People with Parkinson’s disease experience progressive brain damage over many years. Although each person may experience symptoms differently, some medication types to avoid include certain antipsychotics, antidepressants, narcotics, and decongestants.

A person with Parkinson’s disease loses nerve cells in the part of the brain. This reduces levels of the chemical dopamine, which is essential for regulating body movements.

There is no cure for Parkinson’s, but a person can manage the symptoms with medications. However, some medications can interfere with the action of Parkinson’s drugs. The American Parkinsons Disease Association (APDA) details which medications to avoid and why, including some that decrease the amount of dopamine in the body.

This article details which medications to avoid and why, ways to prevent worsening symptoms, and overall treatment for Parkinson’s disease.

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Around 1 million people in the United States have Parkinson’s disease, and one-third of these require hospitalization each year. Visiting hospitals can be riskier for people with Parkinson’s disease due to their complicated, individual medication regimens. Each person with the condition needs individualized medications and exact dosing.

However, a third of people with Parkinson’s disease have received contraindicated medicines while in the hospital. Over half of these people experienced serious, mostly neuropsychiatric, complications.

The APDA has listed a range of medications to avoid or use with caution in people having treatment for Parkinson’s disease. These include:

However, the APDA notes that some people may need to take these medicines despite this contraindication. A person and their family should discuss their individual medication regimen with their doctor. For instance, they may need to taper off using a particular medication rather than stopping suddenly.

If a person with Parkinson’s needs to go to the hospital, their neurologist should speak to their doctor to agree on which medications to avoid.

Visit our hub to learn more about Parkinson’s disease.

The APDA recommends avoiding certain medication types if a person is taking MAOIs. Doctors may prescribe this medication to treat certain types of depression and other nervous system disorders, including panic disorder and social phobia. Types of MAOIs include:

  • selegiline HCL (Eldepryl, Deprenyl, Zelapar)
  • rasagiline (Azilect)
  • safinamide (Xadago)

Narcotics to avoid or use with caution if a person with Parkinson’s disease is also taking one of the above MAOIs include:

  • meperidine (Demerol)
  • tramadol (Ultram)
  • methadone (Dolophine)
  • propoxyphene (Darvon)

Combining these drug types carries a heightened risk of developing serotonin syndrome. For instance, selegiline hydrochloride and tramadol can increase a person’s risk of serotonin syndrome.

This condition occurs when the level of serotonin in a person’s brain becomes too high. It causes symptoms including confusion, agitation, muscle twitching, sweating, shivering, and diarrhea.

Learn more about serotonin syndrome here.

For the same reason, doctors do not recommend taking selegiline, rasagiline, or safinamide with the herbal antidepressant St. John’s Wort.

The APDA also advises all people with Parkinson’s disease to exercise caution around taking certain antidepressant medications because they block monoamine oxidase non-selectively.

If a person takes these antidepressants alongside certain Parkinson’s drugs, they may experience dangerously high blood pressure and become agitated. These specific antidepressants include:

  • phenelzine (Nardil)
  • tranylcypromine (Parnate)
  • isocarboxazid (Marplan)

Additionally, the tricyclic antidepressant amoxapine (Asendin) can block dopamine receptors.

Read more about how antidepressants could delay Parkinson’s progression.

Antipsychotic medications also block dopamine receptors in the brain, worsening a person’s Parkinson’s disease symptoms. These typical antipsychotics include:

  • chlorpromazine (Thorazine)
  • fluphenazine (Prolixin)
  • haloperidol (Haldol)
  • loxapine (Loxitane)
  • thioridazine (Mellaril)
  • thiothixene (Mellaril)
  • trifluoperazine (Stelazine)
  • pimozide (Orap)
  • perphenazine (Trilafon)

Antipsychotics can also cause Parkinson’s-like symptoms or interact with Parkinson’s drugs.

