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A patch formulation of the non-ergot dopamine agonist rotigotine (Neupro – UCB) has returned to the US market after a 4-year absence. Originally approved by the FDA in 2007 for treatment of early Parkinson’s disease,1 it was withdrawn in 2008 because of crystallization of the drug in the patch, which could have led to under-dosing. The new patch has somewhat broader indications than the old one; it is approved for use in any stage of Parkinson’s disease (PD) and also for moderate-to-severe restless legs syndrome (RLS).1. Transdermal rotigotine (Neupro) for Parkinson’s disease. Med...

Glycopyrrolate (Robinul, and others), a synthetic muscarinic receptor antagonist, has been used off-label for many years for treatment of excessive drooling in patients with Parkinson’s disease, in patients taking clozapine for schizophrenia, and in developmentally disabled children.1-3 It has now been approved by the FDA as Cuvposa (Shionogi) for use specifically in children 3-16 years old with severe chronic drooling due to a neurologic condition, such as cerebral palsy. It is being marketed as an oral solution, which will permit more precise weight-based dosing than was possible with the...

Parkinson’s disease (PD) is caused primarily by progressive degeneration of dopamine-containing neurons in the substantia nigra. Dopamine itself cannot be used to treat PD because it does not cross the blood-brain barrier.

Deep brain stimulation (DBS) is increasingly used to treat advanced Parkinson's disease (PD), but few controlled clinical trials have been published. New evidence from a large controlled study has recently become available.

Rotigotine (Neupro - Schwarz Pharma), a nonergot dopamine agonist in a transdermal patch formulation, was recently approved by the FDA for treatment of early Parkinson's disease (PD).

Rasagiline (Azilect - Teva), a monoamine oxidase-type B (MAO-B) inhibitor, was recently approved by the FDA for once-daily oral treatment of Parkinson's disease (PD). It can be taken alone for treatment of early disease or with levodopa/carbidopa (Sinemet, and others) for advanced disease. Selegiline (Eldepryl, and others), the first MAO-B inhibitor marketed in the US, has been available since 1988; a new lower-dose disintegrating tablet (Zelapar) was recently approved.

An orally dissolving, immediate-release tablet formulation of carbidopa/levodopa (Parcopa - Schwarz) that can be taken without water is now available for treatment of Parkinson's disease.

Apomorphine (Apokyn - Mylan/Bertek), an injected non-ergot dopamine agonist, was recently approved by the FDA for intermittent subcutaneous (SC) treatment of hypomobility ("off" episodes) in patients with advanced Parkinson's disease. It has been available in Europe for many years.

Levodopa combined with carbidopa (Sinemet, and others) is the most widely used treatment for patients with Parkinson's disease, but after 2 to 5 years most patients develop troublesome complications (Treatment Guidelines from The Medical Letter 2004; 2:41). The newest treatment for Parkinson's disease patients with end-of-dose "wearing-off" is Stalevo (Novartis), a combination of the catechol-O-methyltransferase (COMT) inhibitor entacapone (Comtan) with 3 different doses of levodopa/carbidopa. The rationale for Stalevo is that it permits some patients to take only one pill rather than...

Recent articles in the press have trumpeted a new era in the management of Parkinson's disease: dopamine agonists have now replaced levodopa for initial treatment.