What is the best medicine for Parkinson's?

Parkinson's disease is a relatively common chronic disease. This disease is quite harmful to human health, especially for the elderly, who are more prone to this disease. There is currently no particularly effective treatment for this disease. Of course, it can be treated with certain medications to alleviate the patient's symptoms. There are also many drugs that can be taken for Parkinson's disease, such as anticholine drugs, such as adamantane drugs, and so on.

What is the best medicine for Parkinson's?

1. Anticholine drugs:

It mainly works by inhibiting the activity of acetylcholine in the brain and correspondingly increasing the effect of dopamine. The commonly used one in clinical practice is benzhexol hydrochloride. In addition, there are kemajun, benztropine, scopolamine, etc. It is mainly suitable for patients with obvious tremor and younger age. It should be used with caution in elderly patients and is contraindicated in patients with narrow-angle glaucoma and prostatic hypertrophy.

2. Amantadine:

It can promote the synthesis and release of dopamine at nerve endings and prevent its reabsorption. It has a slight improvement effect on hypokinesia, rigidity and tremor, and may be effective for dyskinesia. Use with caution in patients with renal insufficiency, epilepsy, severe gastric ulcer, and liver disease.

3. Monoamine oxidase B (MAO-B) inhibitors:

The therapeutic purpose is achieved by irreversibly inhibiting MAO-B in the brain, blocking the degradation of dopamine, and relatively increasing the dopamine content. MAO-B inhibitors can be used as monotherapy to treat new-onset, young patients with Parkinson's disease, and can also be used as an adjunct to the combination of levodopa and other drugs to treat patients in the middle and late stages. It may have a neuroprotective effect, so early use is recommended in principle. MAO-B inhibitors include selegiline and rasagiline. Using it at night can easily cause insomnia, so it is recommended to take it in the morning or noon. Patients with gastric ulcer should use it with caution and should not use it in combination with serotonin reuptake inhibitors (SSRIs).

4. DR agonists:

It can exert its effect by directly stimulating dopamine receptors. Currently, non-ergot DR agonists are commonly used in clinical practice. It is suitable for patients with early Parkinson's disease and can also be used in combination with compound levodopa to treat patients in the middle and late stages. In young patients, MAO-B inhibitors or DR agonists are preferred in the early stages of the disease. Agonists should be started at a small dose and gradually increased. The incidence of symptom fluctuations and dyskinesia was low with agonist use, but the incidence of orthostatic hypotension and psychiatric symptoms was high. Common side effects include gastrointestinal symptoms, drowsiness, hallucinations, etc. Non-ergot DR agonists include pramipexole, ropinirole, piribedil, rotigotine, and apomorphine.

5. Compound Levodopa

(including levodopa/benserazide and levodopa/carbidopa): Levodopa is a precursor to dopamine. Peripherally supplemented levodopa can pass through the blood-brain barrier and be converted into dopamine through decarboxylation by dopa decarboxylase in the brain, thereby playing a role in replacement therapy. Benserazide and carbidopa are peripheral decarboxylase inhibitors that can reduce the decarboxylation of levodopa in the periphery, increase the amount of levodopa entering the brain, and reduce its peripheral side effects.

The dosage should be started with a small dose and then gradually increased slowly until a satisfactory therapeutic effect is achieved without seeking full effect. The dosage should not be increased too quickly and the dosage should not be too large. Take the medicine 1 hour before or 1.5 hours after a meal. Elderly patients can use it as early as possible. Patients under 65 years old, especially young Parkinson's disease patients, should first choose monoamine oxidase B inhibitors or dopamine receptor agonists. When the above drugs cannot control the symptoms well, consider adding compound levodopa. It should be used with caution in patients with active gastrointestinal ulcers and is contraindicated in patients with narrow-angle glaucoma or mental illness.