title: The initial treatment of Parkinson's disease should begin with levodopa.
abstract: For over two decades controversy has surrounded the initial choice of therapeutic agent for patients with early symptomatic Parkinson's disease. Whether levodopa or dopamine receptor agonist monotherapy in these patients is more efficacious and/or results in fewer long-term complications of dopaminergic therapy such as motor fluctuations, dyskinesias, or psychiatric disorders is unresolved. This article examines the evidence related to levodopa-sparing strategies and levodopa-induced toxicity in Parkinson's disease. At this time, there is little evidence to support levodopa-sparing strategies or to suggest that levodopa is toxic and harmful to patients with Parkinson's disease.
authors.affiliation: Department of Neurology, University of Miami School of Medicine, Florida 33136, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Weiner
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000494:pharmacology / Q000627:therapeutic use*; D052160:Benzothiazoles; D001971:Bromocriptine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D020329:Essential Tremor / Q000188:drug therapy; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D007980:Levodopa / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D010479:Pergolide / Q000627:therapeutic use; D000077487:Pramipexole; D011954:Receptors, Dopamine / Q000187:drug effects; D013844:Thiazoles / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000978:Antiparkinson Agents; D052160:Benzothiazoles; D007211:Indoles; D011954:Receptors, Dopamine; D013844:Thiazoles; C046649:ropinirole; D010479:Pergolide; D001971:Bromocriptine; D007980:Levodopa; D000077487:Pramipexole