L-DOPA medication
L-DOPA is currently the best medication for most patients. It comes in two forms, which are virtually indistinguishable:
- Co-careldopa
- Co-beneldopa
L-DOPA should be taken with food when starting treatment. It can cause nausea that can be relieved with domperidone 10–20mg TDS, which can be taken with L-DOPA. Once the nausea goes away, domperidone can be stopped.
L-DOPA can cause low blood pressure, so patients should take care when standing because they may feel light-headed.
The L-DOPA dose is given as 12.5/50mg with the second, higher number being the L-DOPA dose. The maximum dose of L-DOPA is 600 to 800mg in 24 hours.
Escalation regimes
There are two escalation regimes for starting patients on L-DOPA:
- Fast regime
- Slow regime
We generally we advise the fast regime, but if a patient gets bad side-effects, stop and try the slow regime instead.
Fast regime
| Week (number of tablets) | Breakfast | Lunch | Dinner |
|---|---|---|---|
| One (1-1-1) | L-DOPA 62.5mg (12.5mg/50mg) one tablet | L-DOPA 62.5mg (12.5mg/50mg) one tablet | L-DOPA 62.5mg (12.5mg/50mg) one tablet |
| Two (1-1-1) | L-DOPA 62.5mg (12.5mg/50mg) one tablet | L-DOPA 62.5mg (12.5mg/50mg) one tablet | L-DOPA 62.5mg (12.5mg/50mg) one tablet |
| Three (2-2-2) | L-DOPA 62.5mg (12.5mg/50mg) two tablets | L-DOPA 62.5mg (12.5mg/50mg) two tablets | L-DOPA 62.5mg (12.5mg/50mg) two tablets |
| Maintenance dose (to be taken from this point) | L-DOPA 125mg (25mg/100mg) one tablet | L-DOPA 125mg (25mg/100mg) one tablet | L-DOPA 125mg (25mg/100mg) one tablet |
Slow regime
| Week (number of tablets) | Breakfast | Lunch | Dinner |
|---|---|---|---|
| One (1-0-0) | L-DOPA 62.5mg (12.5mg/50mg) one tablet | N/A | N/A |
| Two (1-0-1) | L-DOPA 62.5mg (12.5md/50mg) one tablet | N/A | L-DOPA 62.5mg (12.5mg/50mg) one tablet |
| Three (1-1-1) | L-DOPA 62.5mg (12.5mg/50mg) one tablet | L-DOPA 62.5mg (12.5mg/50mg) one tablet | L-DOPA 62.5mg (12.5mg/50mg) one tablet |
| Four (2-1-1) | L-DOPA 62.5mg (12.5mg/50mg) two tablets | L-DOPA 62.5mg (12.5mg/50mg) one tablet | L-DOPA 62.5mg (12.5mg/50mg) one tablet |
| Five (2-1-2) | L-DOPA 62.5mg (12.5mg/50mg) two tablets | L-DOPA 62.5mg (12.5mg/50mg) one tablet | L-DOPA 62.5mg (12.5mg/50mg) two tablets |
| Six (2-2-2) | L-DOPA 62.5mg (12.5mg/50mg) two tablets | L-DOPA 62.5mg (12.5mg/50mg) two tablets | L-DOPA 62.5mg (12.5mg/50mg) two tablets |
| Maintenance dose (to be taken from this point) | L-DOPA 125mg (25mg/100mg) one tablet | L-DOPA 125mg (25mg/100mg) one tablet | L-DOPA 125mg (25mg/100mg) one tablet |
Other medication
Other medication that is also used for Parkinson's disease is listed below with a brief description. For a more detailed description of the available medication, including a comprehensive list of brand names, please visit the Parkinson's UK website.
Dopamine agonists
The following dopamine agonists can be given instead of, or alongside, L-DOPA:
- Amantadine
- Ropinirole tablets
- Pramipexole tablets
- Rotigotine patches
- Apomorphine injections
The main side effect that we warn people about is impulse control disorder. This is where people start gambling, engaging in risky spending or sexual activity, or even spending long periods on the Internet. It is rare, but very important that patients are aware it exists.
Entacapone/opicapone
Entacapone/opicapone tablets can smooth out the effect of L-DOPA. Sometimes it is given to people who find the effects are wearing off between doses. There is a tablet, Stalevo, which sombines L-DOPA and entacapone. The main side effects are diarrhoea and red-coloured urine.
Rasagiline
Rasagiline is used to get more of an effect out of the L-DOPA. The main issue with this is interaction, most commonly with some anti-depressants, but also with certain foods and some cough and cold remedies.
Fludrocortisone
Fludrocortisone is given to treat low blood pressure.
Midodrine
Midodrine is given to treat low blood pressure.
Last reviewed: 11 August 2025