Most effective, improves disability, prolongs capacity to perform instrumental activities of daily living

Motor complications: dyskinesias, dystonia, confusion, psychosis, sedation

Can be used as monotherapy in early disease or added to levodopa for treatment of motor complications

Less risk of developing motor complications in early disease

All: dopaminergic adverse effects (nausea, vomiting, orthostatic hypotension), neuropsychiatric adverse effects(hallucinations, psychosis, impulse control disorder), excessive daytime sleepiness

Ergot: pulmonary fibrosis, cardiac valve fibrosis, erythromelalgia

Can be used as monotherapy in early disease or to treat motor complications in late disease

Once-daily dosing, well tolerated

Amphetamine and methamphetamine metabolites may cause adverse effects, risk of serotonin syndrome

Used to treat motor complications; no titration, decreased off time,* mild improvement in activities of daily living and quality-of-life scores

Dopaminergic adverse effects, discoloration of urine, tolcapone associated with explosive diarrhea and fatal liver toxicity

Reduces off time in late disease

Requires initiation in hospital, regular subcutaneous injections

Treatment of dyskinesias in late disease

Cognitive adverse effects, livedo reticularis, edema, development of tolerance, potential for withdrawal

Useful for the treatment of tremor in patients younger than 60 years without cognitive impairment

Use limited by anticholinergic adverse effects