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Dementia with Lewy Body and Parkinson's Disease PatientsPatient, Family, and Clinician Working Together for Better Outcomes$
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J. Eric Ahlskog

Print publication date: 2013

Print ISBN-13: 9780199977567

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199977567.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 20 June 2021

Beginning Carbidopa/Levodopa Treatment: Background, Starting Dosages, and Side Effects

Beginning Carbidopa/Levodopa Treatment: Background, Starting Dosages, and Side Effects

Chapter:
(p.61) 6 Beginning Carbidopa/Levodopa Treatment: Background, Starting Dosages, and Side Effects
Source:
Dementia with Lewy Body and Parkinson's Disease Patients
Author(s):

J. Eric Ahlskog

Publisher:
Oxford University Press
DOI:10.1093/oso/9780199977567.003.0012

In the previous chapter the symptoms and signs of parkinsonism were described, along with the rationale for selecting carbidopa/levodopa as the primary drug for treating parkinsonism. In most cases of DLB or PDD, carbidopa/levodopa should be the only drug used for dopamine replenishment. This strategy results in the greatest likelihood of substantial benefits and least risk of side effects. If parkinsonism is minimal and causing no disability, carbidopa/levodopa does not need to be started. Certain non-motor parkinsonism symptoms in DLB and PDD may also respond to carbidopa/levodopa treatment, including anxiety, insomnia, and sometimes pain. Treatment of these non-motor symptoms will be discussed in Chapter 9. This chapter outlines levodopa treatment guidelines for people whose parkinsonism is troublesome and untreated. The guidelines presented here are also relevant to those taking only low doses of carbidopa/levodopa. If other drugs are being taken for parkinsonism it may be wise to begin tapering those off, one by one, before adding carbidopa/levodopa. This process is addressed in further detail in Chapter 7. Tapering off other drugs for parkinsonism should not be done without the clinician’s input. Drugs to consider for slow elimination include ropinirole (Requip), pramipexole (Mirapex), rotigotine (Neupro patch), selegiline (Eldepryl), rasagiline (Azilect), benztropine (Cogentin), and trihexyphenidyl (Artane). Amantadine may also fall into this category, although there are circumstances where it may be indicated (for hard-to-treat dyskinesias). Entacapone, taken as either Comtan or Stalevo, is also addressed in the next chapter. This chapter begins with a discussion of basic facts and principles relating to carbidopa/levodopa, before outlining specific treatment algorithms. The chapter ends with a discussion of possible side effects. Carbidopa/levodopa is usually well tolerated, as long as it is not combined with other parkinsonism drugs. The active ingredient in this formulation is levodopa. Everyone has levodopa in their bodies, and small amounts are present in the diet. This natural substance is the precursor to dopamine. An enzyme, dopa decarboxylase, is present in the brain and body that converts levodopa to dopamine.

Keywords:   Eldepryl (selegiline), amantadine, anti-nausea medications, carbidopa/levodopa, treatment principles, domperidone, entacapone (Comtan), faintness, in orthostatic hypotension, ondansetron (Zofran), pramipexole (Mirapex), trihexyphenidyl (Artane), trimethobenzamide (Tigan)

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