Step 1:
 Assessment
This section gathers information on whether you use levodopa and how well your symptoms are controlled. The tool will use this information to create a list of recommendations for you.

Select your answer to each question with yes or no. You may type or click the up/down arrows to answer numerical questions.

Steps 2 and 3 may be blank if you have not answered all questions in Step 1.

Hover your mouse over '❔' to see further explanation of a word or question.


PURPOSE STATEMENT: The Parkinson Disease (PD) Decision Support Tool is not intended to provide individualized drug recommendations. Rather, it offers general information on medication alternatives for PD.
Levodopa Use
Are you currently on medications for your PD?
Do you take levodopa?
How many times per day do you take your levodopa (including both immediate- and/or controlled-release tablets)?
 
Symptoms
Age
 
Over the past week, have you experienced any of the following symptoms:
My movements feel slow
My movements feel stiff, rigid, or tight
My hands or feet shake when I am not moving
My hands or arms feel shaky when I hold them stretched in front of me
My medication is wearing off early
I experience dyskinesias
Do your symptoms impair your ability to participate in daily activities?
Step 2: 
Drug Options to Discuss with Your Doctor
This section lists medications that may be suitable for you based on Step 1. 

You can learn more about each drug by clicking on the drop-down arrows to the right of each drug name. 

Clicking on the drug name will reveal its benefits and side effects.

