While there is currently no cure for Parkinson’s disease, a variety of treatment options can help reduce symptoms and improve quality of life. Parkinsonism refers to brain conditions that cause movement and balance problems such as stiffness and bradykinesia (slow movements). Most cases of parkinsonism are caused by Parkinson’s disease.

The type of treatment used for Parkinson’s depends on many factors, including symptom severity, the specific type and stage of the disease, and the presence of other health conditions. Some treatments are particularly effective for certain forms of Parkinson’s but may not work as well for others​​.

This article will discuss common treatment options, including medications, surgical interventions, and other therapies.

Medications for Parkinson’s

Parkinson’s disease symptoms are due to changes in dopamine and other neurotransmitters. Neurotransmitters are chemicals that help nerve cells communicate with each other and the rest of the body. In Parkinson’s, the brain cells that produce a type of neurotransmitter called dopamine begin to shrink and die.

Dopamine plays a critical role in controlling movement, coordinating smooth and purposeful actions, and supporting emotional regulation. When dopamine levels drop, the brain struggles to send accurate signals for initiating and managing movement. The loss of dopamine can also lead to imbalances of other neurotransmitters in the brain, further affecting both motor (movement-related) and nonmotor functions​​​.

Since Parkinson’s is caused by a decrease in dopamine, many medications used to treat the disease work by regulating dopamine in the body. They do this by raising levels of dopamine, mimicking the effects of dopamine, or controlling levels of other neurotransmitters.

Other medications may be used to treat specific symptoms of Parkinson’s or to manage side effects from the medications regulating dopamine. Your doctor can recommend the best medications for your situation.

Levodopa

The most common medication for managing Parkinson’s disease is levodopa, which helps increase the level of dopamine in the brain. Since using levodopa alone can cause significant nausea and vomiting, it’s normally taken in combination with carbidopa, a medication that reduces the risk of these side effects and ensures more levodopa reaches the brain​​.

There are many different preparations of levodopa/carbidopa, including Sinemet, Parcopa, Rytary, and Crexont. This medication is usually taken as a pill or tablet. A formulation of levodopa called Inbrija can be inhaled for quick relief of sudden “off” periods​, when symptoms are more noticeable.

If the person still has “off” times, the doctor may recommend Duopa. Duopa is a system that delivers a gel form of levodopa/carbidopa directly into the small intestine through a small, portable, battery-powered pump​​.

Although levodopa/carbidopa is a powerful drug for Parkinson’s, it can also have side effects. In addition to nausea and vomiting, some of the common side effects include:

• Loss of appetite
• Lightheadedness
• Confusion
• Low blood pressure
• Hallucinations (seeing or hearing things that are not there)
• Dyskinesia (involuntary movements, such as twisting or writhing)

COMT Inhibitors

Over time, levodopa/carbidopa medications may become less effective, with their benefits wearing off more quickly, leading to “off” times. To address this, doctors may prescribe a catechol-O-methyltransferase (COMT) inhibitor that works by increasing the amount of levodopa that reaches the brain. COMT inhibitors work by preventing the breakdown of levodopa in the bloodstream, allowing more of it to reach the brain and extend its effectiveness​​.

Common COMT inhibitors include entacapone (Comtan), which can be taken alone or as part of a combination pill containing levodopa, carbidopa, and entacapone (Stalevo). The COMT inhibitor tolcapone (Tasmar) can also be used.

Although COMT inhibitors can help manage “off” times, they may also increase some of the side effects of levodopa, especially dyskinesia. Other potential side effects include:

• Confusion
• Hallucinations
• Urine discoloration (often a harmless reddish or brownish tint)
• Diarrhea

Amantadine

Originally developed as an antiviral medication, amantadine is also used to manage certain symptoms of Parkinson’s disease. It can help reduce tremors and manage dyskinesia, a common side effect of long-term levodopa treatment. Although the exact mechanism is not fully understood, amantadine is believed to work by increasing the amount of dopamine available in the brain and potentially blocking signals that cause overactive muscle movements​​.

Amantadine is available in several formulations, including Gocovri and Osmolex ER. Each formulation is taken orally.

Dopamine Agonists

Dopamine agonists work by mimicking the effects of dopamine by binding to dopamine receptors in the brain. This makes brain cells more responsive to dopamine. They can be used alone, particularly in the early stages of Parkinson’s disease, or in combination with levodopa/carbidopa to enhance symptom management​​.

