Side Effects of levodopa and carbidopa: A Synthesis of Findings from 25 Studies

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Original Abstract of the Article

Major Findings

Levodopa-carbidopa is an effective treatment for Parkinson's disease, but it can cause side effects. This article summarizes the findings of several studies on the side effects of levodopa-carbidopa, and provides a detailed explanation of its mechanisms, countermeasures, and precautions.

Reasons for Side Effects

Levodopa-carbidopa is a therapeutic drug that aims to replenish dopamine neurotransmitters. Dopamine plays a variety of important roles, including motor control, emotions, and cognitive functions. In Parkinson's disease, dopamine-producing nerve cells die, resulting in a dopamine deficiency that causes symptoms such as motor dysfunction. Levodopa-carbidopa replenishes the body with levodopa, a precursor to dopamine, to compensate for the lack of dopamine. However, levodopa is converted to dopamine not only in the brain but also in other parts of the body, which can cause side effects.

Common Side Effects

Nausea and Vomiting

This is one of the most common side effects of levodopa-carbidopa. 19 reported that the frequency of nausea and vomiting was significantly higher in patients treated with levodopa-carbidopa combination than in those treated with levodopa-benserazide combination.

Gastrointestinal Symptoms

Levodopa-carbidopa can affect the gastrointestinal system, causing symptoms such as nausea, vomiting, constipation, and diarrhea. 19 reported that the frequency of gastrointestinal side effects was significantly higher in patients treated with levodopa-carbidopa combination than in those treated with levodopa-benserazide combination.

Worsening of Motor Symptoms

Long-term use of levodopa-carbidopa can lead to worsening of motor symptoms. 8 reported that temporary discontinuation of levodopa-carbidopa improved motor symptoms in patients who had been using the drug for a long period of time.

Psychiatric Symptoms

Levodopa-carbidopa can cause psychiatric symptoms. Symptoms such as hallucinations, delusions, anxiety, and depression may occur. 8 reported that temporary discontinuation of levodopa-carbidopa improved psychiatric symptoms in patients who had been using the drug for a long period of time.

Involuntary Movements

Levodopa-carbidopa can cause involuntary movements. 3 suggests that levodopa-carbidopa can improve motor function, but at the same time, it can cause involuntary movements.

Other

Levodopa-carbidopa may cause other side effects, such as dizziness, headache, drowsiness, fatigue, loss of appetite, and weight loss. 5 reported that selegiline may cause side effects such as urinary retention.

Countermeasures for Side Effects

Dosage Adjustment

Side effects of levodopa-carbidopa may be dose-dependent. Therefore, if side effects are observed, the dose can be reduced to alleviate them. 15 suggests that selegiline is effective in alleviating the “on-off phenomenon” caused by levodopa-carbidopa.

Change of Medication

If side effects are caused by levodopa-carbidopa, changing to a different medication may alleviate the side effects. 22 suggests that the addition of a sustained-release levodopa formulation to levodopa-carbidopa may reduce side effects.

Dietary Therapy

Absorption of levodopa-carbidopa can be affected by food. Therefore, adjusting the timing and content of meals can reduce side effects.

Other Countermeasures

Some countermeasures such as exercise therapy and rehabilitation may be effective for side effects of levodopa-carbidopa.

Comparison of Studies

Common Points

Multiple studies have shown that levodopa-carbidopa is an effective drug for the treatment of Parkinson's disease, while at the same time, there is a possibility of side effects.

Differences

Because the methods of administration, dosage, patient populations, and evaluation methods of levodopa-carbidopa differ among studies, the frequency and severity of side effects may vary.

Points to Note about Application to Real Life

Levodopa-carbidopa is an effective drug for the treatment of Parkinson's disease, but there is a possibility of side effects. In order to minimize side effects, it is important to follow the doctor's instructions, maintain the appropriate dosage, and undergo regular checkups. If you notice any side effects, consult your doctor immediately.

Limitations of Current Research

There are still many unknown aspects of the side effects of levodopa-carbidopa, and further research is needed.

Future Research Directions

It is necessary to clarify the mechanism of side effects of levodopa-carbidopa and develop safer therapeutic methods. It is also necessary to establish optimal treatment methods tailored to the individual constitution and symptoms of each patient.

