Optimising Parkinson’s Disease Management: A Comparative Analysis of Levodopa and Dopamine Agonists

Research Article
Open access

Optimising Parkinson’s Disease Management: A Comparative Analysis of Levodopa and Dopamine Agonists

Ava Guarnotta 1*
  • 1 Pomfret School, Pomfret, 06258, USA    
  • *corresponding author aguarnotta.26@pomfret.org
Published on 20 June 2025 | https://doi.org/10.54254/2753-8818/2025.24198
TNS Vol.116
ISSN (Print): 2753-8826
ISSN (Online): 2753-8818
ISBN (Print): 978-1-80590-197-6
ISBN (Online): 978-1-80590-198-3

Abstract

Motor and non-motor symptoms are hallmarks of Parkinson's disease (PD), a chronic, progressive neurodegenerative illness caused by the decline of dopamine-producing neurones in the substantia nigra. Although the exact cause is still unknown, environmental variables like pesticide exposure and genetic alterations (such as SNCA, LRRK2, and PARK7) are involved in its development. Tremors, bradykinesia, stiffness, and postural instability are the hallmark motor symptoms that are caused by a dopamine deficit in the basal ganglia. Quality of life is impacted by non-motor symptoms such as mood problems, sleep disruptions, and cognitive deterioration. By restoring dopamine levels in the brain, Levodopa efficiently treats motor symptoms and is still the gold standard for treating Parkinson's disease. When combined with carbidopa to increase delivery and reduce side effects, Levodopa dramatically enhances motor function, particularly in the early and middle stages of the disease. However, problems, including dyskinesia and motor irregularities, are linked to prolonged use. Another treatment option is provided by dopamine agonists, which directly activate dopamine receptors, especially in younger or early-stage PD patients. They reduce the risk of early dyskinesia by delaying Levodopa and providing long-lasting symptom alleviation, although less effective than Levodopa. They do, however, have an increased risk of behavioural and cognitive adverse effects, including impulse control issues and hallucinations. Combination therapy maximises symptom management by utilising the advantages of both levodopa and dopamine agonists, but it necessitates close observation. Treatment plans must change as PD worsens to strike a balance between effectiveness and adverse effects. Future studies on sophisticated medication regimens and neuroprotective therapies have the potential to improve long-term results in the treatment of Parkinson's disease.

Keywords:

Parkinson’s disease (PD), Levodopa, Dopamine agonists

Guarnotta,A. (2025). Optimising Parkinson’s Disease Management: A Comparative Analysis of Levodopa and Dopamine Agonists. Theoretical and Natural Science,116,1-7.
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References

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[5]. Mhyre, Timothy R., James T. Boyd, Robert W. Hamill, and Kathleen A. Maguire-Zeiss. "Parkinson's Disease." Subcellular Biochemistry, 2012, 389-455. https://doi.org/10.1007/978-94-007-5416-4_16.

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[7]. Yu, Jun, ed. "Bradykinesia (Slowness of Movement)." Parkinson's Foundation. https://www.parkinson.org/understanding-parkinsons/movement-symptoms/bradykinesia#:~:text=Bradykinesia%20means%20slowness%20of%20movement,Parkinson's%20diagnosis%20to%20be%20considered.

[8]. Poewe, W. "Non‐motor Symptoms in Parkinson's Disease." European Journal of Neurology 15, no. s1 (2008): 14-20. https://doi.org/10.1111/j.1468-1331.2008.02056.x.

[9]. Kouli, Antonina, Kelli M. Torsney, and Wei-Li Kuan. "Chapter 1Parkinson's Disease: Etiology, Neuropathology, and Pathogenesis." National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK536722/.

[10]. Stephenson, Ryan O Stephenson. "Modified Hoehn and Yahr Scale." Edited by Buck Christensen. Medscape. https://emedicine.medscape.com/article/2172546-overview?form=fpf.

[11]. Gandhi, Kavita R., and Abdolreza Saadabadi. "Levodopa (L-Dopa)." National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK482140/.

[12]. Sivanandy, Palanisamy, Tan Choo Leey, Tan Chi Xiang, Tan Chi Ling, Sean Ang Wey Han, Samantha Lia Anak Semilan, and Phoon Kok Hong. "Systematic Review on Parkinson's Disease Medications, Emphasizing on Three Recently Approved Drugs to Control Parkinson's Symptoms." International Journal of Environmental Research and Public Health 19, no. 1 (2021): 364. https://doi.org/10.3390/ijerph19010364.

[13]. Levodopa." Parkinson's Foundation. https://www.parkinson.org/living-with-parkinsons/treatment/prescription-medications/levodopa.

