agonist
- Forms
- Tab: 5, 10, 15mg | Titration pack: 0.25, 1mg tabs
- Dose
- Once daily with or without levodopa (monotherapy in early PD or adjunct for motor fluctuations); ~6-week titration to maintenance dose; no label contraindications
- MOA
- Selective D1/D5 receptor partial agonism (CYP3A substrate)
Carbidopa-levodopa ER
CrexontDopamine precursor · ER
- Forms
- ER cap: 35/140, 52.5/210, 70/280, 87.5/350mg
- Dose
- Not 1:1 with IR carbidopa-levodopa (use label conversion table); up to 4x/day; max 525mg carbidopa / 2100mg levodopa per day; swallow whole
- MOA
- IR granules + ER pellets providing sustained levodopa levels
Pimozide
OrapTypical antipsychotic
- Forms
- Tab: 1, 2mg
- Dose
- Tourette's: start 1-2mg/day divided, increase every other day; max 0.2mg/kg or 10mg/day | Age 12+: start 0.05mg/kg qHS, increase every 3 days | CYP2D6 genotyping if above 4mg/day (adults)
- MOA
- D2 receptor blockade (tic suppression); QT prolongation risk
Aripiprazole
AbilifyAtypical antipsychotic
- Forms
- Tab: 2, 5, 10, 15, 20, 30mg | ODT: 10, 15mg | Sol: 1mg/mL
- Dose
- Tourette's (age 6-18): under 50kg start 2mg, increase to 5mg after 2 days (target 5mg, max 10mg) | 50kg or more: 2mg, 5mg after 2 days, target 10mg on day 8, up to 20mg; halve dose in CYP2D6 poor metabolizers
- MOA
- D2/5-HT1A partial agonism, 5-HT2A antagonism
Haloperidol
HaldolTypical antipsychotic (butyrophenone)
- Forms
- Tab: 0.5, 1, 2, 5, 10, 20mg
- Dose
- Tourette's: adults 0.5-2mg BID-TID (moderate) up to 3-5mg BID-TID (severe) | Children 3-12y (15-40kg): 0.05-0.075mg/kg/day divided, start 0.5mg/day, increase 0.5mg every 5-7 days
- MOA
- D2 receptor blockade
Clonidine
Catapres / KapvayAlpha-2 agonist
- Forms
- Tab: 0.1, 0.2, 0.3mg | ER tab: 0.1, 0.2mg | Patch: 0.1, 0.2, 0.3mg/24h
- Dose
- Tics (off-label): start 0.05mg qHS, increase to 0.1-0.3mg/day divided
- MOA
- Central α2 agonism, ↓sympathetic outflow
Guanfacine
Tenex / IntunivAlpha-2A agonist
- Forms
- IR tab: 1, 2mg | ER tab: 1, 2, 3, 4mg
- Dose
- Tics (off-label): start 0.5-1mg qHS, titrate to 1-4mg/day divided
- MOA
- Selective α2A agonism in prefrontal cortex