Conclusion

Levodopa-carbidopa is an effective drug for the treatment of Parkinson's disease, but there is a possibility of side effects. In order to minimize side effects, it is important to follow the doctor's instructions, maintain the appropriate dosage, and undergo regular checkups. If you notice any side effects, consult your doctor immediately.

Keywords
Benefit Keywords
Improve quality of life
Reduce dyskinesia
Reduce off time
1
Improved motor function
Improved non-motor symptoms
Improved off time
Reduced non-motor fluctuations
2
Parkinson's disease treatment
3
PD treatment
4
Parkinson's treatment
5
Parkinson's treatment
T cell suppression
6
Parkinson's disease treatment
7
Enhanced motor responsiveness
8
Parkinson's disease treatment
9
Improved PD management
11
LCIG dose reduction
PD treatment
13
Pain reduction
14
'On-off' amelioration
Hypomimia improvement
Tremor improvement
15
Parkinson's treatment
Reduces dyskinesias
Reduces fluctuations
17
PD management
18
Equal efficacy
19
Advanced PD treatment
20
Decreased dopac excretion
Increased levodopa AUC
Increased levodopa excretion
Increased levodopa half-life
Reduced side effects
21
Higher levodopa tolerance
Improved parkinsonian signs
22
Control motor symptoms
Optimal motor function
23
Parkinson's treatment
24
Risk Keywords
Infection
Infusion complications
Intracranial bleeding
Noduli formation
1
Abdominal cellulite
Increased dyskinesias
Intestinal perforation
2
Discomfort
Invasiveness
3
Elderly risk
Urinary retention
5
Deterioration of Parkinson's disease
Dyskinesias
Nausea and vomiting
7
Sensitivity to dyskinesia
8
Neuropathic pain
Peripheral neuropathy
9
Parkinsonism
12
Inefficacy
Side effects
13
Choreoathetosis
Hallucinations
15
Memory impairment
16
Malabsorption
Polyneuropathies
Pump and tube problems
Surgical complications
Vitamin deficiency
17
Adverse events
18
Gastrointestinal side effects
Involuntary movements
19
LCIG treatment AE
20
Disease acceleration
Dyskinesia
Dystonia
25
Literature analysis of 25 papers
Positive Content
20
Neutral Content
2
Negative Content
3
Article Type
2
0
0
6
23
2.

Long-term response to continuous duodenal infusion of levodopa/carbidopa gel in patients with advanced Parkinson disease: The Barcelona registry.

Author: BuongiornoMaríateresa, AntonelliFrancesca, CámaraAna, PuenteVictor, de Fabregues-NebotOriol, Hernandez-VaraJorge, CalopaMatilde, Pascual-SedanoBerta, CampolongoAntonia, ValldeoriolaFrancesc, TolosaEduardo, KulisevskyJaime, MartíMaria Jose

Improved motor function
Improved non-motor symptoms
Improved off time
Reduced non-motor fluctuations
Abdominal cellulite
Increased dyskinesias
Intestinal perforation

Continuous infusion of levodopa/carbidopa intestinal gel (LCIG) is an effective treatment option for advanced Parkinson Disease (PD), but dyskinesia can increase and serious side effects are possible.

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.
Observational StudyResearch that observes and collects data on participants' behavior and outcomes in their natural state, without intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

4.

Direct switch from levodopa/benserazide or levodopa/carbidopa to levodopa/carbidopa/entacapone in Parkinson's disease patients with wearing-off: efficacy, safety and feasibility--an open-label, 6-week study.

Author: EggertKarla, SkogarOrjan, AmarKhaled, LuotonenLiisa, KuoppamäkiMikko, LeinonenMika, NissinenHelena, OertelWolfgang

PD treatment

Switching from levodopa/benserazide (LB) or levodopa/carbidopa (LC) to levodopa/carbidopa/entacapone (LCE) in Parkinson's disease (PD) patients with wearing-off resulted in significant improvement in clinical symptoms and quality of life.

Clinical Trial, Phase IVPost-marketing surveillance. Monitors long-term safety/efficacy after approval.
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.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

5.

Side effects of selegiline (Eldepryl).

Author: WatersC H

Parkinson's treatment
Elderly risk
Urinary retention

Selegiline can cause urinary retention in elderly patients with Parkinson's disease.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

6.

Carbidopa, a drug in use for management of Parkinson disease inhibits T cell activation and autoimmunity.

