IMPORTANT INFORMATION
ABOUT LEVODOPA USE IN PARKINSON’S DISEASE
Levodopa is one of
the most important medicines used for treating Parkinson’s disease (PD). It is
sold in combination of levodopa and carbidopa. The commonly used brand names
for this medicine are syndopa, sinemet, tidomet and duodopa. Levodopa is very
useful in ameliorating the symptoms of PD, especially the tremors and rigidity.
However, there are several important points of note regarding its use. The
current article highlights a few of them.
1. Try to avoid levodopa use in
early PD: Though levodopa is very effective in controlling symptoms of PD even
in early stage, it is better to avoid using it in early PD. This is because the
risk of dyskinesia (abnormal movements as a side effect of levodopa) and rapid
wearing off (reduced efficacy of levodopa) are more common, if levodopa is
started early in the course of disease. Also, levodopa loses the efficacy after
longer use, so, it makes sense to start it later.
2. Use the lowest effective dose
of levodopa: It may be tempting to use levodopa at a higher dose or more
frequently, as the symptom control would be better with that. However, for the
same reason mentioned above, it is better to use levodopa at the lowest
possible dose, and as less frequently as possible.
3. Take levodopa on empty stomach:
Presence of food in stomach may interfere with the absorption of levodopa; so,
it is better to take levodopa on empty stomach. In the initial days of starting
levodopa, there may be nausea or vomiting, so, it may be taken after food or
snacks.
4. Reduce or evenly space the
amount of protein intake: High protein diet prevents proper absorption of
levodopa. So, the protein intake should be evenly spaced out in the day; or
better, it can be shifted to dinner time (as most doses of levodopa are taken
before dinner time).
5. Avoid pyridoxine (vitamin B6)
intake: Pyridoxine can reduce the effects of levodopa, if taken alone. However,
pyridoxine does not interfere with the effects, if levodopa is taken along with
carbidopa (as in most cases).
6. Hallucinations and psychosis
can be a side effect of levodopa: Use of levodopa does increase the risk of
visual and auditory hallucinations, and other psychotic reactions (agitation,
anger, irritability, etc). However, it is not a simple relationship. The
severity & duration of PD, presence of cognitive impairment and daytime
somnolence, all increase the risk of psychotic reactions with levodopa use.
7. Avoid using levodopa in late
evenings: The risk of hallucinations and other psychotic reactions are higher
if levodopa is used in late evenings or nights. So, avoid it at those times, as
much as possible.
8. Avoid breaking, crushing or
chewing the controlled release (CR) tablets: Those taking medicines such as
syndopa CR, tidomet CR, etc should swallow the entire tablet, without breaking
or crushing (which would reduce its efficacy).
9. There is a risk of dependence
and abuse with levodopa: Levodopa increases the dopamine levels in brain and
may cause effects such as euphoria (feeling of extreme happiness) and other
positive mental effects. Therefore, a small group of patients with PD may
increase the dose of levodopa by self and take upto 1500-2000 mg per day. These
patients accept the side effects of high dose levodopa (such as hallucinations,
nausea, loss of appetite), in order to experience the positive mental effects.
This behavior (of dependence and abuse of levodopa) should be recognised and
treated.
10. Other side effects of levodopa to watch for:
a.
Dizziness or fainting sensation
on standing up (may occur due to fall in BP on standing),
b.
Feeling of nausea, vomiting,
loss of appetite
c.
Sudden sleep episodes: Patients
taking levodopa may fall asleep without any drowsiness or warning. It can occur
while driving or doing other activities needing full concentration, which can
be potentially harmful.
d.
Sleep disturbance or insomnia
at nights.
DR SUDHIR KUMAR MD
(Medicine) DM (Neurology)
Senior Consultant
Neurologist
Apollo Hospitals,
Hyderabad, India
Phone:
0091-40-23607777/60601066
Email: drsudhirkumar@yahoo.com
Online consultation: https://www.doctorspring.com/doctors/sudhir-kumar
