Effects of levodopa and carbidopa: A Synthesis of Findings from 12 Studies

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Original Abstract of the Article

Main Research Findings

Levodopa/carbidopa intrajejunal gel (LCIG) is an effective treatment for Parkinson's disease (PD) that helps overcome levodopa-induced motor complications in advanced stages of the disease. 5 However, LCIG requires invasive percutaneous endoscopic gastrojejunostomy (PEG-J) and can have serious adverse effects (AE). 5 A study investigated the long-term AEs associated with LCIG treatment in a large homogenous cohort of advanced PD patients. 5 The study found that LCIG can improve gait and posture in patients with advanced PD, but it may also be associated with an increase in axial and motor severity. 8 Another study found that LCIG may affect the levels of B vitamins and neuropathy in patients with advanced idiopathic PD (IPD). 9

Levocetirizine, a substrate of P-glycoprotein, is generally not expected to have sedative effects. 2 However, cetirizine, a mixture of levocetirizine and dextrocetirizine, can slightly penetrate the blood-brain barrier. 2 This raises questions about the sedative effects of levocetirizine, which are currently under investigation. 2 Research has shown that levocetirizine is less sedating than cetirizine when compared to placebo. 1

Benefits and Risks

Benefits Summary

LCIG can improve gait and posture in patients with advanced PD. 8 It can also improve motor function in PD patients, contributing to a better quality of life. 4 LCIG may help stabilize blood levodopa levels, leading to longer-lasting dopamine effects and potential improvement in motor function. 11

Risks Summary

LCIG requires invasive PEG-J surgery. 5 LCIG can have serious adverse effects, including complications associated with the PEG-J procedure. 7 LCIG may affect B vitamin levels and increase the risk of neuropathy. 9

Comparison Across Studies

Commonalities Across Studies

Multiple studies have shown that levodopa/carbidopa is an effective treatment for Parkinson's disease. 5 7 10 9 8 4 6 3 11 12 These studies highlight the potential benefits of levodopa/carbidopa for improving motor function and quality of life in Parkinson's disease patients. 4 However, there are also potential risks associated with levodopa/carbidopa use, including serious adverse effects. 5

Differences Across Studies

The route and method of levodopa/carbidopa administration can influence the effectiveness and side effects of the treatment. 5 7 Levodopa/carbidopa can also interact with other medications, necessitating careful consideration. 10

Consistency and Contradictions in Results

Research findings on levodopa/carbidopa consistently demonstrate its effectiveness in managing Parkinson's disease symptoms, particularly in improving motor function. 5 7 8 However, the findings also emphasize the potential for serious adverse effects. 5 7 9 This underscores the need for careful monitoring and management of patients receiving levodopa/carbidopa therapy.

Practical Implications

Levodopa/carbidopa is a valuable tool for managing Parkinson's disease, but its use should be carefully considered, weighing its potential benefits against the risks. 5 It's crucial for patients to discuss treatment options with their healthcare providers, including the potential benefits and risks of levodopa/carbidopa therapy. 5

Limitations of Current Research

Research on levodopa/carbidopa is still ongoing, and more information is needed to fully understand its long-term effects, especially regarding LCIG and its impact on B vitamin levels and neuropathy. 5 9

Future Directions for Research

Further research is necessary to investigate the long-term safety and efficacy of LCIG. 5 Additional studies should explore the effects of levodopa/carbidopa on conditions other than Parkinson's disease. 10 Furthermore, research into minimizing levodopa/carbidopa's adverse effects is essential. 5

Conclusion

Levodopa/carbidopa remains a vital treatment for Parkinson's disease. It provides significant benefits in managing motor symptoms, but careful monitoring and consideration of potential side effects are crucial. 5 10 1 Patients should consult their healthcare providers to discuss treatment options and understand the potential benefits and risks associated with levodopa/carbidopa therapy. 5

Literature analysis of 12 papers
Positive Content
11
Neutral Content
0
Negative Content
1
Article Type
2
2
1
3
12
1.

Comparison of the sedating effects of levocetirizine and cetirizine: a randomized, double-blind, placebo-controlled trial.

