Key takeaways

  • Returning or worsening Parkinson’s symptoms may indicate that your current medication isn’t working as well, signaling a need to consider switching or adjusting your treatment plan.
  • In advanced stages of Parkinson’s, when medications become less effective, doctors may explore options such as dopamine agonists, MAO-B inhibitors, COMT inhibitors, or surgical treatments to manage symptoms.
  • If a new medication isn’t helping or causes significant side effects, communicating with your doctor and tracking your symptoms can help them determine the best course of action. This may include adjusting the dosage, adding another medication, or exploring alternative treatments.

If your medication has been helping control your Parkinson’s disease symptoms, signs that it may not be working as well often show up as returning or worsening symptoms. These may include:

  • tremors
  • muscle stiffness
  • difficulty getting started when you want to move or walk
  • feeling off balance while walking
  • slowed movements
  • lightheadedness or dizziness
  • trouble swallowing
  • a quieter voice

If your medication seems like it’s no longer working, your doctor may first try adjusting the dose or adding another medication before deciding whether it’s best to switch completely.

Sometimes, a doctor may recommend switching medications because of side effects, even if the medication is helping with symptoms. Common side effects of Parkinson’s medications include:

  • nausea
  • vomiting
  • dizziness
  • lightheadedness
  • fatigue
  • sleepiness

Hallucinations and confusion are less common, but they can be very upsetting when they occur.

It’s also important to note that Parkinson’s itself can cause symptoms like dizziness and lightheadedness, which can also be medication side effects. This can make it challenging to determine whether symptoms are related to the condition, the medication, or both.

There are five stages of Parkinson’s disease. Stages 4 and 5 are considered more advanced and can have a significant impact on daily function. At these stages, medications may not work as consistently, and their benefits may wear off more quickly, sometimes within a few hours.

When Parkinson’s symptoms become harder to manage, doctors may consider several treatment approaches, including:

  • higher medication doses
  • a combination of medications
  • more frequent dosing
  • injected forms of medication for longer-lasting effects
  • pump infusion medication for continuous dosing

In some cases, doctors may also discuss surgical treatment options when medications no longer provide enough benefit. These may include procedures that target specific areas of the brain involved in movement and coordination, or the implantation of a device that helps regulate abnormal brain signals.

Doctors often start Parkinson’s disease treatment with these first-line medications right after diagnosis:

  • carbidopa/levodopa
  • carbidopa/levodopa/benserazide
  • dopamine agonists, such as pramipexole, ropinirole, rotigotine, or apomorphine

In the early stages of Parkinson’s, these medications may work well, even at lower doses. Over time, however, their effects may become less noticeable or wear off more quickly.

If someone is already taking carbidopa/levodopa, a doctor may add a dopamine agonist to help improve symptom control. In some cases, doctors may also add other types of medications, such as:

  • monoamine oxidase B inhibitors, including selegiline or rasagiline
  • anticholinergics, such as benztropine or trihexyphenidyl

These decisions are based on a person’s symptoms, how well they respond to current medications, and whether they experience side effects.

If side effects are severe or significantly interfere with daily life, doctors may discuss other treatment options.

Infused or injected medications may be considered if swallowing pills becomes difficult. In some cases, surgical treatments may also be discussed.

Talk with your doctor if you feel your medication isn’t helping or if side effects begin to affect your quality of life. It can be difficult to determine whether symptoms are due to medication changes, side effects, worsening Parkinson’s disease, or another medical condition.

Keeping track of your symptoms may help. Try noting patterns throughout the day, including when symptoms improve or worsen.

During your appointment, your doctor may ask about your symptoms, examine your movements and walking, and possibly order diagnostic tests. Based on these findings, they may recommend adjustments, such as physical therapy, a higher medication dose, adding another medication, switching treatments, or discussing surgical options.

Dr. Heidi Moawad is a neurologist and teaches at Case Western Reserve University School of Medicine in Cleveland, Ohio. She serves on the editorial board of Neurology Clinical Practice and is a reviewer for Neurology.