Pharmacotherapy: problems and practices.

Treatment of Parkinson's disease is not difficult in the early stages of the disease; a therapeutic regimen of carbidopa-levodopa or possibly, a combination of carbidopa-levodopa and bromocriptine, provides the best therapeutic results. There is no reason to withhold carbidopa-levodopa therapy early in the disease. During the more advanced stages of the disease, in addition to meticulous titration of carbidopa-levodopa, the administration of a dopamine agonist (such as bromocriptine), amantadine, or an anticholinergic agent may be required in an attempt to smooth the therapeutic effect. All of these drugs, with the exception of amantadine, require small initial doses with subsequent cautious increases in dosage. Mental side effects are less likely to occur with carbidopa-levodopa therapy than with any of the other drugs.