Drug | Step | Mode of action within the dopaminergic system | Tolerability | Main clinical relevant side effects | Efficacy |
---|---|---|---|---|---|
MAO-B-I | I | stabilize dopamine levels in the striatal synaptic cleft by inhibition of dopamine metabolism | +++ | risk for rise of raised blood pressure and increase of liver enzymes, contraindication for simultaneous fluoxetine and fluvoxamine use, precaution with application of SSRI in general | + |
NMDA-A | I | indirect dopaminergic modulation, reduce motor complications (?) | + | oedema, insomnia, hallucinations | + |
DA | II | stimulate directly postsynaptic striatal receptors linked to motor symptom control | + | Orthostatic syndrome, oedema, nausea, slow titriation necessary | ++ |
LD/DDI/COMT-I | III | precursor of dopamine, DDI and COMT-I reduce LD metabolism | +++ | orthostatic syndrome, homocysteine elevation (LD/DDI alone), motor complications, diarrhea (COMT-I) | +++ |
infusion systems (apomorphine, LD) | IV | See DA, respectively LD line | + | Subcutaneous local inflammatory reactions | +++ |
DBS | V | electric stimulation of the subthalamic nuclei or globus pallidus | + | Social adjustment problems, depression, cognitive dysfunction. | +++ |