When dyskinesia becomes disabling, reduce individual levodopa doses before adding amantadine, and choose non-ergot dopamine agonists to avoid fibrotic complications. Document whether domperidone or apomorphine rescue is available before discharging a patient with unpredictable off episodes, and monitor liver function closely if tolcapone is prescribed.

Try lowering the individual doses but increasing the frequency—meaning smaller, more frequent amounts throughout the day; Most common issues to watch for are nausea, vomiting, orthostatic hypotension, constipation, hallucinations, and dyskinesias; If it becomes deeply disabling, it's time to consider surgical options; They can be used as an initial monotherapy to delay levodopa use in early stages, or as helpful adjuncts to manage fluctuations in advanced disease; Also add a dopamine agonist or introduce amantadine