title: Revisiting the Medical Management of Parkinson's Disease: Levodopa versus Dopamine Agonist.
abstract: The optimal treatment strategy for Parkinson's disease has been debated for decades. The introduction of levodopa (LD) treatment is frequently delayed because of theoretical concerns about its toxicity or the risk of drug-induced motor complications. These concerns have resulted in "LD phobia" with clinicians selecting dopamine agonist (DA) over LD as initial therapy. More recently, a shift in the treatment approach towards initial LD use appears to be occurring. It is therefore necessary to review current evidence for the use of LD and DA. This review discusses the medical management of Parkinson's disease with regards to the use of LD versus DA. Pendulum swings in treatment strategies between LD-first and DA-first therapies should be avoided. A balanced perspective is needed as there is a place for both drugs in the management of PD.
authors.forename: Jinglin
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Parkinson's Disease and Movement Disorder Center, Department of Neurology, National Neuroscience Institute, Republic of Singapore, USA National Parkinson Foundation International Center of Excellence, Singapore, 11 Jalan Tan Tock Seng, Singapore, 308433. louis_tan@nni.com.sg.
authors.forename: Louis Chew-Seng
authors.initials: LC
authors.lastname: Tan
mesh_terms: D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018491:Dopamine Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D004409:Dyskinesia, Drug-Induced / Q000517:prevention & control; D006801:Humans; D007980:Levodopa / Q000009:adverse effects / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D018491:Dopamine Agonists; D007980:Levodopa