Author: TzanetosDouglas B, FahrenholzJohn M, ScottTheresa, BuchholzKristina

Tolerable for patients with sedation history
No significant difference in sedation compared to cetirizine

Levocetirizine was not found to be significantly less sedating than its parent drug cetirizine in patients who had previously reported sedation with cetirizine. The study suggests that many patients who perceive sedation with cetirizine might tolerate it if given in a masked manner.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

2.

Sedative Effects of Levocetirizine: A Systematic Review and Meta-Analysis of Randomized Controlled Studies.

Author: SnidvongsKornkiat, SeresirikachornKachorn, KhattiyawittayakunLikhit, ChitsuthipakornWirach

Allergy treatment
Sedative effects

This study investigated the sedative effects of levocetirizine. The study found that levocetirizine has modest sedative effects with a risk ratio of 1.67 when compared with placebo. The sedative effects observed for levocetirizine are not different from other second-generation antihistamines.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

3.

Effects of Levodopa-Carbidopa Intestinal Gel Compared with Optimized Medical Treatment on Nonmotor Symptoms in Advanced Parkinson's Disease: INSIGHTS Study.

Author: ChungSun Ju, CalopaMatilde, CeravoloMaria G, TambascoNicola, AntoniniAngelo, ChaudhuriK Ray, RobiesonWeining Z, Sánchez-SoliñoOlga, ZadikoffCindy, JinMan, BarbatoLuigi M

Improved NMS

There were no significant differences between LCIG versus OMT in NMSS or PDSS-2; both LCIG and OMT groups significantly improved from baseline.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

4.

Effects of Levodopa-Carbidopa Intestinal Gel on Dyskinesia and Non-Motor Symptoms Including Sleep: Results from a Meta-Analysis with 24-Month Follow-Up.

Author: ChaudhuriK Ray, AntoniniAngelo, PahwaRajesh, OdinPer, TitovaNataliya, ThakkarSandeep, SnedecorSonya J, HegdeSaket, AlobaidiAli, ParraJuan Carlos, ZadikoffCindy, BergmannLars, StandaertDavid G

Improved dyskinesia
Reduced non-motor symptoms

Levodopa-carbidopa intestinal gel (LCIG) showed significant sustained improvements in dyskinesia and non-motor symptoms in patients with advanced Parkinson’s disease (PD) up to 24 months after initiation.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

9.

Effects of levodopa/carbidopa intestinal gel versus oral levodopa/carbidopa on B vitamin levels and neuropathy.

Author: LoensSebastian, ChorbadzhievaElena, KleimannAlexandra, DresslerDirk, SchraderChristoph

This study aimed to determine the possible interactions between levodopa therapy and plasma levels of B vitamins in patients with advanced Parkinson's disease. It also aimed to investigate the prevalence of neuropathy and its relation to plasma levels of B vitamins and homocysteine.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

10.

Effects of levodopa-carbidopa-entacapone and smoked cocaine on facial affect recognition in cocaine smokers.

Author: BediGillinder, ShiffrinLaura, VadhanNehal P, NunesEdward V, FoltinRichard W, BisagaAdam

Social processing impairment

Cocaine users have problems with social processing, which can be exacerbated by certain medications. This study found that levodopa-carbidopa-entacapone (LCE), a potential treatment medication for cocaine addiction, increased the response threshold for identifying facial fear in cocaine users. Cocaine itself had no effect on facial emotion recognition.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

11.

Unwanted effects and interaction of intrajejunal levodopa/carbidopa administration.

Author: JostWolfgang H

Parkinson's treatment
Reduces dyskinesias
Reduces fluctuations
Malabsorption
Polyneuropathies
Pump and tube problems
Surgical complications
Vitamin deficiency

Levodopa/carbidopa intestinal gel (LCIG) is a beneficial and very useful treatment option as escalation therapy for Parkinson's disease.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

12.

Immediate versus delayed switch from levodopa/carbidopa to levodopa/carbidopa/entacapone: effects on motor function and quality of life in patients with Parkinson's disease with end-of-dose wearing off.

Author: LewMark F, SomogyiMonique, McCagueKevin, WelshMickie,

Motor function improvement
Quality of life improvement
Diarrhea
Dizziness
Nausea

Immediate switch to levodopa/carbidopa/entacapone (LCE) provided greater motor improvement and improved quality of life in Parkinson’s disease (PD) patients with end-of-dose wearing off (EODWO) compared to delayed switch.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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