Adjunctive Pathways to Optimize Dopamine Levels in Parkinson’s Disease

A panelist discusses how adjunctive therapies play a critical role in optimizing the management of Parkinson disease (PD), particularly when used alongside levodopa therapy. As the disease progresses, levodopa alone may become less effective or lead to motor complications. Adjunctive treatments help maintain more stable dopamine levels in the central nervous system, improving symptom control and reducing "off" periods. These therapies are tailored to support levodopa by enhancing its effects or modulating other pathways involved in motor function.

The panelist explains that different adjunctive therapies operate through various mechanisms of action. Monoamine oxidase-B inhibitors prevent dopamine breakdown, thereby prolonging its activity. Catechol-O-methyltransferase inhibitors also slow dopamine metabolism, working peripherally to increase levodopa’s availability. Dopamine agonists directly stimulate dopamine receptors and can reduce the reliance on levodopa, while adenosine A2A receptor antagonists offer an alternative mechanism by modulating basal ganglia pathways. Each of these strategies helps address the dopamine deficiency that underlies Parkinson symptoms.

Ultimately, the panelist emphasizes the importance of a personalized approach in selecting adjunctive treatments, as the mechanisms of action and adverse effect profiles vary significantly between drug classes. The right combination can enhance quality of life and delay the need for escalating levodopa doses, which often bring complications. Understanding how each therapy supports dopamine signaling allows clinicians to better manage fluctuations and maintain symptom stability in patients living with PD.