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Parkinson’s OFF-time: what you need to know and how to manage it

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There’s a lot to understand when it comes to Parkinson’s and OFF-time is an important part of managing one’s symptoms.  

It is possible for people living with Parkinson’s to live fully and manage their motor symptoms, including tremors, impaired balance and slowness of movement, with medication such as levodopa which is specifically developed to help in treating Parkinson’s. However, many people experience fluctuations in their symptoms as their medication wears off. These fluctuations are known as OFF-time: periods when the medication has yet to take effect or has worn off.  

During this OFF-time period, many people limit their activities and avoid social situations for fear of experiencing unexpected motor and non-motor symptoms, which add to the insecurity and anxiety the person may already be feeling. Fortunately, you can improve OFF-time with a few helpful tips and by talking with your doctor about what will work best for you: 

1. Modify your diet

There is more to healthy eating than the food you eat. It’s also essential to develop healthy lifestyle habits, such as balancing your diet and exercising regularly, as these habits can improve your mood and make your medication more effective. In people with Parkinson’s, helpful dietary considerations may include: 

  • Eating a balanced diet which includes vegetables, fruit, dairy, grains, and protein.  
  • Keeping hydrated with plenty of water each day. 
  • Improving fibre intake to reduce constipation caused by medication. 

It is also good to note that foods high in protein, such as meat, fish, dairy, and nuts, can interfere with the absorption of the drug levodopa. As a result, there is less of the drug in the body, making it less effective at managing symptoms.  

Taking your medication 30 minutes before or 1 hour after meals containing protein or eating protein-containing foods at dinner rather than breakfast or lunch can reduce absorption interference. It is best to speak with your doctor and your dietitian about your diet and how it can help manage your OFF-time. 

 2. Adjust dosage/timing

Managing medications can be complicated. It is best to be proactive and take your medications as directed by your doctor, which includes getting refills and staying alert to side effects/ OFF-time. 

For the best results, your medication should be taken on time and as prescribed. Otherwise, the medicine may take longer to begin working. We all forget from time to time, so here are some tips to help you remember: 

  • Set an alarm 
  • Make taking medications part of your daily routine ie. right before brushing your teeth, 
  • Keep pills in a container. Some pill containers have sections for multiple doses and for specific times of the day (morning, lunch and night).  

As the saying goes, timing is everything. However, if you still have concerns about the effectiveness of your dosage/timing, your doctor may also need to adjust depending on your medication. 

3. Consider adjunct medical therapy

There are different medication options available to combat OFF periods. Some are used to help maintain dopamine levels in the brain, while others are used as needed for the intermittent treatment of OFF episodes. In Canada, a sublingual apomorphine film, KYNMOBI™, is available for intermittent treatment of OFF episodes. This medication is covered under certain exceptional or special access programs. Under medical supervision, approved medications in Canada can be used to treat OFF episodes and help make it easier for people living with Parkinson’s to function in their daily lives. People are encouraged to maintain open and ongoing discussions with their Parkinson’s healthcare team when considering treatment options. 

Everyone experiences Parkinson’s differently, but you are not alone. For more information, resources, and community support, contact Parkinson Canada’s advocacy team at (800) 565-3000 or email  

Our mission at Parkinson Canada is to transform the lives of Canadians living with Parkinson’s. Articles like this represent our commitment to building awareness and providing resources and support for people living with Parkinson’s and their care network.

This blog was made possible with sponsorship from Paladin Labs.

Disclaimer: The contents of this article are provided for information purposes only. They do not represent the advice, an endorsement or a recommendation, with respect to any product, service or enterprise, and/or the claims and properties thereof, by Parkinson Canada.    

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