Why delay taking dopamine drugs

I have only recently been diagnosed with Parkinsons (in January this year) and my neurologist has told me that I don't need to take levadopa or any dopamine agonists yet (I'm taking 1mg rasagiline).

I'm having a bladder op tomorrow which may help with some of my bladder symptoms, however I've just spoken to another Parkinson's person who recommends I take levodopa as it has totally transformed her life (she had been in a wheelchair and incontinent before taking the drugs).

There seems to be a reluctance to proscribe levadopa where I live but I'm not sure if it's because of my age ( 48 ) or if there are genuine concerns about side affects/tolerance.

Am I about to undergo a surgical operation unnecessarily ? When and who decides that I should start taking levadopa? Will I get my sex life back? Will the pain and stiffness in my back get better? Will my balance improve ?

Apologies for all the questions but my neurologist is quite distant and has told me to come back in 6 months.



Hello, Stephen --

If you really are "unshakey," your neurologist may be right in delaying DA's at this point.  Taking rasagiline is wise, though.  I credit it at least partially with the slow progress my PD is making.  I started taking it as soon as it came on the US market (about ten years ago?) and am still enjoying relative stability in the first stages of this disease.

I am far from the most knowledgeable member of this forum and cannot answer many of your questions, especially those regarding symptoms I have never experienced.  But in regard to balance, medications can help, yes.  Exercise in forms requiring balance also helps (dance, yoga, tai chi, etc.).  I know, too, that meds can help ease pain and stiffness, but the right combination for treatment varies greatly from patient to patient.

Others on this forum will probably respond soon and offer more info.

Best wishes,      J

Why delay? 

Yes, your age plays a role. You have probably  some thirty odd years of treatment ahead of you. You can only tolerate a certain amount of levodopa drugs after which the side effects overtake the benefits. So they generally postpone levodopa medication in the under 70 year olds .A lot of young patients experience slow progression of the disease and the first few years can often be managed without levodopa. Someone in a wheelchair , however, is severely affected of course and they will certainly welcome the kind of relief that levdopa can give. Levodopa is wonderful with few side effects in the beginning. So whether you start or delay is all a question of severity (and your tolerance) of symptoms

I am 55 and have just gone onto Levodopa. I was Dx 3 years ago and was given Different DA's until they found one that I could tolerate however the side effects have proven too severe and developed an impulse control disorder.


My neuro told me it was better to have a good quality of life now so I can carry on doing the job I love, spend time with my family, going on holidays etc. and worry about the side effects later. After all I might get run over by a bus when I am 65 and never get the benefit of these drugs.

My tremor is almost completely gone and I feel well for the first time in three years.




I was diagnosed in August 2013 at first my neuro gave me Rasagiline  , but when i went back to see him 3 months later  and i told him i was not really getting much relief with Rasagiline he gave me the choice of a DA or Levodopa , i chose Levodopa , i was 47 at the time  ,  my neuro said  there is nothing to be gained from delaying levodopa in fact he said the younger you are at diagnosis you have more of a risk of developing impulsive behaviour side effects from Dopamine Agonists which is why i opted for Levodopa

Thanks for the responses and sorry for not replying earlier. I'm on the levodopa now (madopar) but it didn't have the life changing effect I thought it would.