Summary points

• A wide variety of drugs is available for treating Parkinson's disease, including anticholinergics, amantadine levodopa, dopamine agonists, and selegeline

• In younger patients (<50) levodopa is usually delayed provided that adequate relief of symptoms can be achieved with other drugs. In older patients (>70) levodopa should be started as soon as symptom relief is required. Between these ages there is no consensus, but at present most such patients should probably be given controlled release levodopa before a dopamine agonist is added

• Fluctuations can often be alleviated by giving controlled release preparations of levodopa, by giving small doses at frequent intervals, by adding selegiline or a long acting oral agonist, or by subcutaneous apomorphine

• Dyskinesia can be peak dose, diphasic, or “off period.” The diphasic form is hardest to alleviate

• Psychiatric side effects should initially be managed by changing the antiparkinsonian treatment before resorting to antipsychotic drugs