The shorter answer is none is proven. Azilect may have some of these properties. Some researchers are not convinced. There is disappointing news of the failure of yet another Parkinson’s disease modifying or neuroprotective clinical trial using pioglitazone, already being used for diabetes. On the other hand, a drug called isradipine is starting to be studied in a new clinical trial. This is looking for disease-modifying activity.

There are 3 new drugs to treat symptoms. Droxidopa is approved for neurogenic orthostatic hypotension, a common problem in Parkinson’s. With this, patients’ blood pressure falls with standing, and this may cause dizziness or even faints.

Levodopa-carbidopa intestinal gel, branded as Duodopa, will become available in Canada in April and probably in the United States later in 2015 or early 2016. It requires a tube in the intestine to infuse levodopa continuously but has been shown to reduce motor fluctuations.

A truly extended release levodopa-carbidopa tablet may be superior to all other levodopa pills such as Sinemet and Stalevo, being longer acting and thus reducing fluctuations. It is branded Rytary, not yet available but being reviewed by the FDA, with a decision expected by January of 2015.

Dr. Jack Florin, MD

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