Levodopa, which is nowadays always combined with a decarboxylase inhibitor, is the most efficient drug for the treatment of Parkinson's disease. It is irrelevant which of the two decarboxylase inhibitors is used. Levodopa treatment is normally started when anticholinergic agents and amantadin do not suffice any longer, or when the patients are severely hindered in their daily activities or social contacts. It is still not clear if an early levodopa treatment has a negative impact on the later development of the disease. At the beginning over 75% of the patients respond to levodopa treatment. The combination with other Parkinsonian drugs (especially with bromocriptine or selegilin) makes it possible to reduce the dose and therefore also the side-effects. The efficacy of levodopa usually diminishes through the years. After two to five years of therapy the complications slowly mutliply (dyskinesias, fluctuation of the effect). In advanced stages, the physicians' efforts concentrate on the reduction of side-effects. Parkinsonism induced by drugs cannot be treated with levodopa.

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