Suggested Medications
Based on the information you provided in Step 1, the following medications may be most suitable for you. 
This section may be blank. 
Levodopa Combinations
TypeCapsule
Regimen1 to 8 times a day
Cost Around $75 to $300 for 3 months, depending on number of tablets taken per day
Notes
  • Levodopa comes in combination with carbidopa or benserazide to prevent the breakdown of levodopa before it reaches the brain
  • Carbidopa and benserazide are equally effective
  • Levodopa/benserazide may be used for people who experience intolerable side effects on levodopa/carbidopa
  • The benefit of this medication is LOWER when taken with high protein foods
  • Exercise may SHORTEN how long the medication lasts for
Type
  • IR = immediate-release tablet
  • Effect is felt in 30-60 minutes
Regimen1 to 8 times a day
Cost Around $30 to $150 for 3 months, depending on number of tablets taken per day
Notes
  • Levodopa comes in combination with carbidopa or benserazide to prevent the breakdown of levodopa before it reaches the brain
  • Carbidopa and benserazide are equally effective
  • The benefit of this medication is LOWER when taken with high protein foods
  • Exercise may SHORTEN how long the medication lasts for
Type
  • CR = controlled-release tablet
  • Effect is felt in 90-120 minutes
Regimen1 to 4 times a day
Cost Around $75 for 3 months
Notes
  • Do not crush or chew
  • The benefit of this medication is LOWER when taken with high protein foods
  • Exercise may SHORTEN how long the medication lasts for
TypeGastrointestinal pump
RegimenContinuously
Cost
  • May be covered by provincial insurance plans only if your doctor completes the necessary paperwork
  • Without this paperwork, the cost is >$5000/month
Notes
  • This medication is taken through a permanent tube in the stomach wall
  • This option is mostly used in people with advanced Parkinson Disease. They may have wearing off and/or dyskinesia that has not improved with other drug therapies
  • It is also helpful for people who have trouble taking medication by mouth
Dopamine Agonists
TypeTablet
Regimen3 times a day
Cost
  • Around $75 for 3 months
  • May be covered by provincial insurance plans only if your doctor completes the necessary paperwork
Notes
  • Take with food to prevent nausea
  • Do not crush or chew tablets
  • Dopamine agonists increase the risk for developing impulsive or addictive behaviours. You should discuss these risks with your doctor.
TypeTablet
Regimen3 times a day
Cost
  • Around $100 for 3 months
  • May be covered by provincial insurance plans only if your doctor completes the necessary paperwork
Notes
  • Do not crush or chew tablets
  • Dopamine agonists increase the risk for developing impulsive or addictive behaviours. You should discuss these risks with your doctor.
TypePatch
RegimenOnce a day
Cost
  • Around $750 dollars for 3 months
  • May be covered by provincial insurance plans only if your doctor completes the necessary paperwork
Notes
  • Apply patch at the same time each day
  • Apply patch to a different site each day to prevent skin irritation (e.g. abdomen, thigh, hip, lower back, shoulder, upper arm)
  • Avoid applying heat to patches while wearing them (e.g. heating pad, hot tub, direct sunlight)
  • Dopamine agonists increase the risk for developing impulsive or addictive behaviours. You should discuss these risks with your doctor.
MAO-B Inhibitors
TypeTablet
Regimen2 times a day
Cost Around $70 for 3 months
Notes
  • This medication can cause trouble sleeping. Avoid this by taking it before 1PM
  • Selegiline may be used on its own or in combination with levodopa medications
TypeTablet
RegimenOnce a day
Cost Around $750 for 3 months
Notes
  • Avoid taking rasagiline at the same time as eating high fat meals
  • Rasagiline can be taken with or without food
  • Rasagiline may be used on its own or in combination with levodopa medications
TypeTablet
RegimenOnce a day
Cost Around $850 for 3 months
Notes
  • Safinamide can be taken with or without food
  • Usually used in combination with levodopa
Add-On Medications
TypeTablet
Regimen1 to 8 times a day
Cost
  • May be covered by provincial insurance plans only if your doctor completes the necessary paperwork
  • Without this paperwork, the cost is around $50 for 3 months
Notes
  • Always take at the same time as levodopa
  • You may need to LOWER your levodopa dose when you start entacapone
  • Entacapone is available as a single tablet on its own or as a combination tablet with levodopa/carbidopa
  • Do NOT stop entacapone suddenly because this can cause side effects
TypeCapsule
Regimen2 times a day
Cost Around $85 for 3 months
Notes
  • May cause difficulty sleeping if taken late in the day
  • Do NOT stop amantadine suddenly because this can cause side effects
TypeTablet
Regimen2 times a day
Cost Around $25 for 3 months
Side EffectsThe incidence of side effects with benztropine is not available. Some common side effects include: Confusion, Dizziness, Anxiety or Depression, Memory Impairment, Blurred Vision, Dry Mouth, Constipation, Decreased Urination
NotesNot recommended for those over 65 years old due to the risks of drowsiness and confusion
TypeTablet
Regimen1 to 4 times a day
Cost Around $25 for 3 months
Notes
  • Do not stop this medication suddenly. This can cause withdrawal symptoms, such as high blood pressure
  • Take on an empty stomach
Other Medications
These medications are used to treat PD, but may not be suitable for you based on the information you provided in Step 1. 
