Topical ointment: 1/2 inch initially, applied to a non-hairy area of the trunk every 6 to 8 hours during waking hours (2 times a day); titrate as needed and tolerated. Usual range is 1/2 to 2 inches ( to 30 mg) every 8 hours, typically applied to 36 square inches of truncal skin.
Transdermal patch: to mg/hr patch applied to a dry and hairless area of the upper arm or body for 12 to 14 hours per day; titrate as needed and tolerated up to mg/hr. Application sites should be rotated to avoid skin irritation.
Transmucosal (buccal) tablet: 1 mg dissolved between the lip and gum above the upper incisors or between the cheek and gum every 3 to 5 hours during waking hours (approximately 3 times a day); titrate as needed and tolerated. Usual maintenance dosage is 2 mg three times a day.
Oral: every 8 to 12 hours; titrate as needed and tolerated up to 9 mg every 8 to 12 hours
In the examination of a patient with resting tremor, the physician checks for rigidity and bradykinesia by flexing and extending the patient's arms, seeking signs of cogwheel rigidity. Tremor and rigidity may become more pronounced if patients perform voluntary movements with the opposite limb (., the patient draws a circle in the air with the opposite hand). The patient is asked to stand and to walk, thus displaying evidence of difficulty initiating movement, reduced arm swing, or shuffling gait. If PD is suspected, a trial of therapy with a dopaminergic agent such as levodopa-carbidopa (Sinemet) is appropriate. Referral to a neurologist is indicated when patients fail to respond to the medication or demonstrate an atypical presentation.