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"Pro-levodopa" management approach

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The evidence that levodopa accelerates the pathology of Parkinson's disease is not conclusive.

The "pro-levodopa" managment approach is outline below:

  • delay drug treatment as long as possible

  • introduce levodopa with a decarboxylase inhibitor:
    • 100 mg levodopa dose 3-4 times per day may control early disease

  • the combination of levodopa with a dopamine agonist may provide control with fewer side-effects:
    • a regimen for more advanced disease might comprise:
      • levodopa/decarboxylase inhibitor combined 500-800 mg daily in divided doses
      • bromocriptine 20 mg, or pergolide 2 mg, or lisuride 2 mg

  • the combination of levodope with a COMT inhibitor reduces motor fluctuations:
    • entacapone is licensed in the UK



  • anticholinergic agents
  • amantadine
  • apomorphine

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