The trajectory of the use of dopamine replacement therapy (DRT) in Parkinson’s disease (PD) is variable and doses may need to be increased, but also tapered. The plan for dose adjustment is usually done as per drug information recommendations from the licensing bodies, but there are no clear guidelines with regards to the best practice regarding the tapering off schedule given sudden dose reductions of drugs such as dopamine agonists may have serious adverse consequences. A systematic literature search was, therefore, performed to derive recommendations and the data show that there are no controlled studies or evidence-based recommendations how to taper or discontinue PD medication in a systematic manner. Most of the data were available on the dopamine agonist withdrawal syndrome (DAWS) and we found only two instructions on how to reduce pramipexole and rotigotine published by the EMA. We suggest that based on the available data, levodopa, dopamine agonists (DA), and amantadine should not be discontinued abruptly. Abrupt or sudden reduction of DA or amantadine in particular can lead to severe life-threatening withdrawal symptoms. Tapering off levodopa, COMT inhibitors, and MAO-B inhibitors may worsen motor and non-motor symptoms. Based on our clinical experience, we have proposed how to reduce PD medication and this work will form the basis of a future Delphi panel to define the recommendations in a consensus.

在帕金森病 (PD) 中使用多巴胺替代疗法 (DRT) 的轨迹是可变的，剂量可能需要增加，但也需要逐渐减少。剂量调整计划通常是根据许可机构的药物信息建议进行的，但由于突然减少多巴胺激动剂等药物的剂量可能会产生严重的不良后果，因此没有关于逐渐减少时间表的最佳实践的明确指南. 因此，进行了系统的文献检索以得出建议，数据显示没有对照研究或基于证据的建议如何以系统的方式逐渐减少或停止 PD 药物治疗。大多数数据都是关于多巴胺激动剂戒断综合征 (DAWS) 的，我们只找到了 EMA 发布的两个关于如何减少普拉克索和罗替戈汀的说明。我们建议，根据现有数据，不应突然停用左旋多巴、多巴胺激动剂 (DA) 和金刚烷胺。突然或突然减少 DA 或金刚烷胺尤其会导致严重的危及生命的戒断症状。逐渐减少左旋多巴、COMT 抑制剂和 MAO-B 抑制剂可能会加重运动和非运动症状。根据我们的临床经验，我们提出了如何减少 PD 用药，这项工作将构成未来 Delphi 小组的基础，以在共识中定义建议。金刚烷胺不应突然停药。突然或突然减少 DA 或金刚烷胺尤其会导致严重的危及生命的戒断症状。逐渐减少左旋多巴、COMT 抑制剂和 MAO-B 抑制剂可能会加重运动和非运动症状。根据我们的临床经验，我们提出了如何减少 PD 用药，这项工作将构成未来 Delphi 小组的基础，以在共识中定义建议。金刚烷胺不应突然停药。突然或突然减少 DA 或金刚烷胺尤其会导致严重的危及生命的戒断症状。逐渐减少左旋多巴、COMT 抑制剂和 MAO-B 抑制剂可能会加重运动和非运动症状。根据我们的临床经验，我们提出了如何减少 PD 用药，这项工作将构成未来 Delphi 小组的基础，以在共识中定义建议。