Author: ZhuHuabin, LemosHenrique, BhattBrinda, IslamBianca N, SinghAbhijit, GuravAshish, HuangLei, BrowningDarren D, MellorAndrew, FulzeleSadanand, SinghNagendra

Parkinson's treatment
T cell suppression

Carbidopa is a drug that is used to treat Parkinson's disease. This study looked at the effects of carbidopa on the immune system. The study found that carbidopa inhibited the activation of immune cells in both laboratory and animal studies.

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

Language : English

7.

Comparison of levodopa with carbidopa, and levodopa with domperidone in Parkinson's disease.

Author: LangdonN, MalcolmP N, ParkesJ D

Parkinson's disease treatment
Deterioration of Parkinson's disease
Dyskinesias
Nausea and vomiting

Levodopa-carbidopa was more effective in controlling Parkinson's disease than levodopa-domperidone in 20 patients. While both treatments were similar in clinical response, dyskinesia, and nausea and vomiting, levodopa-domperidone resulted in higher peak plasma levodopa concentration and bioavailability.

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.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

8.

Drug holiday and management of Parkinson disease.

Author: WeinerW J, KollerW C, PerlikS, NausiedaP A, KlawansH L

Enhanced motor responsiveness
Sensitivity to dyskinesia

A drug holiday may be beneficial for Parkinson's patients experiencing complications from chronic levodopa therapy. It can improve motor responsiveness, reduce side effects, and potentially allow for a lower levodopa dosage.

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

Language : English

9.

Infusion-rate-dependent Acute Neuropathic Pain with Duopa in a Patient with Parkinson's Disease and Pre-existing Neuropathy.

Author: KaurHarleen, BhatiaKunal, YelamAnudeep, ShuklaAnukrati, AsherIrving, GovindarajanRaghav

Parkinson's disease treatment
Neuropathic pain
Peripheral neuropathy

This study reports a case of Parkinson's disease in a patient who presented with acute exacerbations of pre-existing peripheral neuropathy on exceeding certain rates of continuous Carbidopa-Levodopa Infusions (CLI).

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

11.

Combining Device-Aided Therapies in Parkinson's Disease: A Case Series and a Literature Review.

Author: BouraIro, HaliasosNikolaos, GiannopoulouΙrene-Areti, KarabetsosDimitrios, SpanakiCleanthe

Improved PD management

This case series examines patients with advanced Parkinson's disease (PD) who required two device-aided therapies (DATs) for optimal management. The study also includes a systematic review of similar studies.

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.

Tramadol-induced parkinsonism: a case report of a 75-year-old woman.

Author: SinghRanbir

Parkinsonism

Tramadol-induced parkinsonism is a rare but serious side effect that can occur after long-term use of tramadol. A 75-year-old woman was diagnosed with tramadol-induced parkinsonism after taking tramadol for pain management following breast cancer surgery. The symptoms resolved within a week after she was prescribed levodopa/carbidopa. This case report emphasizes the importance of monitoring for tramadol-induced parkinsonism in older patients, especially those who are female.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

13.

Opicapone and Levodopa-Carbidopa Intestinal Gel Infusion: The Way Forward Towards Cost Savings for Healthcare Systems?

Author: LetaValentina, van WamelenDaniel J, SauerbierAnna, JonesShelley, ParryMiriam, RizosAlexandra, ChaudhuriK Ray

LCIG dose reduction
PD treatment
Inefficacy
Side effects

This retrospective analysis suggests that adding Opicapone to LCIG treatment for Parkinson's disease can reduce LCIG daily dose by 24.8% without worsening dyskinesia, potentially leading to significant cost savings.

LetterA written message for communication and exchange of information between individuals.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

14.

Chronic Pain Treatment Strategies in Parkinson's Disease.

Author: EdinoffAmber, SathivadivelNiro, McBrideTimothy, ParkerAllyson, OkeaguChikezie, KayeAlan D, KayeAdam M, KayeJessica S, KayeRachel J, M ShethMeeta, ViswanathOmar, UritsIvan

Pain reduction

This study reviews the management of chronic pain in patients with Parkinson's disease. It discusses various treatment options, including medications, physical therapies, and deep brain stimulation.

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

15.

Double-blind trial of R-(-)-deprenyl for the "on-off" effect complicating Parkinson's disease.

