"Pro-levodopa" management approach

The evidence that levodopa accelerates the pathology of Parkinson's disease is not conclusive.

The "pro-levodopa" managment approach is outline below:

• delay drug treatment as long as possible
  
  
• introduce levodopa with a decarboxylase inhibitor:
  • 100 mg levodopa dose 3-4 times per day may control early disease
    
    
• the combination of levodopa with a dopamine agonist may provide control with fewer side-effects:
  • a regimen for more advanced disease might comprise:
    • levodopa/decarboxylase inhibitor combined 500-800 mg daily in divided doses
    • bromocriptine 20 mg, or pergolide 2 mg, or lisuride 2 mg
      
      
• the combination of levodope with a COMT inhibitor reduces motor fluctuations:
  • entacapone is licensed in the UK
    
    
    
    
• anticholinergic agents
• amantadine
• apomorphine