Medications to Avoid or Use with Caution

It can be challenging to keep track of all your medications, especially if you’re using medications for both motor and non-motor symptoms. However, keeping an accurate up-to-date list of your medications decreases the likelihood of an unwanted medication interaction. Studies have found that one in three people with Parkinson’s have been prescribed contraindicated drugs while they were hospitalized, which highlights the importance of having an up-to-date list of medications available at all times.

MAO-B Contraindicated Medications

Most prescription antidepressants have a potential interaction with MAO-B inhibitors. Prescription antidepressants have been used safely in thousands of people with Parkinson’s, but your prescribing physician may need to inform the pharmacy if they consider the benefits to outweigh the risks.

Generic Name
Trade name
Meperidine (pain medication) Demerol
Tramadol (pain medication) Ultram
Methadone (pain medication) Dolophine
St. John's Wort (antidepressant) Several brands
Cyclobenzaprine (muscle relaxant) Flexeril
Dextromethorphan (cough suppressant) Robitussin, other brands
Pseudoephedrine (decongestant/stimulant) Sudafed
Phenylephrine (decongestant/stimulant) Vicks Sinex, etc.
Ephedrine (decongestant/stimulant) Emerphed, Akovaz, etc.
Linezolid Zyvox
Phenelzine Nardil
Tranylcypromine Parnate
Isocarboxazid Marplan

First-generation antipsychotics

These medications block dopamine receptors in the brain, thus countering the desired effects of Parkinson’s medications and likely worsening Parkinson’s motor symptoms.

Generic Name
Trade Name
Loxapine Loxitane
Pimozide Orap
Fluphenazine Prolixin
Trifluoperazine Stelazine
Haloperidol Haldol
Chlorpromazine Thorazine
Thiothixine Navane
Perphenazine Trilafon
Thiothixine Mellaril

Second-generation antipsychotics

These medications block dopamine receptors in the brain, thus countering the desired effects of Parkinson's medications and likely worsening Parkinson's motor symptoms. These medications block less dopamine than first generation antipsychotics, but they should nonetheless be avoided.

Generic Name
Trade Name
Lurasidone Latuda
Asenapine Saphris
Olanzapine Zyprexa
Aripiprazole Abilify
Iloperidone Fanapt
Cariprazine Vraylar
Risperidone Risperdal
Brexpiprazole Rexulti
Ziprasidone Geodon
Paliperidone Invega

Antiemetics

These medications treat nausea by blocking dopamine receptors in the brain, thus countering the desired effects of Parkinson's medications and possibly worsening Parkinson's motor symptoms.

Generic Name
Trade Name
Prochlorperazine Compazine
Chlorpromazine Thorazine
Promethazine Phenergan
Metoclopramide Reglan
Droperidol Inapsine

Treatments for Hyperkinetic Movements

These medications are used for a condition called tardive dyskinesia, which is different than levodopa-induced dyskinesia. These medications lower dopamine, possibly worsening Parkinson's motor symptoms.

Generic Name
Trade Name
Tetrabenazine Xenazine
Valbenazine Ingrezza
Deutetrabenazine Austedo

Antihypertensives

These medications reduce dopamine, possibly worsening Parkinson's motor symptoms.

Generic Name
Trade Name
Reserpine Serpalan
Methyldopa Aldomet

Antidepressants

Amoxapine is a TCA but unlike other TCAs also blocks dopamine receptors. Phenelzine, isocarboxazid, and tranylcypromine are nonselective MAO inhibitors and cannot be taken in conjunction with MAO-B inhibitors.

Generic Name
Trade Name
Amoxapine Asendin
Phenelzine Nardil
Isocarboxazid Parnate
Tranylcypromine Marplan

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