Some less commonly prescribed or atypical antipsychotics also block dopamine receptors. However, these particular medications uncouple from the dopamine receptor more quickly than typical antipsychotics. These atypical antipsychotics can also block serotonin receptors at the same time. So, these medicines cause fewer Parkinson’s symptoms than typical antipsychotics.

Atypical antipsychotics on this list include:

  • risperidone (Risperdal)
  • olanzapine (Zyprexa)
  • ziprasidone (Geodon)
  • aripiprazole (Abilify)
  • lurasidone (Latuda)
  • paliperidone (Invega)
  • iloperidone (Fanapt)
  • brexpiprazole (Rexulti)
  • cariprazine (Vraylar)
  • asenapine (Saphris)

Learn more about atypical antipsychotics here.

Certain blood pressure medications may cause problems for people with Parkinson’s disease.

For instance, reserpine (Serpalan) decreases a person’s dopamine stores in the brain. It can cause a decrease in cardiac output and blood pressure while simultaneously decreasing the amount of dopamine.

Additionally, methyldopa (Aldomet) blocks the action of an enzyme that converts the amino acid L-dopa into dopamine in the brain.

Learn about dopamine deficiency here.

ADPA recommends avoiding the muscle relaxant cyclobenzaprine if taking selegiline, rasagiline, or safinamide.

Taking cyclobenzaprine at the same time as, or within 14 days of stopping, MAOIs have caused hyperpyretic or abnormally high fever, crisis seizures, and death in some people.

Learn about hyperpyrexia here.

Certain decongestant or stimulant medications also interact with selegiline, rasagiline, or safinamide. They can prevent Parkinson’s medications from working properly and potentially increase side effects.

The APDA recommends that people avoid both at the same time or proceed with caution if their doctor decides they must take both at once.

Common cold and allergy medicines may contain the following decongestants or stimulants to watch out for if a person has Parkinson’s disease:

  • pseudoephedrine
  • phenylephrine
  • ephedrine

Learn more about pseudoephedrine and phenylephrine here.

While there is no cure for Parkinson’s disease, many therapies can help with symptom reduction.

Supportive therapies for people with Parkinson’s disease include:

  • physiotherapy to relieve muscle stiffness and joint pain
  • occupational therapy to help a person find practical solutions to everyday problems, such as getting dressed
  • speech and language therapy to help with any difficulties talking and swallowing due to Parkinson’s disease
  • dietary advice to ensure a person is eating enough fiber to reduce constipation, salt to maintain blood pressure, and calories to maintain body weight

Medications for treating Parkinson’s disease include:

  • levodopa to increase a person’s dopamine levels and improve movement problems
  • dopamine agonists, which are substitutes for dopamine and have a similar but milder effect than levodopa
  • monoamine oxidase-B inhibitors to increase dopamine levels by blocking the effects of an enzyme that breaks down dopamine known as monoamine oxidase-B

Some people may have a type of surgery known as deep brain stimulation. This involves having a surgeon implanting a pulse generator into the brain to stimulate the part of the brain affected by Parkinson’s disease.

Learn more about treatment options for Parkinson’s disease.

A person can take action to prevent the worsening of Parkinson’s symptoms. These include:

  • taking all medications as prescribed by their doctor
  • participating in all recommended supportive therapies, such as physiotherapy
  • exercising to maintain gait and balance
  • eating a balanced, nutritious diet to increase energy, optimize the action of medications, and boost well-being

Some people may also feel better through using relaxing complementary therapies, such as yoga and massage, alongside their conventional treatment. However, these therapies do not have robust scientific evidence to back them up.

Parkinson’s disease reduces dopamine levels in the brain, a chemical essential for regulating body movements. Parkinson’s medications can help to manage the symptoms of the disease, which include tremors, slow movement, muscle stiffness, depression, and memory problems.

However, some other medicines can interact with Parkinson’s drugs and worsen a person’s symptoms. Drugs to avoid or use with caution include narcotics, antidepressants, muscle relaxants, decongestants, antipsychotics, and more.