Many dopamine agonists are taken by mouth, including pramipexole (Mirapex ER) and ropinirole. Other formulations include rotigotine (Neupro), which is delivered through a skin patch, and apomorphine, available as an injectable medication (Apokyn) or as a sublingual film (Kynmobi) that dissolves under the tongue​​.

Side effects of dopamine agonists can include:

• Dizziness
• Headaches
• Nausea
• Heart problems, such as irregular heartbeat or low blood pressure
• Behavioral changes, including compulsive behaviors like gambling or shopping

Adenosine A2A Antagonists

In the brain, adenosine A2A receptors are located near dopamine receptors and play a role in regulating motor function. Medications that block these receptors, known as adenosine A2A antagonists, may help improve Parkinson’s symptoms by enhancing the effects of dopamine.

Istradefylline (Nourianz) is an adenosine A2A antagonist that can be used alongside levodopa to reduce “off” times. This medication is typically prescribed for people experiencing motor fluctuations that are not well controlled with standard treatments​.

Anticholinergics

Anticholinergics, such as trihexyphenidyl and benztropine mesylate (Cogentin), work by blocking acetylcholine in the brain. Acetylcholine is another neurotransmitter that works in balance with dopamine to regulate movement.

Anticholinergics are particularly effective for managing tremors and muscle cramping that may occur when Parkinson’s medications wear off​​​.

Common side effects include:

• Memory problems
• Constipation
• Blurred vision
• Urinary retention

MAO B Inhibitors

Early in the course of Parkinson’s, some people take medications from a class of drugs called monoamine oxidase-B (MAO B) inhibitors. These drugs work by blocking the action of MAO B, an enzyme that breaks down dopamine in the brain. This, in turn, improves motor symptoms of Parkinson’s disease.

MAO B inhibitors include:

• Rasagiline (Azilect)
• Safinamide (Xadago)
• Selegiline (Eldepryl and Zelapar)

The most common side effects of MAO B inhibitors include:

• Mild nausea
• Lightheadedness
• Constipation
• Confusion
• Hallucinations

Symptom Management Medications

In addition to medications that target motor symptoms, other drugs may be prescribed to manage specific symptoms of Parkinson’s disease or to address side effects caused by Parkinson’s treatments. These include:

• Rivastigmine (Exelon) — This acetylcholinesterase inhibitor works by increasing levels of the neurotransmitter acetylcholine, which is involved in memory and learning. Rivastigmine is used to treat dementia associated with Parkinson’s.
• Droxidopa (Northera) — This medication helps treat orthostatic hypotension (a sudden drop in blood pressure when standing up) by increasing levels of norepinephrine, which helps maintain blood pressure​​.
• Pimavanserin (Nuplazid) — This is an antipsychotic specifically approved to treat hallucinations and delusions (false beliefs, such as thinking others are trying to harm you) associated with Parkinson’s disease psychosis. Pimavanserin works by regulating activity of the serotonin receptors. This helps manage psychosis without interfering with dopamine, preserving motor function​​.

Some people with Parkinson’s also use medical marijuana to manage symptoms including pain, anxiety, and sleep problems. Although some individuals report benefits, research on the effectiveness and safety of medical marijuana for Parkinson’s symptoms is still limited. Additionally, laws regarding medical marijuana vary widely by state or country, so it is important to understand local regulations. Its use should always be under medical supervision​​.

Surgical Treatments for Parkinson’s

For some people with Parkinson’s, medications may not adequately control motor symptoms, or they may cause serious side effects. In these cases, certain surgical treatments can help manage symptoms.

Deep Brain Stimulation

The most common surgical treatment for symptoms of Parkinson’s is called deep brain stimulation (DBS). This procedure involves implanting an electrode (thin wire) into specific areas of the brain that regulate movement. The electrode is connected to a device called an impulse generator battery (IPG), which is implanted under the skin of the collarbone or stomach. The IPG delivers electrical signals to parts of the brain that cause tremors and other Parkinson’s symptoms. This can help reduce some of the motor symptoms of Parkinson’s.

DBS is most useful in people with:

• Disabling tremors
• Motor fluctuations (periods when medications are less effective)
• Dyskinesia caused by long-term medication use

Research shows that the benefits of DBS can last for several years, often up to five years or more, depending on the individual​​.

