Adenosine A2a antagonists

Since it is not dopaminergic, it can reduce “off” time by 30-60 minutes per day without worsening dyskinesia. However, dyskinesia can still be a side effect. Reduction in “Off” time should be seen by 4 weeks.

Patients who smoke the equivalent of 20 cigarettes per day or more will require a higher dose (40mg) of medication. This is because the cigarettes cause the liver to increase the breakdown of (metabolize) Nourianz™, making the medication less effective. It should be taken upon wakening to reduce the chance of causing insomnia.

Forms of Adenosine A2a antagonists

istradefylline (NOURIANZ™)

Available Doses: 20 mg, 40 mg
Typical Treatment Regimen: 20 – 40 mg once/day
Common Side Effects: Dyskinesia, insomnia, hallucinations, dizziness
Indications for Usage: Combination therapy with carbidopa/levodopa for “off” episodes


* Please note that the side effects listed in the tables that accompany each class of medication are the most commonly experienced. Not all individuals will experience such side effects. For many people who do experience side effects, they can often be effectively limited or eliminated with careful adjustments to dosage or the timing of the individual doses.

Speak to the treating physician immediately if any side effects are experienced. For a complete description of each drug and its possible side effects, please request a “package insert” from your pharmacist for each drug used. It is recommended that all prescriptions be filled at the same pharmacy to avoid interactions between medications. Interactions can be dangerous and even life-threatening, so make sure the pharmacist knows of all medications and supplements being taken, including over-the-counter medications and supplements.

Caution: PD medications may have interactions with certain foods, other medications, vitamins, herbal supplements, over the counter cold pills and other remedies. Anyone taking a PD medication should talk to their doctor and pharmacist about potential drug interactions.

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