Drugs to the Rescue: Comparison of On-Demand Therapies for OFF Symptoms in Parkinson's Disease

Document Type

Article

Publication Date

6-13-2023

Publication Title

J Parkinsons Dis

Abstract

Patients with Parkinson's disease often suffer from OFF symptoms disrupting their daily routines and adding to disabilities. Despite polypharmacy and adjustments to medication schedules, they often do not experience consistent relief from their motor symptoms. As the disease progresses, impaired gastric emptying may evolve, making it even more challenging for dopaminergic drugs to provide consistent results. This review focuses on a group of drugs that have the pharmacokinetic advantage of a much earlier onset of action by virtue of their non-oral routes of absorption. We compare the current marketed options: subcutaneous apomorphine, sublingual apomorphine, and inhaled levodopa. Subcutaneous apomorphine is the speediest to take effect, whereas sublingual apomorphine offers the longest clinical effect. Inhaled levodopa has the most favorable side effect profile among the three options. An inhaled form of apomorphine is currently under development, having passed safety and efficacy studies. Each of these drugs has unique characteristics for the user, including different side effect profiles and onset of action. The best choice for a patient will depend on individual needs and circumstances. In this review, we explore those nuances to allow clinicians to select the best option for their patients.

Medical Subject Headings

Humans; Parkinson Disease; Apomorphine; Levodopa; Antiparkinson Agents; Dopamine Agonists; Drug-Related Side Effects and Adverse Reactions

PubMed ID

37182902

ePublication

ePub ahead of print

Volume

13

Issue

4

First Page

441

Last Page

451

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