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 is optimized first for Parkinson OFF episodes?
Optimize levodopa timing + absorption. - What provides rapid rescue for sudden OFF episodes?
Apomorphine.
Drugs used for this (12)
All clinical uses · Open Parkinson disease — OFF episodes/motor fluctuations in the interactive console ↗