Surprisingly, seven new medications for the treatment for Parkinson’s motor symptoms have been licensed in the preceding five years, with two more due in 2020. That is a remarkable progression! Even while having so many options is good, they may be confusing, therefore today I will describe these new medications and their uses.
Already Have Prescription Medications On Hand
Some of the older medications used to the new treatment for parkinson’s disease include carbidopa/levodopa formulations, dopamine agonists (available in immediate-release, long-acting, patch, and injectable forms), catechol-O-methyltransferase (COMT) inhibitors, monoamine oxidase B (MAO-B) inhibitors, anticholinergics, and amantadine. Although these medications may greatly improve specific motor symptoms of Parkinson’s disease, additional therapies are necessary to address other important hurdles to quality of life as the disease advances, such as:
Dyskinesias during non-work hours
New Treatment for Parkinson’s Disease
Important details regarding the new medications
Because of multiple new medications currently available for the treatment of Parkinson’s disease, there is more hope than ever that the symptoms will be adequately treated for many years. Several things to consider:
- These new treatments are fantastic additions to what was previously available for those whose symptoms are difficult to control, and many people with Parkinson’s disease have used them with considerable success.
- However, since many newly approved medications are quite similar to those already on the market (i.e., they have many of the same mechanisms of action), they do not represent a substantial breakthrough in symptom management.
- Furthermore, the effect on symptoms may be small or inconsequential for some people.
These limits may suggest that your doctor has not encouraged you to change your medication. Despite the availability of multiple new medications, carbidopa/levodopa remains the most effective therapy for Parkinson’s disease motor symptoms.
If your doctor decides to investigate one of the new options, he or she may take many approaches to changing your prescription. You may need to be patient while you work with your doctor to determine what works and what doesn’t, since trial and error is sometimes the only way to build the best medication regimen for you.
New medicines for off-duty use
Many of the recently approved new medications attempt to reduce OFF time. These medications are classified into two types:
- pharmaceuticals that extend the benefits of a carbidopa/levodopa dose medicines used “as needed” if the treatment’s effects diminish
More specific instances are provided below. In general, new medications that lengthen the duration of a carbidopa/levodopa combination are used if the OFF period is relatively predictable and occurs before the following dose. When OFF time is unexpected, new medications that are taken “as needed” are in handy.
New medications that extend the effects of a carbidopa/levodopa dose
Istradefylline (Nourianz®), an adenosine A2A receptor antagonist that was approved in the United States in 2019, is used in concert with levodopa to treat Parkinson’s disease (PD) OFF time. It is the first medicine in its class to be approved for Parkinson’s disease, and, unlike many other treatments, it has a novel method of action. Although it is not directly dopaminergic, it influences the dopaminergic system through acting on the adenosine receptor. The medicine was clinically tested in the United States and Japan, where it was developed.
Opicapone (Ongentys®), a catechol-O-methyltransferase (COMT) inhibitor, is taken once daily. It was approved in the United States in 2020 as an additional therapy for motor fluctuations to levodopa.
Safinamide (Xadago®), a carbidopa/levodopa supplement for the treatment of OFF, was approved in 2017. Although it is a selective MAO-B inhibitor, it also functions via other mechanisms, such as inhibiting glutamate release.
The Food and Drug Administration (FDA) has relaxed prior restrictions on consuming tyramine-containing foods (such as aged cheeses, red wine, and draught beers). However, some antidepressants, nasal decongestants, and narcotic pain relievers may interact with MAO-B inhibitors. A person who is taking a selective MAO-B inhibitor and is scheduled for hospital surgery is typically recommended to discontinue it two weeks before the procedure and restart it one to two weeks afterwards to avoid any unwanted medication interactions.
New levodopa formulations have been developed to be used as needed if medication effects fade.
Inbrija® is a powder for inhaling levodopa. In 2018, levodopa inhalation powder was approved for use as needed after the effects of oral carbidopa/levodopa tablets wore off. Levodopa tablets of 42 mg are placed in available breath-activated inhalation equipment. A dose is made up of two capsules. Drug absorption occurs in the pulmonary tree, bypassing the stomach system. One disadvantage of this method is that the inhalation device cannot be pre-loaded; instead, a capsule must be opened and inserted into the device as needed. This fine motor technique may be difficult for a person with Parkinson’s disease who is attempting to use an inhalation device that has been switched off. Because the capsules only contain levodopa and no dopa-decarboxylase inhibitor, the inhalation powder must be used with a carbidopa/levodopa regimen.
Taking more medications as needed if prescription effects fade
Apomorphine HCl sublingual film (Kynmobi®) Apomorphine, a dopamine agonist, has a rapid onset of action. It might be used as a last-resort therapy for those whose levodopa medication runs out before the next dose is due. Apomorphine may be administered subcutaneously. In 2020, a sublingual film (Kynmobi®) that may be used as needed throughout the day if the medication effects wear off was approved.
Dry mouth, oral mucosal irritation and edoema, throat pain, and other side effects of this novel delivery route may prompt physicians to discontinue its use. Apomorphine (both injectable and sublingual) may produce nausea, hence it is best used alongside an antiemetic, commonly trimethobenzamide. It is not always required to take the anti-emetic long term in order to acquire the benefits of apomorphine.
Amantadine formulations for dyskinesias (Gocovri® and Osmolex ERTM) Amantadine, which was initially used to treat or prevent influenza, has been found to reduce tremors and muscle spasms in people with Parkinson’s disease. As a consequence, it has been used as a pharmacological complement to conventional Parkinson’s disease treatment. It was also demonstrated to be effective in decreasing the dyskinesias caused by levodopa.
In 2017, the FDA approved amantadine extended-release capsules (Gocovri®). It is suggested for the treatment of levodopa-induced dyskinesias and for lowering OFF time. It is administered once a day, at night. It is designed to cause an initial lag, a progressive rise in amantadine concentration over the night, and a high concentration in the morning and throughout the waking day. In 2018, a second extended-release amantadine formulation (Osmolex ERTM) was approved. It is used to treat both drug-induced parkinsonism and Parkinson’s disease motor symptoms. It is taken in the morning once a day.
PD, despite the new medications listed above, causes significant problems for many people, especially as the disease advances. There is continuing research being conducted to minimise both motor and non-motor symptoms. Current Parkinson’s disease research is also focused on developing medicines that will postpone or halt the illness’s progression in the hopes that, in the near future, pharmaceuticals may be available not just to treat symptoms but also to change the course of the disease.
Conclusions and Recommendations
Seven new medications have been authorised to treat Parkinson’s motor symptoms since 2017.
If you believe one of the new medications may be beneficial to you, see your doctor.
Finding the best pharmacological combination for your specific disease may take some time (and patience). It may take some trial and error, but don’t give up too soon—a few little tweaks may have a major influence in the end.
Despite new medications, the scientific community is working on a treatment that will not only cure symptoms but also reduce or halt disease progression.