This section may be blank. 
Levodopa Combinations
TypeCapsule
Regimen1 to 8 times a day
Cost Around $75 to $300 for 3 months, depending on number of tablets taken per day
Notes
  • Levodopa comes in combination with carbidopa or benserazide to prevent the breakdown of levodopa before it reaches the brain
  • Carbidopa and benserazide are equally effective
  • Levodopa/benserazide may be used for people who experience intolerable side effects on levodopa/carbidopa
  • The benefit of this medication is LOWER when taken with high protein foods
  • Exercise may SHORTEN how long the medication lasts for
Type
  • IR = immediate-release tablet
  • Effect is felt in 30-60 minutes
Regimen1 to 8 times a day
Cost Around $30 to $150 for 3 months, depending on number of tablets taken per day
Notes
  • Levodopa comes in combination with carbidopa or benserazide to prevent the breakdown of levodopa before it reaches the brain
  • Carbidopa and benserazide are equally effective
  • The benefit of this medication is LOWER when taken with high protein foods
  • Exercise may SHORTEN how long the medication lasts for
Type
  • CR = controlled-release tablet
  • Effect is felt in 90-120 minutes
Regimen1 to 4 times a day
Cost Around $75 for 3 months
Notes
  • Do not crush or chew
  • The benefit of this medication is LOWER when taken with high protein foods
  • Exercise may SHORTEN how long the medication lasts for
TypeGastrointestinal pump
RegimenContinuously
Cost
  • May be covered by provincial insurance plans only if your doctor completes the necessary paperwork
  • Without this paperwork, the cost is >$5000/month
Notes
  • This medication is taken through a permanent tube in the stomach wall
  • This option is mostly used in people with advanced Parkinson Disease. They may have wearing off and/or dyskinesia that has not improved with other drug therapies
  • It is also helpful for people who have trouble taking medication by mouth
Dopamine Agonists
TypeTablet
Regimen3 times a day
Cost
  • Around $75 for 3 months
  • May be covered by provincial insurance plans only if your doctor completes the necessary paperwork
Notes
  • Take with food to prevent nausea
  • Do not crush or chew tablets
  • Dopamine agonists increase the risk for developing impulsive or addictive behaviours. You should discuss these risks with your doctor.
TypeTablet
Regimen3 times a day
Cost
  • Around $100 for 3 months
  • May be covered by provincial insurance plans only if your doctor completes the necessary paperwork
Notes
  • Do not crush or chew tablets
  • Dopamine agonists increase the risk for developing impulsive or addictive behaviours. You should discuss these risks with your doctor.
TypePatch
RegimenOnce a day
Cost
  • Around $750 dollars for 3 months
  • May be covered by provincial insurance plans only if your doctor completes the necessary paperwork
Notes
  • Apply patch at the same time each day
  • Apply patch to a different site each day to prevent skin irritation (e.g. abdomen, thigh, hip, lower back, shoulder, upper arm)
  • Avoid applying heat to patches while wearing them (e.g. heating pad, hot tub, direct sunlight)
  • Dopamine agonists increase the risk for developing impulsive or addictive behaviours. You should discuss these risks with your doctor.
MAO-B Inhibitors
TypeTablet
Regimen2 times a day
Cost Around $70 for 3 months
Notes
  • This medication can cause trouble sleeping. Avoid this by taking it before 1PM
  • Selegiline may be used on its own or in combination with levodopa medications
TypeTablet
RegimenOnce a day
Cost Around $750 for 3 months
Notes
  • Avoid taking rasagiline at the same time as eating high fat meals
  • Rasagiline can be taken with or without food
  • Rasagiline may be used on its own or in combination with levodopa medications
TypeTablet
RegimenOnce a day
Cost Around $850 for 3 months
Notes
  • Safinamide can be taken with or without food
  • Usually used in combination with levodopa
Add-On Medications
TypeTablet
Regimen1 to 8 times a day
Cost
  • May be covered by provincial insurance plans only if your doctor completes the necessary paperwork
  • Without this paperwork, the cost is around $50 for 3 months
Notes
  • Always take at the same time as levodopa
  • You may need to LOWER your levodopa dose when you start entacapone
  • Entacapone is available as a single tablet on its own or as a combination tablet with levodopa/carbidopa
  • Do NOT stop entacapone suddenly because this can cause side effects
TypeCapsule
Regimen2 times a day
Cost Around $85 for 3 months
Notes
  • May cause difficulty sleeping if taken late in the day
  • Do NOT stop amantadine suddenly because this can cause side effects
TypeTablet
Regimen2 times a day
Cost Around $25 for 3 months
Side EffectsThe incidence of side effects with benztropine is not available. Some common side effects include: Confusion, Dizziness, Anxiety or Depression, Memory Impairment, Blurred Vision, Dry Mouth, Constipation, Decreased Urination
NotesNot recommended for those over 65 years old due to the risks of drowsiness and confusion
TypeTablet
Regimen1 to 4 times a day
Cost Around $25 for 3 months
Notes
  • Do not stop this medication suddenly. This can cause withdrawal symptoms, such as high blood pressure
  • Take on an empty stomach
Comparing the Benefits
How well can it control my symptoms?
Levodopa
🙂🙂🙂
Dopamine Agonists
🙂🙂
MAO-B Inhibitors
🙂
Comparing the Risks
Side Effects
No treatment selected
Step 3: 
Things You Can Do

