Commonly used pharmacological agents to treat symptoms of Parkinson disease

Adapted from Armstrong and Okun (2020) and Seppi et al. (2019).

SymptomMechanism of ActionMedicationFDA-Approved Indication for PD or Off Label
Motor symptomsCore PD symptomsDA precursorIR carbidopa-levodopaFDA approved
CR carbidopa-levodopaFDA approved
ER carbidopa-levodopaFDA approved
Core PD symptoms and motor fluctuationsNonergot DA agonistsPramipexoleFDA approved
RopiniroleFDA approved
RotigotineFDA approved
Monoamine oxidase-B inhibitorsSelegilineFDA approved
RasagilineFDA approved
SafinamideFDA approved
ZonisamideOff label
Motor fluctuationsCatechol-O-methyltransferase inhibitorsEntacaponeFDA approved
OpicaponeFDA approved
Adenosine A2A receptor antagonistIstradefyllineFDA approved
Rescue medicationLevodopa formulationInhaled carbidopa/levodopaFDA approved
Nonergot dopamine agonistSublingual apomorphineFDA approved
Injectable apomorphineFDA approved
DyskinesiasNoncompetitive NMDA receptor antagonistIR amantadineFDA approved
ER amantadine capsule/tabletFDA approved
AnticholinergicsTrihexyphenidylFDA approved
BenztropineFDA approved
Nonmotor symptomsCognitive changesAcetylcholinesterase inhibitorsRivastigmineFDA approved
DonepezilOff label
GalantamineOff label
NMDA receptor antagonistMemantineOff label
PsychosisD2 and 5-HT2 receptor antagonistQuetiapineOff label
ClozapineOff label
5-HT2A and 5-HT2C receptor agonist and antagonistPimavanserinFDA approved
Depression and anxietyTricyclic antidepressantsNortriptylineOff label
AmitriptylineOff label
ImipramineOff label
DesipramineOff label
Selective serotonin reuptake inhibitor/serotonin norepinephrine inhibitorCitalopramOff label
EscitalopramOff label
SertralineOff label
ParoxetineOff label
VenlafaxineOff label
Levodopa formulationsCarbidopa/levodopa formulationsOff labela
DA precursorsPramipexoleOff labela
RopiniroleOff labela
RotigotineOff labela
Insomnia/sleep disordersMelatonin receptor 1A agonistMelatoninSupplement
DA precursorsControlled-release carbidopa/levodopaOff labela
Orthostatic hypotensionFluid retentionSalt tabsSupplement
DA2-receptor antagonistDomperidoneNot FDA approved
α1-adrenergic receptor stimulatorMidodrineOff label
Increased Na reabsorptionFludrocortisoneOff label
Increased norepinephrineDroxidopaFDA approved
Acetylcholinesterase inhibitorPyridostigmineOff label
ConstipationAnionic surfactantDocusateOff label
Stool bulkingFiberSupplement
Mixes stool fat and waterPolyethylene glycolOff label
Anorexia, nausea, vomitingDA2-receptor antagonistDomperidoneNot FDA approved
VGNA and K channel blocker, GABA receptor enhancerZonisamideOff label
DroolingAnticholinergicAtropine 1% ophthalmic drops under the tongueOff label
GlycopyrrolateOff label
Botulinum toxin BFDA approved
UrinaryMuscarinic antagonistSolifenacinOff label
β3-adrenergic agonistMirabegronOff label
FatigueMonoamine oxidase-B inhibitorsRasagilineOff labela
DA and NE reuptake inhibitorsMethylphenidateOff label
DA reuptake inhibitorModafinilOff label
PainNonergot dopamine agonistsRotigotineOff labela
DA precursorCarbidopa/levodopa formulationsOff labela
  • CR, controlled release; ER, extended release; IR, immediate release; NE, norepinephrine; VGNA, voltage-gated sodium.

  • aThese medications are FDA-approved for treatment of PD, but they are often used to treat these PD-related symptoms off label.