A 72-year-old man with longstanding Parkinson’s comes to the surgery.
He is maintained on high dose l-dopa therapy but is suffering significant on/off phenomena. This is really
affecting his life and he feels unable to leave the house and go on excursions with his wife.
Other past history of note includes prostatism for which he takes an alpha-blocker and a 5-alpha reductase
inhibitor. He has also suffered a myocardial infarction some five years earlier.
Which one of the following would be the most appropriate next therapeutic option for him?
Amitriptyline
Cabergoline This is the correct answer
Change to soluble levodopa before meals
Entacapone
Selegiline Incorrect answer selected
On/off phenomena may be considerably improved either by the addition of cabergoline (a dopamine agonist) or a subcutaneous infusion of apomorphine.
Liquid forms of l-dopa may also be helpful as they allow closer titration of dose, and splitting meals into smaller snacks and one larger evening meal also affects the pharmacokinetics (PK) of l-dopa positively.