Synopsis
Choose person-centred motor treatment, preserve time-critical dopaminergic dosing and manage wearing-off, dyskinesia and advanced disease without overlooking behavioural and non-motor harms.
- Offer levodopa when early motor symptoms affect quality of life; if they do not, discuss levodopa, a non-ergot dopamine agonist or an MAO-B inhibitor using individual risks and preferences.
- Doses must be given at the person's established times, not merely standard drug-round times. Delayed or omitted levodopa can cause profound immobility, aspiration and a hyperpyrexia syndrome.
- Wearing-off is predictable return of symptoms before the next dose; delayed-on reflects slow absorption, while sudden unpredictable immobility is an on-off phenomenon.
Key red flags
New gambling, spending, eating, sexual behaviour, hobbyism or compulsive medicine use may be concealed from the patient; collateral history and non-judgemental direct questions are essential.
Investigation priorities
Map each exact dose against on-time, wearing-off, freezing, dyskinesia, sleep and food to classify the motor complication.
Management branches
A specialist has confirmed Parkinson disease and motor symptoms need treatment.
- Define which activities, discomfort or participation the person wants to improve and assess cognition, postural pressure, sleepiness, hallucination and impulse-control vulnerability.
- Offer levodopa when motor symptoms impair quality of life; for lesser impact, discuss levodopa, non-ergot dopamine agonist and MAO-B inhibitor with comparative benefits and harms.
Key medicines
Co-beneldopa or co-careldopaStart and titrate an immediate or modified-release preparation individually through the specialist treatment plan.
Non-ergot dopamine agonistPramipexole, ropinirole or rotigotine is titrated slowly using the product-specific licensed schedule.