Pharmacology of major neurological drugs

Antiparkinsonian

Class	Agents	Position
Levodopa + peripheral DDCI	Carbidopa, benserazide	Most effective for bradykinesia and rigidity; recommended first agent at any age. Motor fluctuations and dyskinesia with time
Dopamine agonists (non-ergot)	Pramipexole, ropinirole, rotigotine patch, apomorphine	Levodopa-sparing; impulse control disorders ~15-20%
Ergot agonists	Bromocriptine, pergolide, cabergoline	*Avoid - cardiac valvulopathy and retroperitoneal/pulmonary fibrosis*
MAO-B inhibitors	Rasagiline, selegiline, safinamide	Less effective than levodopa; useful early or as adjunct
COMT inhibitors	Entacapone (with each dose), opicapone (once daily), tolcapone	Prolong levodopa "on" time. Tolcapone: hepatotoxicity, restricted
Amantadine		The drug for dyskinesia
Anticholinergics	Benztropine, trihexyphenidyl	Tremor only, in the young. Avoid over 65

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