What is add-on treatment for Parkinson’s?

Add-on treatment means the medication is considered a secondary therapy. It’s “added on” to the primary treatment you’re on.

The common primary treatment for Parkinson’s motor symptoms is carbidopa-levodopa. This is considered the standard of Parkinson’s treatment. Other medications might be considered as an add-on treatment for non-motor symptoms. For instance:

  • sleep
  • lightheadedness
  • memory loss
  • depression
  • anxiety
  • hallucinations

Why do people with Parkinson’s usually start add-on treatment?

You’ll be given add-on treatment if the effects of carbidopa-levodopa start to wane, or stop working altogether. Add-on therapies can also be used for more specific symptoms like:

  • resting tremor
  • dyskinesia
  • freezing of gait

What are the commonly used add-on therapies for Parkinson’s?

There are a wide variety of add-on therapies for the motor symptoms of Parkinson’s disease. These include dopamine agonist medications such as:

  • ropinirole
  • pramipexole
  • rotigotine
  • apomorphine

Others include:

  • amantadine (both immediate and extended-release options are available)
  • monoamine oxidase (MAO) inhibitors such as selegiline, rasagiline, and safinamide

There’s a catechol-o-methyl transferase (COMT) inhibitor called entacapone that must be taken with carbidopa-levodopa. And, there’s a recently released levodopa inhaler called Inbrija that’s supposed to be used with someone’s regular carbidopa-levodopa regimen.

How long will it take add-on therapy to start working? How will I know it’s working?

The answer to this depends on which add-on therapy you’re trying. Your doctor will likely start you on a lower dose and increase it as time goes on. This will help you to avoid any adverse side effects.

Benefits may be seen within the first week for some people. It may take longer. The exception to this is an apomorphine injection and the Inbrija inhaler. These are short-acting treatments that work in minutes.

What type of lifestyle modifications can I make to manage my Parkinson’s better?

The best lifestyle modification you can make is increasing the amount of physical activity you’re doing. This includes cardio, as well as some strength-training exercises and stretching.

A minimum of 2.5 hours a week of exercise a week is recommended. Not only will you experience symptomatic relief, but it’s possible that engaging in physical activity may slow your disease progression.

If I start add-on therapy, how long will I be on it?

The answer to this varies, but many add-on treatments will have an indefinite schedule, especially if you have a measurable benefit from the add-on therapy. Some people need two or three add-on treatments to manage their Parkinson’s motor symptoms as their disease progresses.

Medications used for non-motor symptoms are usually taken indefinitely.

Is it normal to have “off” periods while on treatment? Will add-on treatment prevent that?

You’re unlikely to experience many off periods early on in your disease. In fact, you may not experience any at all. As your Parkinson’s progresses, though, you’ll start to have more off periods. Most of the time, an adjustment to your treatment plan is all you’ll need to minimize off periods. If add-on treatment is necessary, it should also help to decrease or get rid of any off periods.

Are there any risks to not starting add-on treatment?

If you’re experiencing off periods and you don’t start add-on treatment, you run the risk of them becoming more bothersome. These off periods may begin to affect your quality of life and ability to perform everyday activities, like bathing, cleaning the house, or getting dressed.

If your disease is more progressed, the difference between on and off periods can be stark. This can put you at risk of falls, especially if you experience freezing of gait or poor balance in your off periods.

Also, many people with Parkinson’s develop anxiety because of the extreme discomfort they experience during off periods.


Sachin Kapur, MD, MS, completed his neurology residency at University of Illinois at Chicago and his movement disorders fellowship at Rush University Medical Center in Chicago. He practiced movement disorder and neurology for almost eight years before deciding to start his own practice dedicated to the care of people living with Parkinson’s and other movement disorders. He is the medical director of movement disorders at Advocate Christ Medical Center.