In early PD (E-PD) the aim is to preserve dopaminergic function for as long as possible by using dopamine supplementations. Levodopa preparations, non-ergot derived dopamine agonists and MAO-B inhibitors are all first line options in early PD. The choice is dependent on the individual circumstances of the person with PD.

For example, age, preference, tolerability and once the short- and long-term benefits and drawbacks of each medicine have been explained to the patient. Historically, levodopa with a decarboxylase inhibitor (DCI) has been the gold standard of treatment, but tolerance to levodopa occurs over time (estimated at 10 per cent year on year tolerance), making it inappropriate to use first-line in younger patients as it will be ineffective within 10 years.

Anticholinergic agents, amantadine and beta-blockers are not recommended in E-PD
due to lack of evidence or limited efficacy.