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Table 2 Existing and novel approaches to the treatment of ‘wearing off’

From: Treatment of the later stages of Parkinson’s disease – pharmacological approaches now and in the future

Dopaminergic approaches Examples Status
Drug combinations   
L-dopa plus DA IR – ropinirole. pramipexole Marketed
DA plus L-dopa IR – Sinemet, Madopar Marketed
+ MAOB inhibitor Irreversible – rasagiline, selegiline Marketed
  Reversible - safinamide Approved in EU
+ COMT inhibitor Entacapone, tolcapone Marketed
  Opicapone Clinical trials
L-dopa + carbidopa + entacapone Stalevo Marketed
Extended release   
L-dopa Sinemet CR Marketed
  Rytary Approved in USA
DA ER – ropinirole, pramipexole Marketed
  TD – rotigotine Marketed
Non-dopaminergic approaches   
GABA/glutamate Zonisamide Marketed in Japan
A2a adenosine antagonist Istradefylline Marketed in Japan
Gene therapy   
TH/AADC/GTP-cyclohydrolase-1 ProSavin Clinical trials
  1. DA – dopamine agonist; IR- immediate release; CR – controlled release; TD – transdermal; TH-tyrosine hydroxylase; AADC – aromatic aminoacid decarboxylase.