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Understanding Parkinson's

"Off" Time in Parkinson’s Disease

"Off" time is when Parkinson's symptoms — motor and/or non-motor — return between medication doses. Not everyone experiences "off" time, but it's more common when living with Parkinson’s or taking levodopa for many years. Check out our resources to help you learn more and talk with loved ones and care providers.

Watch Our Webinar
Thursday, September 16
12:00 pm EDT
Too Much or Not Enough: Dyskinesia and "Off" Time in Parkinson's
Our expert panelists discuss common Parkinson’s issues — “off” time and dyskinesia — and how to treat them. “Off” time is when symptoms return between medication doses. Dyskinesia is uncontrolled, involuntary movement. We cover tips for managing these problems and the latest research. Register to watch on demand anytime.

Ask the MD Video

Movement disorder specialist Rachel Dolhun, MD, talks with MJFF Board Member Jeff Keefer, who was diagnosed with Parkinson's disease (PD) in 2007, about "off" time, available treatments, and the latest research.

Understanding “Off” Time

"Off" is a term doctors and researchers use in Parkinson's care and research. But people with Parkinson's may be less familiar with this term or what it means for them.

"Off" time is when Parkinson’s motor and/or non-motor symptoms happen between medication doses. It may occur in the morning, before the first dose of medication. Or it can happen during the day, between scheduled doses of medication. (This is called "wearing off"). "Off" time can come on gradually or suddenly and unexpectedly.

Because everyone has different symptoms, "off" time is different in different people. Examples of "off" include:

  • stiffness and foot cramping (dystonia) in the morning;
  • a gradual return of tremor and feeling of anxiety 30 minutes before the next scheduled levodopa dose; or
  • unpredictable, sudden episodes of significant difficulty moving.

To help you and your doctor understand your symptoms and "off" time, it may be helpful to keep a log for a few days or weeks. You can track your symptoms, how long they last, how they come on (slowly or suddenly, for example), and when you take medication. This can help you see how well medication is or isn’t working and how to guide treatment.

"My 'off' episodes are extremely variable...

Sometimes I feel my medications slowly draining out of me, and sometimes it feels like a switch has flipped, shutting me down almost instantly. One constant: I always seem to turn off in the airport security line!"

– Margaret Sheehan, 62, McLean, Virginia

Margaret photo

Managing “Off” Time

If you experience "off" time, you may want to first look at how you take medication. Missing or skipping doses can contribute to "off" time. Taking levodopa with high-protein meals also may lead to "off." (This is because levodopa and protein are absorbed in the same part of the intestine, so your body may absorb less medication.) If you take medication on schedule and separate it from meals but still experience "off," you and your doctor may want to adjust your medications.

There are many medications available to help lessen "off" time and more are in the research pipeline.

Some medications are taken with levodopa, which turns into dopamine, the brain chemical that’s lost in Parkinson’s. They work to boost the effect of levodopa, making it last longer or helping more get into the brain, for example. Others — including inhaled levodopa and an under-the-tongue dissolvable apomorphine — are taken only as needed (in addition to other regularly scheduled Parkinson’s medications) for sudden, unexpected episodes. Still others treat Parkinson’s motor symptoms (tremor, slowness, stiffness) and, in doing so, may also decrease "off" time.

Learn more about available medications and talk with your doctor about which options may be right for you.

Resources to Learn More

Subscribe to Our Podcast 

Coming soon: A new podcast episode will explore how people experience “off” differently. Subscribe to our podcast to get notified when it’s available.

A behind-the-scenes look at the Parkinson's "off" podcast coming later this month

Read a Blog on the Language of Parkinson’s 

Read more about how doctors define and treat “off” time. 

Read a Blog on Choosing the Right Therapy 

Learn tips for talking with your doctor about finding the right treatment for you. 

The medical information contained in this article is for general information purposes only. The Michael J. Fox Foundation has a policy of refraining from advocating, endorsing or promoting any drug therapy, course of treatment, or specific company or institution. It is crucial that care and treatment decisions related to Parkinson’s disease and any other medical condition be made in consultation with a physician or other qualified medical professional. 

These resources were made possible by select members of our Parkinson’s Disease Education Consortium, including Acorda Therapeutics, the maker of Inbrija, and Amneal Pharmaceuticals, the maker of Rytary. If you prefer to speak with someone on the phone to learn more, you can call 1‑833‑INBRIJA for more on Inbrija or call 1-844-467-2928 for more on Rytary.

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Partner support allows us to furnish high-quality educational content to the Parkinson’s community while maintaining our commitment to allocate donor dollars to high-impact research. The Michael J. Fox Foundation is solely responsible for the content in these resources.  

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