Other Surgical Treatments

In rare cases, other surgeries may be considered when medications and DBS do not provide sufficient relief. These include:

• Thalamotomy — This procedure targets and disrupts part of the thalamus, part of the brain involved in controlling tremors. It is typically used for severe tremors.
• Pallidotomy — This surgery targets the globus pallidus, part of the brain involved in movement regulation. It can help with tremors, stiffness, and slowness. However, it is not recommended for individuals who have not responded well to levodopa.
• Subthalamotomy — The procedure disrupts an area of the brain called the subthalamus, which is also involved in movement control. This surgery can help treat tremors.

Therapies for Parkinson’s

In addition to medication or surgery, various therapies can help people with Parkinson’s manage symptoms and improve their quality of life. These include:

• Physical therapy — Working with a physical therapist can help address issues like loss of balance and walking difficulties by improving strength, flexibility, and mobility. Physical therapy also can help manage symptom progression and boost confidence and sense of control.
• Occupational therapy — This type of therapy teaches ways to remain independent and manage daily tasks despite motor symptoms. Occupational therapists can recommend tools or modifications for managing daily tasks, such as dressing, cooking, or writing​.
• Speech therapy — Also known as speech-language pathology, this therapy assists with communication symptoms, including challenges such as slurred speech, hypophonia (soft voice), or dysphagia (difficulty swallowing).

These therapies are typically tailored to each person’s unique symptoms and goals. Regular engagement with therapists can improve both physical and emotional well-being.

Lifestyle Changes for Parkinson’s

Making certain healthy lifestyle changes can help improve symptoms and quality of life in people with Parkinson’s.

Exercise

There are many benefits of exercise for people with Parkinson’s. Research shows that regular exercise can improve shoulder, hip, and back pain, as well as slow the progression of motor symptoms and improve the overall quality of life for people with Parkinson’s. Regular exercise also has general health benefits, including promoting a healthy body weight, reducing the risk of heart disease, and improving overall mood.

People with any stage or severity of Parkinson’s disease can benefit from exercise. Doctors and researchers agree that the more exercise you do, the more benefit you will receive from the activity.

You can work with your doctor to determine what type of exercise would be best for you. Research has shown that dance, water exercise, balance training, and strength and resistance training have been especially beneficial for motor symptoms.

Diet

While there is no specific diet for Parkinson’s, eating a healthy, balanced diet consistently can help slow the progression of the disease and ensure that your medications work their best. A balanced diet with lots of fruits and vegetables can also help maintain a healthy weight and lower the risk of developing health conditions such as diabetes and heart disease.

If you’re taking certain medications for Parkinson’s, your doctor may recommend some changes to your diet. For instance, protein can delay or reduce the effects of levodopa/carbidopa. If you take either of those, it’s important to consider the timing of your medication when you eat foods rich in protein.

Your doctor may also tell you to limit your intake of foods with high amounts of tyramine since these foods can cause high blood pressure in people taking MAOIs. Some examples of foods high in tyramine include:

• Cheese
• Aged meat
• Smoked fish
• Fermented or aged products

If you have questions about the best diet to follow for Parkinson’s, be sure to talk to your doctor for personalized advice.

Clinical Trials

You may be eligible to participate in clinical trials researching new treatments for Parkinson’s disease or parkinsonism. These trials are designed to test a variety of approaches, including new medications or surgical procedures. However, it’s important to carefully weigh the potential benefits and risks with your doctor before enrolling.

Work With Your Doctor

Managing Parkinson’s disease requires a collaborative approach with your doctor to identify treatments and therapies that align with your or your loved one’s goals. Clear and open communication is essential — be sure to discuss what is or isn’t working and any concerns you may have.

Remember, finding the right combination of treatments may take time, and adjustments are often necessary as symptoms and needs change. Patience, persistence, and teamwork with your health care provider can help you achieve the best possible outcomes.

Talk With Others Who Understand

MyParkinsonsTeam is the social network for people with Parkinson’s disease and their loved ones. On MyParkinsonsTeam, more than 106,000 members come together to ask questions, give advice, and share their stories with others who understand life with Parkinson’s disease.

Which, if any, of these treatments have you used to manage your Parkinson’s? Which treatments worked best for you? Share your experiences in the comments below, start a conversation by posting on your Activities page, or connect with like-minded members in Groups.