[14]. Tolosa, Eduardo, Maria J. Martí, Francesc Valldeoriola, and José L. Molinuevo. "History of Levodopa and Dopamine Agonists in Parkinson's Disease Treatment." Neurology 50, no. 6_suppl_6 (1998). https://doi.org/10.1212/wnl.50.6_suppl_6.s2.

[15]. Choi, Jaehwa, and Kristen Ashley Horner. "Dopamine Agonists." National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK551686/.

[16]. "Dopamine Agonists." Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/24958-dopamine-agonists.

[17]. Pringsheim, Tamara, Gregory S. Day, Don B. Smith, Alex Rae-Grant, Nicole Licking, Melissa J. Armstrong, Rob M.A de Bie, Emmanuel Roze, Janis M. Miyasaki, Robert A. Hauser, Alberto J. Espay, Justin P. Martello, Julie A. Gurwell, Lori Billinghurst, Kelly Sulilvan, Michael S. Fitts, Nicolas Cothros, Deborah A. Hall, Miriam Rafferty, Lynn Hagerbrant, Tara Hastings, Mary Dolan O"Brien, Heather Silsbee, Gary Gronseth, and Anthony E. Lang. "Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary." Neurology. https://www.neurology.org/doi/10.1212/WNL.0000000000012868.

[18]. Grall-Bronnec, Marie, Caroline Victorri-Vigneau, Yann Donnio, Juliette Leboucher, Morgane Rousselet, Elsa Thiabaud, Nicolas Zreika, Pascal Derkinderen, and Gaëlle Challet-Bouju. "Dopamine Agonists and Impulse Control Disorders: A Complex Association." Drug Safety 41, no. 1 (2017): 19-75. https://doi.org/10.1007/s40264-017-0590-6.

[19]. Pringsheim, Tamara, Gregory S. Day, Don B. Smith, Alex Rae-Grant, Nicole Licking, Melissa J. Armstrong, Rob M.A de Bie, Emmanuel Roze, Janis M. Miyasaki, Robert A. Hauser, Alberto J. Espay, Justin P. Martello, Julie A. Gurwell, Lori Billinghurst, Kelly Sullivan, Michael S. Fitts, Nicholas Cothros, Deborah A. Hall, Miriam Rafferty, Lynn Hagerbrant, Tara Hastings, Mary Dolan O'Brien, Heather Silsbee, Gary Gronseth, Anthony E. Lang, Tamara Pringsheim, Gregory S. Day, DonB Smith, and Alex Rae-Grant. "Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary." Neurology 97, no. 20 (2021): 942-57. https://doi.org/10.1212/wnl.0000000000012868.

[20]. Weiss, Howard D., and Laura Marsh. "Impulse Control Disorders and Compulsive Behaviors Associated with Dopaminergic Therapies in Parkinson's Disease." Neurology Clinical Practice 2, no. 4 (2012): 267-74. https://doi.org/10.1212/cpj.0b013e318278be9b.

[21]. Pandey, Sanjay, and Prachaya Srivanitchapoom. "Levodopa-induced Dyskinesia: Clinical Features, Pathophysiology, and Medical Management." Annals of Indian Academy of Neurology 20, no. 3 (2017): 190. https://doi.org/10.4103/aian.aian_239_17.

[22]. Weiner, William J. "Initial Treatment of Parkinson's Disease Levodopa or Dopamine Agonists." JAMA Neurology. Last modified December 2004. https://jamanetwork.com/journals/jamaneurology/article-abstract/787192.

[23]. Mack, Joel, and Laura Marsh. "Parkinson's Disease: Cognitive Impairment." FOCUS 15, no. 1 (2017): 42-54. https://doi.org/10.1176/appi.focus.20160043.

[24]. Ecker, Daniel, Alexander Unrath, Jan Kassubek, and Michael Sabolek. "Dopamine Agonists and Their Risk to Induce Psychotic Episodes in Parkinson's Disease: A Case-control Study." BMC Neurology 9, no. 1 (2009). https://doi.org/10.1186/1471-2377-9-23.

[25]. Zhang, Qian, XiangTing Chen, FeiFei Chen, SiYuan Wen, and ChangQing Zhou. "Dopamine Agonists versus Levodopa Monotherapy in Early Parkinson's Disease for the Potential Risks of Motor Complications: A Network Meta-analysis." European Journal of Pharmacology 954 (September 2023): 175884. https://doi.org/10.1016/j.ejphar.2023.175884.

[26]. Choi, Jeehwa, and Kristen Ashley Hormer. "Levodopa." National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK551686/.

[27]. "Motor Fluctuations and Dyskinesias (diagnosis and Management)." Annals of Indian Academy of Neurology 14, no. Suppl1 (2011): S13-S15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152175/.

