Levodopa - epgonline.org
Levodopa - epgonline.org
Levodopa - epgonline.org
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ENT416_NURSES LEAVEPIECE.qxd 2/10/06 14:08 Page 10<br />
Complications of levodopa are<br />
due to pulsatile delivery<br />
• Pulsatile delivery of levodopa leading to abnormal variations in blood<br />
levels is believed to lead to physiological changes that may result in motor<br />
complications such as wearing-off and dyskinesia 1<br />
• Improving the way levodopa is given at an early stage may reduce the<br />
development of motor complications such as wearing-off<br />
[1] Stocchi. Parkinsonism Relat Disord 2003; 9: S73–81<br />
However, most therapeutic<br />
strategies targeting wearing-off<br />
fail to address pulsatility<br />
• Steady plasma levels of levodopa may be provided by a constant infusion<br />
of levodopa; however, its use is cumbersome and impractical<br />
• Other commonly used methods include increasing the dose of levodopa<br />
or giving smaller, more frequent doses (fractionation); using controlledrelease<br />
preparations which have a longer duration of action, or using<br />
dopamine agonists<br />
Modifying the dose<br />
Plasma levels with titrated levodopa/DDCI 1<br />
<strong>Levodopa</strong> plasma levels<br />
(ng/mL)<br />
4000<br />
3000<br />
2000<br />
1000<br />
0<br />
Dose<br />
DDCI=dopa-decarboxylase inhibitor<br />
• Does nothing to improve the short, 1.5-hour half-life of levodopa
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