Parkinson's disease
A progressive neurodegenerative disease with a motor triad: resting tremor, rigidity, bradykinesia (plus postural instability in advanced disease). Underlying cause is loss of dopaminergic neurons in the substantia nigra. AAN 2021 and the Spanish SEN 2024 set foundation therapy as levodopa with a DDC inhibitor (carbidopa, benserazide). With marked motor fluctuations, add dopamine agonists (pramipexole, ropinirole, rotigotine), MAO-B inhibitors (rasagiline, selegiline), or COMT inhibitors. In younger patients under 65, dopamine agonists or MAO-B inhibitors are often started first to delay levodopa.
Also known as: Idiopathic Parkinson's
Drugs used for this condition
- APramipexoleFirst line · Non-ergot dopamine D2/D3 receptor agonistFirst-line in Parkinson's disease in patients under 65 to delay levodopa per AAN 2021 and SEN 2024. In patients over 65, levodopa start is preferred. Starting dose 0.125 mg three times daily (immediate-release) or 0.375 mg once daily (extended-release), slowly titrated to 1.5–4.5 mg daily. Added to levodopa for motor fluctuations. CALM-PD showed pramipexole reduces dyskinesia risk by 50% in the first 5 years but causes more non-motor side effects.
- ARasagilineFirst line · Selective irreversible monoamine oxidase B inhibitorFirst-line in early Parkinson's disease in patients under 65 as monotherapy to delay levodopa per AAN 2021 and SEN 2024. In advanced disease, added to levodopa for motor fluctuations – reduces «off» time by 0.9 hours/day (LARGO, PRESTO). Dose 1 mg once daily, no titration.
- ARopiniroleFirst line · Non-ergot dopamine D2/D3 receptor agonistFirst-line in Parkinson's disease in patients under 65 to delay levodopa or in combination with levodopa for motor fluctuations. Starting dose immediate-release 0.25 mg three times daily or extended-release 2 mg once daily. Efficacy comparable to pramipexole per REAL-PET and CALM-PD. Also raises impulse-control disorder risk (FDA 2012, EMA 2014 warning).
- BLevodopa + Carbidopa + EntacaponeSecond line · Triple fixed-dose combination: dopamine precursor, peripheral decarboxylase inhibitor, and COMT inhibitorParkinson's disease in patients with wearing-off on levodopa-carbidopa therapy. Per MDS 2018 and SEN 2024, the triple combination is second-line for motor fluctuations. Dose: individualized, based on prior levodopa dose; standard tablets 50/12.5/200, 75/18.75/200, 100/25/200, 125/31.25/200, 150/37.5/200, 200/50/200 mg 4–10 times daily depending on regimen. Not first-line in levodopa-naïve patients.
- BSelegilineAdd-on therapy · Selective irreversible MAO-B inhibitorSelective MAO-B inhibitor as monotherapy in early Parkinson disease and as levodopa adjunct to reduce dose and motor fluctuations. SEN recognises a modest symptomatic effect.
- CMucuna pruriens (velvet bean)Add-on therapy · Plant source of L-DOPA. Used in Ayurveda for Parkinson disease; in the West – biohacking supplementMucuna is the only plant preparation containing significant L-DOPA (4–7% in seeds). Katzenschlager 2004 RCT (J Neurol Neurosurg Psychiatry) in 8 Parkinson patients showed mucuna (30 g seed powder) had pharmacokinetic profile comparable to levodopa/carbidopa 200/50 mg, with faster onset and longer duration. MDS 2018 evidence-based medicine review does not include mucuna in proven-efficacy preparations for Parkinson motor symptoms; standard levodopa/carbidopa or levodopa/benserazide remains the only first-line under expert neurology supervision. AEMPS and EMA do not register mucuna as a medicine. Self-administration of mucuna in Parkinson is unsafe: unpredictable L-DOPA concentration across seed batches, absence of peripheral decarboxylase inhibitor (significant peripheral effects), drug interaction risk with MAO-I, antipsychotics and antihypertensives.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit