Indications: Parkinson's disease, used alone or as adjunct to levodopa with dopa-decarboxylase inhibitor (but not drug-induced extrapyramidal effects).

Cautions: avoid abrupt withdrawal; gastric and duodenal ulceration (avoid in active ulceration), uncontrolled hypertension, arrhythmias, angina, psychosis, side effects: of levodopa may be increased, concurrent levodopa dosage can be reduced by 10–20%.

Contra-indications: pregnancy; breast-feeding.

Side Effects: nausea, constipation, diarrhoea, dry mouth; postural hypotension; dyskinesia, vertigo, sleeping disorders, confusion, hallucinations; arthralgia, myalgia; mouth ulcers with oral lyophilisate; rarely arrhythmias, agitation, headache, micturition difficulties, skin reactions; also chest pain.

Dose: 10 mg in the morning or 5 mg at breakfast and midday.

To avoid initial confusion and agitation, it may be appropriate to start treatment with a dose of 2.5 mg daily, particularly in the elderly.