Levodopa in the early treatment of Parkinson's disease

l-dopa has many advantages as initial therapy for Parkinson's disease (PD). It is safer, more efficacious, associated with fewer adverse effects, few interactions, easier for patients to use and for clinicians to prescribe, and cheaper than dopamine (DA) agonists. Although l-dopa is more likely than DA agonists to introduce motor fluctuations and dyskinesia, l-dopa is also more effective in improving motor function. Furthermore, there is no long-term benefit from delaying l-dopa based on the risk of motor complications or psychiatric symptoms. Many investigations have shown that l-dopa does not accelerate disease progression. Now is the time to re-evaluate l-dopa for initial treatment of PD.