Author: GolbeL I, DuvoisinR C

'On-off' amelioration
Hypomimia improvement
Tremor improvement
Choreoathetosis
Hallucinations

Deprenyl was tested against placebo in treating 'on-off' oscillations in Parkinson's disease. Patients on deprenyl showed significant improvement in time spent in the 'on' state and were more likely to experience improvement in tremor and hypomimia during the 'on' state. Hallucinations and worsening choreoathetosis were common side effects.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Controlled Clinical TrialA clinical trial that evaluates the effectiveness of a treatment by comparing a group that receives the intervention with a group that receives a placebo or standard treatment.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

16.

Fluctuations in plasma dopamine level impair memory in Parkinson's disease.

Author: HuberS J, ShulmanH G, PaulsonG W, ShuttleworthE C

Memory impairment

Fluctuations in dopamine levels were found to impair memory in Parkinson's disease patients, suggesting that consistent dopamine levels are important for memory function.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

17.

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

18.

Comprehensive assessment of levodopa-carbidopa intestinal gel for Turkish advanced Parkinson’s disease patients

Author: Sücüllü KaradağYeşim, SaltoğluTuğçe, Erdoğan KüçükdağliFadime, ÖztürkÖmer, KöseoğluHasan Tankut, AltiparmakEmin

PD management
Adverse events

Levodopa-carbidopa intestinal gel is effective for managing advanced Parkinson’s disease, but it has frequent adverse events.

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

Language : English

19.

Parkinson's disease treated with Sinemet or Madopar. A controlled multicenter trial.

Author: PakkenbergH, Birket-SmithE, DupontE, HansenE, MikkelsenB, PresthusJ, RautakorpiI, RimanE, RinneU K

Equal efficacy
Gastrointestinal side effects
Involuntary movements

In a triple-blind trial, 92 patients with Parkinson's disease were randomly assigned to receive either levodopa + benserazide or levodopa + carbidopa. Both treatments were equally effective in reducing Parkinsonian symptoms. However, gastrointestinal side effects and involuntary movements were significantly higher and more severe in patients receiving levodopa + carbidopa.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
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.

Language : English

21.

The effect of an increased ratio of carbidopa to levodopa on the pharmacokinetics of levodopa.

Author: KaakkolaS, MännistöP T, NissinenE, VuorelaA, MäntyläR

Decreased dopac excretion
Increased levodopa AUC
Increased levodopa excretion
Increased levodopa half-life
Reduced side effects

Increasing the ratio of carbidopa to levodopa in 11 healthy subjects led to increased levodopa levels, longer half-life, and decreased dopac excretion. This suggests a potential benefit with fewer side effects, warranting further clinical studies.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
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.

Language : English

22.

Effect of a slow release preparation of levodopa on Parkinson's disease in combination with a peripheral decarboxylase inhibitor.

Author: SaarinenA, MyllyläV V, TokolaO, HokkanenE

Higher levodopa tolerance
Improved parkinsonian signs

A slow release levodopa preparation helped to reduce fluctuations in plasma levodopa levels and improve parkinsonian signs in patients whose earlier therapy had proved inadequate.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

23.

Apomorphine in the treatment of Parkinson's disease: a review.

Author: PessoaRenata Ramina, MoroAdriana, MunhozRenato Puppi, TeiveHélio A G, LeesAndrew J

Control motor symptoms
Optimal motor function

This review summarizes the historical background, structure, mechanism of action, indications, contraindications, and side effects of apomorphine, a dopamine agonist used as rescue therapy for Parkinson's disease. The review compares apomorphine infusion therapy with other treatments and provides practical instructions on how to initiate treatment.

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

24.

Treating the Motor Symptoms of Parkinson Disease.

Author: MorganJohn C, FoxSusan H

Parkinson's treatment

This article provides a guide to the various pharmacologic and nonpharmacologic treatment options for the motor symptoms of Parkinson's disease (PD). The article discusses different medication classes and their benefits and risks, as well as non-pharmacological therapies such as physical therapy and speech therapy.

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

25.

[Aggravation of Parkinson's disease after inadequate use of levodopa in controlled-release preparations].

Author: MateoD, DobatoJ L, Giménez-RoldánS

Disease acceleration
Dyskinesia
Dystonia

Levodopa/carbidopa controlled-release preparations may worsen Parkinson's disease symptoms, including disease progression, dyskinesias, and akinetic off periods, even with increased levodopa doses.

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : Spanish

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