Optimizing levodopa therapy for Parkinson’s disease with levodopa/carbidopa/entacapone: implications from a clinical and patient perspective
David J BrooksDivision of Neuroscience, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, UKAbstract: After 40 years of clinical experience, levodopa remains the gold standard treatment for Parkinson’s disease (PD) despite the recent emergence of a host of new therap...
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| Formato: | article |
| Lenguaje: | EN |
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Dove Medical Press
2008
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| Acceso en línea: | https://doaj.org/article/97669d152cbb42ba97bbf2f8b725cd6f |
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| Sumario: | David J BrooksDivision of Neuroscience, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, UKAbstract: After 40 years of clinical experience, levodopa remains the gold standard treatment for Parkinson’s disease (PD) despite the recent emergence of a host of new therapies. Some physicians are cautious when prescribing levodopa because of its association with motor complications. Evidence now suggests that levodopa-associated complications are a result of deep troughs in delivery of levodopa to the brain caused by the short plasma half-life of conventional levodopa formulations (levodopa and a dopa decarboxylase inhibitor [DDCI]). Dosing strategies, such as dose increases and dose fractionation, may be effective in the short term. For the longer-term, levodopa/carbidopa/entacapone provides pharmacokinetically optimized levodopa therapy that significantly increases the plasma half-life and bioavailability of levodopa, providing more consistent plasma levodopa levels without deep troughs. Evidence from clinical trials in PD patients experiencing re-emergence of symptoms due to wearing-off has consistently shown that levodopa/DDCI and entacapone significantly increases ON-time and affords greater functionality, as measured by the Unified Parkinson’s Disease Rating Scale (UPDRS) with conventional levodopa. These trials have also shown that levodopa/DDCI and entacapone is generally well tolerated, with notable adverse events including worsening dyskinesia, nausea and diarrhea. Patients experiencing re-emergence of symptoms due to wearing-off may benefit from optimized levodopa therapy with levodopa/carbidopa/entacapone.Keywords: levodopa, wearing-off, dyskinesia, entacapone, Stalevo |
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