This section provides information on: (1) How you can adjust medications on your own AND (2) Which changes require a doctor visit.

This section may be blank if you have indicated that you are not on levodopa in Step 1.

Click the buttons to learn more about each option

This section may be blank.
Please indicate in Step 1 if you are experiencing wearing off or dyskinesia
Management for Medication Wearing Off Early
Management for Dyskinesias
Management for Medication Wearing Off Early PLUS Dyskinesias
Changes You Can Make on Your Own
  • Increase the number of doses of levodopa IR tablets that you take per day.
  • You can increase up to a maximum of 8 doses per day, spaced a minimum of 2 hours apart.
  • If your medication wears off around the same time each day, you can try adding a dose 30 minutes before that time.
  • It is recommended to increase the number of doses per day slowly to prevent side effects - you can increase by 1 dose per day every 1 - 2 days.
  • Levodopa IR doses can range from 50/12.5mg - 150/36.5mg.
  • You can increase your dose by taking an additional one-half or one whole tablet.
  • It is recommended to increase only one of your daily doses at a time to prevent side effects.
  • Consider increasing the dose prior to when you most often notice your medication wearing off (e.g. increase morning dose if medication wears off around lunch time).
  • Dyskinesia is caused by too much medication being in the body at one time. Decreasing the amount of medication you take at once can reduce this side effect.
  • You may need to increase the number of times you take medication to achieve the same benefit from your medication.
  • Levodopa IR doses can range from 50/12.5mg - 150/36.5mg.
  • Doses can be decreased by one-half or one whole tablet at a time.
  • You can increase the number of doses per day up to a maximum of 8 doses per day, spaced a minimum of 2 hours apart.
  • It is recommended to increase the number of doses per day slowly to prevent side effects - you can increase by 1 dose per day every 1 - 2 days.
  • Levodopa IR (immediate-release) tablets can be chewed for rapid symptom relief (effect is felt in 5-10 minutes).
  • You can try chewing one-half or one whole tablet at a time.
  • Additionally, taking the tablet with a fizzy or acidic drink can also speed up symptom relief. Drink examples include try orange juice or pop.
Changes Requiring a Doctor's Appointment
  • If you are on a dopamine agonist or MOA-B Inhibitor but are experiencing slow, rigid, or shaky movements, it may be beneficial to start levodopa to control your symptoms.
  • Refer to Step 2 for more information on levodopa.
  • CR stands for "controlled-release." This form of levodopa releases more slowly, which means it lasts longer.
  • If you wake up in the night or early morning with slow, stiff, or shaky movements, your physician may write you a prescription for levodopa CR.
  • Levodopa CR's slow release can be helpful for maintaining symptom control overnight.
  • Taking levodopa together with a dopamine agonist has been found to reduce wearing off.
  • When adding a dopamine agonist, you will likely take a lower dose of levodopa. This is done to prevent side effects.
  • Dopamine agonists include: pramipexole, ropinirole, and rotigotine.
  • Taking levodopa together with a MAO-B Inhibitor has been found to reduce wearing off.
  • When adding a MAO-B Inhibitor, you will likely take a lower dose of levodopa. This is done to prevent side effects.
  • MAO-B Inhibitors include: rasagiline, safinamide
  • Entacapone slows the breakdown of levodopa in the brain. This lets levodopa work for longer.
  • See Step 2 for more information on entacapone.
  • Because of its slower release, levodopa controlled-release (CR) has been associated with more dyskinesia than levodopa immediate-release (IR).
  • Taking MAO-B inhibitors together with levodopa can increase the chances of experiencing dyskinesia.
  • MAO-B Inhibitors include: selegiline, rasagiline, safinamide.
  • Drugs such as benztropine can increase the risk of dyskinesias
  • Amantadine is only useful for treating dyskinesia. It does not have an effect on symptoms of Parkinson Disease
  • See Step 2 for more information on amantadine.
  • Taking levodopa together with a dopamine agonist means you can take a lower dose of levodopa. This can lower your risk of getting dyskinesias.
  • Taking levodopa together with a dopamine agonist has been found to reduce wearing off.
  • Dopamine agonists include: pramipexole, ropinirole, and rotigotine.
  • Benztropine is only effective for treating tremors - it has no effects on slow or stiff movement.
  • Benztropine can be added on to levodopa therapy for people who still get tremors.
  • Benztropine should NOT be used by people who have dyskinesia or wearing off of their medication.
  • Propranolol is effective for treating some types of tremors - it has no effects on slow or stiff movements.
  • Propranolol may be used in combination with levodopa for individuals who still get tremors.
Step 4: 
Non-Drug Options and Resources

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R
Click the links for more information on managing PD symptoms
Non-Drug Tips
Exercise Can reduce symptom severity and improve overall quality of life
Physical Therapy Can train Parkinson's specific exercises to improve function
Speech Therapy Can help with swallowing and speech difficulties
Occupational TherapyCan help identify physical, behavioural, or environmental changes to support work and day-to-day activity
Psychologist or Counsellor Can provide support through mental health or mood changes related to PD
Group Classes & Activities Maintaining social connection plays a role in maintaining mental health and improving mood
More Resources
Managing Problems with Movement: Click this link 
Managing Medication Wearing off and Dyskinesias: Click this link  
Managing Other Symptoms Related to Parkinson Disease, such as Changes in Digestion, Sleep, and Mental Health: Click this link 
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