Are there any better medications for Parkinson's than Carbidopa and Levodopa?

Felix asked...

My husband has had Parkinson's for ten years. Are there any better medications besides Carbidopa 50/Levodopa 200mg. 7:00 AM.11:00 AM and 3:00 PM?

Expert Answer

Graham A. Glass, MD, is the co-founder of PEAK Neurology and Sleep Medicine, LLC with multiple locations across Alaska. Previously, he was deputy director of the San Francisco Parkinson's Disease Research, Education, and Clinical Care Center PADRECC and assistant clinical professor of neurology at the University of California, San Francisco (UCSF). Glass received his medical degree from the University of Texas Health Sciences Center at the San Antonio School of Medicine and completed his neurology residency at Tufts-New England Medical Center. He subsequently completed a fellowship in movement disorders at the Mayo Clinic.

Carbidopa/Levodopa, though around since the early 70's in a usable form, still remains the gold standard for Parkinson's patients. Although there are a number of other medications including the dopamine agonists (ropinirole, pramipexole), MAO-inhibitors (rasagiline, selegiline), COMT inhibitors (entacapone, tolcapone), anti-cholinergics (trihexyphenidyl) and amantadine, none are better than carbidopa/levodopa. None are as strong for the motor symptoms (or really even close except for tremor) and most have worse side effects.

That being said, when we don't feel that a patient is having a robust response to sinemet, we will usually use the 25/100 immediate release formulation (as opposed to the 50/200 Controlled Release or sustained action formulation). Typically the 50/200 is not as well absorbed (only about 60%) as the 25/100 and is a bit more variable in response. It may help to ask your husband's doctor about switching to the IR 25/100 tablets and slowly working the dose up to look for a good response. It is important to keep an eye out for side effects (hallucinations, low blood pressure) as the dose increases, but sometimes this technique is helpful for patients that are not responding to lower doses or to the CR formulation. We usually feel that a patient has given carbidopa/levodopa a "fair trial" if they have reached 900 or 1000mg of levodopa per day total (levodopa is the second number on the pills--25/100--the 100 is the number in question so that if you took 2 tablets of the IR dose, that would be 200mg of levodopa). We also don't reccomend taking more than 2.5-3 tabs per dose.

Before making any changes, you should obviously consult with your husband's doctor or request to see a movement disorders specialist