Parkinson’s disease in adults

Movement and balance: medicines to try first

The medicine that you will be offered for movement and balance problems will depend on your symptoms and how severe they are.

If your symptoms affect your day-to-day life, you should be offered a medicine called levodopa. This is usually prescribed as a medicine called co‑beneldopa or co‑careldopa.

If your symptoms are mild and don't affect your quality of life, there is more than one medicine that could help. The choice will depend partly on what is most important to you, and partly on your symptoms, other health problems you have and if you are taking any other medicines.

Your healthcare professional should discuss the treatment options with you, and the possible effects and side effects of the different medicines, for example, the risk of having uncontrolled (involuntary) movements (called dyskinesia), sleep problems, impulse control disorder, and psychotic symptoms (hallucinations and delusions). Table 1 shows the different medicines.

More help with movement and balance

If levodopa does not help your symptoms enough, your healthcare professional should offer you another medicine to take as well as levodopa. Table 2 shows the different types of medicine that you can try.

Sleep problems

If you feel abnormally sleepy during the day, your healthcare professional should try to find out the cause of the sleepiness, for example, if it is a side effect of a medicine. If there is no obvious cause, your healthcare professional might talk with you about trying a medicine called modafinil. But you shouldn't take this medicine if you are pregnant or planning to get pregnant. If you feel abnormally sleepy during the day, you should not drive or operate heavy machinery, and let the Driver and Vehicle Licensing Agency (DVLA) know.

You may experience other sleep problems such as:

There are medicines that can help to treat these symptoms. Some sleep problems can be caused by medicines you are taking, or the time of day you take them. If you experience sleep problems, talk to a healthcare professional.

Impulse control disorder

One of the important possible side effects of Parkinson's disease treatment is impulse control disorder. This is where your behaviour changes and you can't stop yourself from doing something. This may harm you or those around you.

Symptoms may include compulsive gambling, binge eating, obsessive shopping or becoming preoccupied with sex, including pornography.

Impulse control disorders are more common in people who are taking a type of medicine known as a dopamine agonist (ask your healthcare professional if you are unsure whether you take this type of medicine). Also see the section movement and balance: medicines to try first.

You are also more likely to develop impulse control disorder if you:

Your healthcare professional should give you, your family and carers information about impulse control disorder if you start taking dopamine agonist therapy. They should explain the symptoms, the risks, who to contact if you develop the symptoms, and that certain medicines will be reviewed and might be reduced or stopped if you develop an impulse control problem. People who have impulse control might keep it hidden from their family and carers.

You should be able to discuss any concerns at your review appointments. If you have symptoms, this is a chance for you and your family or carers to talk about:

If you develop impulse control disorder, and changing your medicine doesn't help, you should be offered specialist cognitive behavioural therapy, which is a type of talking therapy.

Psychotic symptoms (hallucinations and delusions)

Psychosis is a mental health condition that causes a person to see or hear things (called hallucinations), or stops a person from understanding what's real and what's not (called delusions). You should be asked if you are experiencing any psychotic symptoms at follow‑up appointments and if your medicine changes. If you have psychotic symptoms, you should have a thorough health check to try to understand what may be causing the problem.

If it's possible that one of your medicines for Parkinson's disease is causing psychotic symptoms, your healthcare professional might suggest gradually reducing the dose to see if that helps. They should explain that this might mean that your Parkinson's disease symptoms get worse. Your healthcare professional can help you to decide whether to change your medicine or not. If the problem is not severe or not upsetting for you or your family and carers, you might prefer not to have any treatment.

If you decide that you should take a medicine to treat psychotic symptoms, medicines called quetiapine or clozapine may help. Quetiapine is recommended 'off‑label'; see where can I find out more? If you take clozapine, you need to be registered with a monitoring scheme and have regular blood tests.

Healthcare professionals should not offer some medicines that would normally be used to help psychotic symptoms (called 'antipsychotics') because they can make Parkinson's disease symptoms worse.

Dementia

Parkinson's disease can sometimes cause symptoms of dementia, including memory loss and confusion. This is known as 'Parkinson's disease dementia'.

Speak to your healthcare professional if you are worried; help is available, and there are medicines you can try, depending on your symptoms. Your healthcare professional can tell you about medicines that can help, such as cholinesterase inhibitors or memantine. These treatments are recommended 'off‑label'; see where can I find out more? You may also want to read our information for the public on dementia.

Depression

Depression is common in adults with Parkinson's disease. Speak to your healthcare professional if you are struggling with feelings of hopelessness, guilt, worthlessness or pessimism: help is available. You may also want to read our information for the public on depression in adults with a chronic physical health problem.

Low blood pressure when standing

Feeling light-headed, faint or dizzy when you stand up quickly can be caused by a drop in your blood pressure – known as orthostatic hypotension. If you have these symptoms, talk to your healthcare professional.

Orthostatic hypotension can be caused by medicines you are taking for Parkinson's disease symptoms and/or other conditions. Your healthcare professional should review your medicines to see if that can help your symptoms.

There are also medicines that you could try for orthostatic hypotension, for example, midodrine or fludrocortisone. Fludrocortisone is recommended 'off‑label'; see where can I find out more? Your healthcare professional should talk with you about the risks of those medicines and the monitoring that you need during treatment with them.

Drooling

Excessive drooling can be eased with treatments such as speech and language therapy.

If speech and language therapy does not help, your healthcare professional may discuss treatment with anticholinergic medicines (for example, medicines called glycopyrronium bromide or atropine), or refer you to have treatment with botulinum toxin A. Glycopyrronium bromide and botulinum toxin A are recommended 'off‑label'; see where can I find out more?