Do not delay prescribing levodopa if appropriate, and instead, do not use drugs for the complicated phase of the disease prematurely.

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Levodopa prescription as a drug treatment in Parkinson’s disease is often delayed in favour of other drug categories (such as dopamine agonists) due to concerns about the risk of drug-induced motor complications or levodopa toxicity. However, recent evidence has mitigated these concerns and thus levodopa can be introduced early if required by the patient’s clinical condition, although using a low dosage. Conversely, there is no evidence that the use of drugs indicated in the complicated phase of the disease (such as COMT catechol-O-methyltransferase inhibitors) reduce the risk of motor complications of the disease and should therefore be avoided in the earliest stages.


1. Cilia R, Akpalu A, Sarfo FS, Cham M, Amboni M, Cereda E, Fabbri M, Adjei P, Akassi J, Bonetti A, Pezzoli G. The modern pre-levodopa era of Parkinson's disease: insights into motor complications from sub-Saharan Africa. Brain. 2014;137:2731-42
2. Ferreira JJ et al. Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson’s disease. Eur J Neurol 2013; 20: 5-15



Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.