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Old 02-28-2013
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Default Best initial for Severe Parkinson?

different books say different things.

MTB2: Dopamine agonist like Pramipexole and Ropinirole

Blueprint: Cardidopa/levodopa


what is your take?

Thanks
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Old 02-28-2013
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Quote:
Originally Posted by Dr.Dream View Post
different books say different things.

MTB2: Dopamine agonist like Pramipexole and Ropinirole

Blueprint: Cardidopa/levodopa


what is your take?

Thanks
I believe Cardidopa/levodopa is first line and most effective treatment. However you can use dopamine agonists if there is inadequate response to sinemet
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Old 02-28-2013
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Question

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Originally Posted by OzoneZone234 View Post
I believe Cardidopa/levodopa is first line and most effective treatment. However you can use dopamine agonists if there is inadequate response to sinemet
I think it is hard to tell which one is better.

I can only find references for early Parkinson disease;


Arch Neurol. 2009 May;66(5):563-70.
Long-term effect of initiating pramipexole vs levodopa in early Parkinson disease.


Arch Neurol. 2004 Jul;61(7):1044-53. Pramipexole vs levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial.

CONCLUSIONS: Initial treatment with pramipexole resulted in lower incidences of dyskinesias and wearing off compared with initial treatment with levodopa. Initial treatment with levodopa resulted in lower incidences of freezing, somnolence, and edema and provided for better symptomatic control, as measured by the Unified Parkinson's Disease Rating Scale, compared with initial treatment with pramipexole. Both options resulted in similar quality of life. Levodopa and pramipexole both appear to be reasonable options as initial dopaminergic therapy for Parkinson disease, but they are associated with different efficacy and adverse-effect profiles.
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