[28]. "Motor Fluctuations and Dyskinesias (diagnosis and Management)." Annals of Indian Academy of Neurology 14, no. Suppl1 (2011): S13-S15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152175/.

[29]. Michel, Martin C., and David Staskin. "Study Designs for Evaluation of Combination Treatment: Focus on Individual Patient Benefit." Biomedicines 10, no. 2 (2022): 270. https://doi.org/10.3390/biomedicines10020270.

Cite this article

Guarnotta,A. (2025). Optimising Parkinson’s Disease Management: A Comparative Analysis of Levodopa and Dopamine Agonists. Theoretical and Natural Science,116,1-7.

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Volume title: Proceedings of the 3rd International Conference on Modern Medicine and Global Health

ISBN：978-1-80590-197-6(Print) / 978-1-80590-198-3(Online)
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Conference date: 20 January 2025
Series: Theoretical and Natural Science
Volume number: Vol.116
ISSN：2753-8818(Print) / 2753-8826(Online)

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References

[1]. Mandybur, George, and Maureen Gartner. "Parkinson's disease (PD)." Mayfield Brain & Spine. https://mayfieldclinic.com/pe-pd.htm#:~:text=Overview,stiffness%2C%20and%20balance%20problems%20occur.

[2]. Nuytemans, Karen, Jessie Theuns, Marc Cruts, and Christine Van Broeckhoven. "Genetic Etiology of Parkinson Disease Associated with Mutations in the SNCA, PARK2, PINK1, PARK7, and LRRK2 Genes: A Mutation Update." Human Mutation 31, no. 7 (2010): 763-80. https://doi.org/10.1002/humu.21277.

[3]. "Can Environmental Toxins Cause Parkinson's Disease?" John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/parkinsons-disease/can-environmental-toxins-cause-parkinson-disease.

[4]. Sonne, James, Vamsi Reddy, and Morris R. Beato. "Neuroanatomy, Substantia Nigra." National Library of Medicine. Last modified September 10, 2024. https://www.ncbi.nlm.nih.gov/books/NBK536995/.

[5]. Mhyre, Timothy R., James T. Boyd, Robert W. Hamill, and Kathleen A. Maguire-Zeiss. "Parkinson's Disease." Subcellular Biochemistry, 2012, 389-455. https://doi.org/10.1007/978-94-007-5416-4_16.

[6]. Mayo Clinic Staff. "Parkinson's disease." Mayo Clinic. Last modified September 27, 2024. https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055.

[7]. Yu, Jun, ed. "Bradykinesia (Slowness of Movement)." Parkinson's Foundation. https://www.parkinson.org/understanding-parkinsons/movement-symptoms/bradykinesia#:~:text=Bradykinesia%20means%20slowness%20of%20movement,Parkinson's%20diagnosis%20to%20be%20considered.

[8]. Poewe, W. "Non‐motor Symptoms in Parkinson's Disease." European Journal of Neurology 15, no. s1 (2008): 14-20. https://doi.org/10.1111/j.1468-1331.2008.02056.x.

[9]. Kouli, Antonina, Kelli M. Torsney, and Wei-Li Kuan. "Chapter 1Parkinson's Disease: Etiology, Neuropathology, and Pathogenesis." National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK536722/.

[10]. Stephenson, Ryan O Stephenson. "Modified Hoehn and Yahr Scale." Edited by Buck Christensen. Medscape. https://emedicine.medscape.com/article/2172546-overview?form=fpf.

[11]. Gandhi, Kavita R., and Abdolreza Saadabadi. "Levodopa (L-Dopa)." National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK482140/.

[12]. Sivanandy, Palanisamy, Tan Choo Leey, Tan Chi Xiang, Tan Chi Ling, Sean Ang Wey Han, Samantha Lia Anak Semilan, and Phoon Kok Hong. "Systematic Review on Parkinson's Disease Medications, Emphasizing on Three Recently Approved Drugs to Control Parkinson's Symptoms." International Journal of Environmental Research and Public Health 19, no. 1 (2021): 364. https://doi.org/10.3390/ijerph19010364.

[13]. Levodopa." Parkinson's Foundation. https://www.parkinson.org/living-with-parkinsons/treatment/prescription-medications/levodopa.

[14]. Tolosa, Eduardo, Maria J. Martí, Francesc Valldeoriola, and José L. Molinuevo. "History of Levodopa and Dopamine Agonists in Parkinson's Disease Treatment." Neurology 50, no. 6_suppl_6 (1998). https://doi.org/10.1212/wnl.50.6_suppl_6.s2.

[15]. Choi, Jaehwa, and Kristen Ashley Horner. "Dopamine Agonists." National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK551686/.

