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Delay drugs till disabling Sx then use dopamine receptor agonist unless elderly when use levodopa

''Dopamine receptor agonist''
eg Bromocriptine, ropinirole, cabergoline, apomorphine]
pulmonary, retroperitoneal and cardiac fibrosis - do echo, ESR, creatinine and CXR preRx and monitour closely
 warn about impulse control disorder and xs daytime sleepiness
hallucinations in elderly, nasal congestion and postural hypotension  (FISHHN)

''Levodopa''
combine with decarboxylase inhibitor (carbidopa) to prevent peripheral metabolism of levodopa
reduced effectiveness with time (approx 2 yrs)
SE - dyskinesia, on-off, dry mouth, anorexia, palpitations, postural hypotension, psychosis, drowsiness (DDDOPPPA)
no use in drug induced parkinsons

''MAOI-B'' eg Selegiline
inhibits breakdown of dopamine from neurons

''Amantadine''
mechanism not understood (works at dopaminergic synapses)
SE - ataxia, slurred speech, confusion, dizzy, livedo reticularis

''COMT inhibitors'' eg entacapone
COMT breaks dopamine down (so can use with levodopa)

''Antimuscarinics'' eg, Procyclidine, benzotropine and benzhexol
helps tremor and rigidity
used for drug induced PD