Parkinson disease — OFF episodes/motor fluctuations
- First optimize levodopa timing + absorption
- Shorten intervals or use longer-acting formulation
- Add COMT or MAO-B inhibitor
- Dopamine agonist is another adjunct
- Istradefylline can reduce OFF time
- Apomorphine gives rapid rescue for sudden OFF
- More dopaminergic effect may worsen dyskinesia
Use at a glance
- First optimize levodopa timing + absorption
Practical pearls
- Shorten intervals or use longer-acting formulation
Other practical pearls
- Add COMT or MAO-B inhibitor
- Dopamine agonist is another adjunct
Clinical pearls
- Istradefylline can reduce OFF time
- Apomorphine gives rapid rescue for sudden OFF
- More dopaminergic effect may worsen dyskinesia
Self-check
- What should be done first in Parkinson disease — OFF episodes/motor fluctuations?
optimize levodopa timing + absorption.
Drugs used for this (4)
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