From the Guidelines
The most recent and effective medications for Parkinson's disease (PD) include istradefylline (Nourianz), opicapone (Ongentys), and apomorphine sublingual film (Kynmobi), which have shown promise in managing symptoms and potentially slowing disease progression. These medications offer different approaches to modulating brain chemistry and can be integrated into existing treatment regimens to optimize symptom control.
Key Medications
- Istradefylline is an adenosine A2A receptor antagonist approved by the FDA in 2019, typically prescribed as an add-on therapy to levodopa/carbidopa, with a recommended starting dose of 20 mg once daily, which can be increased to 40 mg daily if needed 1.
- Opicapone is a catechol-O-methyltransferase (COMT) inhibitor approved in 2020, taken once daily at a dose of 50 mg, alongside levodopa therapy, helping to prolong the effects of levodopa by preventing its breakdown, thereby extending periods of symptom relief 1.
- Apomorphine sublingual film (Kynmobi) was approved in 2020, providing rapid relief from "off" episodes, administered sublingually as needed, with doses ranging from 10 to 30 mg 1.
Considerations for Use
It is essential to monitor patients for potential side effects and adjust dosages as needed under the guidance of a healthcare provider specializing in Parkinson's disease management. Additionally, considerations should be given to the patient's nutritional status, as certain medications, such as levodopa, may contribute to weight loss and malnutrition 1.
Nutritional Considerations
Patients with PD should be advised to take their levodopa-containing medications at least 30 min before meals to avoid interactions, and those experiencing motor fluctuations may benefit from a protein-redistribution dietary regimen to maximize levodopa absorption and efficacy 1.
Monitoring and Adjustment
Regular monitoring of the patient's condition, including motor function, "off" time, and potential side effects, is crucial to adjust the treatment regimen as needed and optimize symptom control.
From the FDA Drug Label
The provided drug labels do not mention new medications for Parkinson's disease (PD), but rather discuss the use of existing medications such as rasagiline and carbidopa/levodopa. The FDA drug label does not answer the question.
From the Research
New Medications for Parkinson's Disease
There are several new medications for Parkinson's disease (PD) that have been developed in recent years. Some of these medications include:
- Dopamine agonists, such as pramipexole, which can be used as monotherapy in early disease and as an adjunct to levodopa in patients with motor fluctuations 2
- Monoamine oxidase type B (MAO-B) inhibitors, which provide mild symptomatic benefit, delay the need for levodopa, and may provide long-term disease-modifying effects 3
- Extended-release formulations of existing medications, such as extended-release pramipexole, which offers the advantages of easy continuous delivery of drug and convenience to patients 2
Treatment Approaches
The treatment of PD depends on the individual patient's needs and circumstances. Some treatment approaches include:
- Delaying levodopa therapy, particularly in younger patients, until the PD symptoms become troublesome and interfere with social or occupational functioning 4
- Using dopamine agonists as initial monotherapy in patients below 65 years old, or above 65 years old but with preserved mental function and with no severe comorbidity 5
- Using sustained-release levodopa preparations, which have a longer half-life and possibly stimulate the dopamine receptors more continuously 5
- Considering the adverse effect profile when choosing initial or adjunctive therapy 5
Emerging Therapies
There are also emerging therapies for PD, including: