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Educational Activity

Pharmacology and Evidence-Based Strategies for Current and Emerging Treatments for OFF Periods in Parkinson Disease

Rajesh Pahwa, MD, and Stuart H. Isaacson, MD

Published: December 1, 2020

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Find more articles on this and other psychiatry and CNS topics:
The Journal of Clinical Psychiatry
The Primary Care Companion for CNS Disorders

Parkinson disease (PD) is a progressive neurodegenerative disease characterized by motor symptoms such as rigidity, resting tremor, and slowed movement in addition to nonmotor symptoms. As the disease advances and a patient’s response duration to a levodopa dose is shortened, OFF episodes become more prevalent, negatively impacting their quality of life. Clinicians may employ a variety of therapeutic strategies to reduce OFF time, such as altering the levodopa dose or initiating adjuvant therapy. Medications to treat daily OFF time include dopamine agonists, MAO-B inhibitors, COMT inhibitors, amantadine ER, and adenosine A2A antagonists; as-needed rescue therapies include subcutaneous apomorphine, apomorphine sublingual film, and orally inhaled levodopa; and, when necessary, advanced therapies such as carbidopa/levodopa enteral suspension or DBS may be indicated.

To cite: Pahwa R, Isaacson SH. Pharmacology and evidence-based strategies for current and emerging treatments for OFF periods in Parkinson disease. J Clin Psychiatry. 2021;82(1):SU19004BR2C.
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© Copyright 2020 Physicians Postgraduate Press, Inc.

From the University of Kansas, Kansas City (Dr Pahwa); and Parkinson’s Disease and Movement Disorders Center of Boca Raton, Florida (Dr Isaacson)

Volume: 82

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