Objective Till now, there is lack of evidence on the initial medication for patients with de novo Parkinson’s disease (PD) in China. We aimed to explore the status and influencing factors of the medication by a cross-sectional study about the selection of initial medication for the patients from different regions. Methods Clinical data of 342 PD patients from the Outpatient Department of the Aerospace Central Hospital and the Specialized PD Clinic of Beijing Tiantan Hospital from August 2014 to April 2015 were collected in this study. Their gender, age of onset, disease duration, type of initial medication, and Hoehn-Yahr staging score were recorded and classified. Results The cohort had a median onset age of 50.9 years, median duration of 6.7 years, and an average Hoehn-Yahr staging score of 2.43. For them, there were 4 types of initial drugs, that is, levodopa (LD), dopamine agonist (DA), LD＋DA, and non-LD and non-DA. The first one was the most commonly used as initial drug in the study, accounting for 51.8%. What’s more, it was still the first choice (41.0%) for the young onset patients (age of onset younger than 40 years; this finding was different from other studies). But in recent 5 years, there was a trend of using DA as initial option for de novo PD patients, which may be due to the update of guideline. Conclusion LD is still the main first option for initial medication in de novo PD patients at variable ages in clinical practice.