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Despite the introduction of other classes of dopaminergic therapies, levodopa remains the most effective treatment for managing the motor symptoms of Parkinson’s disease. However, with chronic levodopa exposure, troublesome dyskinesias frequently emerge and limit the potential for maximizing therapy. Although dopamine agonists such as pramipexole or ropinirole may delay the need for levodopa, dyskinesias emerge once levodopa is added to manage motor symptoms. Provision of dopaminergic therapy using parenteral methods for more continuous delivery (e.g., subcutaneous or direct intraintestinal administration) has minimized motor fluctuations and the severity and duration of dyskinesias. Amantadine and, to some extent, clozapine have demonstrated anti‐dyskinetic effects in controlled studies and support the notion that other pharmacologic pathways may be involved. These pathways may provide an opportunity for pharmacologic intervention. Oral therapies such as preladenant, pardoprunox, and levitiracetam are among compounds that may delay or prevent the onset of dyskinesias, and compounds targeting other biochemical pathways are in the early stages of development.

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