[16]. "Dopamine Agonists." Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/24958-dopamine-agonists.

[17]. Pringsheim, Tamara, Gregory S. Day, Don B. Smith, Alex Rae-Grant, Nicole Licking, Melissa J. Armstrong, Rob M.A de Bie, Emmanuel Roze, Janis M. Miyasaki, Robert A. Hauser, Alberto J. Espay, Justin P. Martello, Julie A. Gurwell, Lori Billinghurst, Kelly Sulilvan, Michael S. Fitts, Nicolas Cothros, Deborah A. Hall, Miriam Rafferty, Lynn Hagerbrant, Tara Hastings, Mary Dolan O"Brien, Heather Silsbee, Gary Gronseth, and Anthony E. Lang. "Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary." Neurology. https://www.neurology.org/doi/10.1212/WNL.0000000000012868.

[18]. Grall-Bronnec, Marie, Caroline Victorri-Vigneau, Yann Donnio, Juliette Leboucher, Morgane Rousselet, Elsa Thiabaud, Nicolas Zreika, Pascal Derkinderen, and Gaëlle Challet-Bouju. "Dopamine Agonists and Impulse Control Disorders: A Complex Association." Drug Safety 41, no. 1 (2017): 19-75. https://doi.org/10.1007/s40264-017-0590-6.

[19]. Pringsheim, Tamara, Gregory S. Day, Don B. Smith, Alex Rae-Grant, Nicole Licking, Melissa J. Armstrong, Rob M.A de Bie, Emmanuel Roze, Janis M. Miyasaki, Robert A. Hauser, Alberto J. Espay, Justin P. Martello, Julie A. Gurwell, Lori Billinghurst, Kelly Sullivan, Michael S. Fitts, Nicholas Cothros, Deborah A. Hall, Miriam Rafferty, Lynn Hagerbrant, Tara Hastings, Mary Dolan O'Brien, Heather Silsbee, Gary Gronseth, Anthony E. Lang, Tamara Pringsheim, Gregory S. Day, DonB Smith, and Alex Rae-Grant. "Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary." Neurology 97, no. 20 (2021): 942-57. https://doi.org/10.1212/wnl.0000000000012868.

[20]. Weiss, Howard D., and Laura Marsh. "Impulse Control Disorders and Compulsive Behaviors Associated with Dopaminergic Therapies in Parkinson's Disease." Neurology Clinical Practice 2, no. 4 (2012): 267-74. https://doi.org/10.1212/cpj.0b013e318278be9b.

[21]. Pandey, Sanjay, and Prachaya Srivanitchapoom. "Levodopa-induced Dyskinesia: Clinical Features, Pathophysiology, and Medical Management." Annals of Indian Academy of Neurology 20, no. 3 (2017): 190. https://doi.org/10.4103/aian.aian_239_17.

[22]. Weiner, William J. "Initial Treatment of Parkinson's Disease Levodopa or Dopamine Agonists." JAMA Neurology. Last modified December 2004. https://jamanetwork.com/journals/jamaneurology/article-abstract/787192.

[23]. Mack, Joel, and Laura Marsh. "Parkinson's Disease: Cognitive Impairment." FOCUS 15, no. 1 (2017): 42-54. https://doi.org/10.1176/appi.focus.20160043.

[24]. Ecker, Daniel, Alexander Unrath, Jan Kassubek, and Michael Sabolek. "Dopamine Agonists and Their Risk to Induce Psychotic Episodes in Parkinson's Disease: A Case-control Study." BMC Neurology 9, no. 1 (2009). https://doi.org/10.1186/1471-2377-9-23.

[25]. Zhang, Qian, XiangTing Chen, FeiFei Chen, SiYuan Wen, and ChangQing Zhou. "Dopamine Agonists versus Levodopa Monotherapy in Early Parkinson's Disease for the Potential Risks of Motor Complications: A Network Meta-analysis." European Journal of Pharmacology 954 (September 2023): 175884. https://doi.org/10.1016/j.ejphar.2023.175884.

[26]. Choi, Jeehwa, and Kristen Ashley Hormer. "Levodopa." National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK551686/.

[27]. "Motor Fluctuations and Dyskinesias (diagnosis and Management)." Annals of Indian Academy of Neurology 14, no. Suppl1 (2011): S13-S15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152175/.

[28]. "Motor Fluctuations and Dyskinesias (diagnosis and Management)." Annals of Indian Academy of Neurology 14, no. Suppl1 (2011): S13-S15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152175/.

[29]. Michel, Martin C., and David Staskin. "Study Designs for Evaluation of Combination Treatment: Focus on Individual Patient Benefit." Biomedicines 10, no. 2 (2022): 270. https://doi.org/10.3390/biomedicines10020270.

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