Initial Monotherapy for Parkinson's Disease: Which Drug Class to Start With

Selecting the right first-line agent for Parkinson's disease requires weighing several established drug classes against one another. The structured protocol covers how to make that choice in a systematic, evidence-based way.

Clinical scenario This is a first-line protocol for Parkinson's disease — applicable at initial pharmacotherapy, before any prior anti-parkinsonian treatment has been tried.

Treatment approach — partial overview Initial management draws on three established drug classes for monotherapy — Levodopa preparations, non-ergoline dopamine agonists, and MAO-B inhibitors — with the full selection criteria, preferred sequencing by patient profile, and individual considerations detailed in the complete protocol. Patient age is one of several factors that guides which class is preferred…

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References

DOI: 10.1186/s42466-024-00325-4

Levodopa preparations can be used for PD therapy without prioritization among preparations based on the comprised decarboxylase inhibitor (Carbidopa or Benserazide).
Non-ergoline dopamine agonists (Pramipexole, Ropinirole, Piribedil, Rotigotine, with limitations Apomorphine) can be used for PD therapy, considering specific indications outlined below.
MAO-B inhibitors Selegiline or Rasagiline can be used as monotherapy for early PD or in combination with Levodopa for treatment of PD with fluctuations.
Dopamine agonists or MAO-B inhibitors should therefore be considered preferentially over Levodopa for biologically younger patients.
However, patients requiring Levodopa in initial monotherapy should of course receive it.

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