The initial treatment of Parkinson's disease should begin with levodopa

For over two decades controversy has surrounded the initial choice of therapeutic agent for patients with early symptomatic Parkinson's disease. Whether levodopa or dopamine receptor agonist monotherapy in these patients is more efficacious and/or results in fewer long‐term complications of dopaminergic therapy such as motor fluctuations, dyskinesias, or psychiatric disorders is unresolved. This article examines the evidence related to levodopa‐sparing strategies and levodopa‐induced toxicity in Parkinson's disease. At this time, there is little evidence to support levodopa‐sparing strategies or to suggest that levodopa is toxic and harmful to patients with Parkinson's disease.