All Your Questions About Levodopa for Parkinson's Disease, Answered
1. What is levodopa?
Levodopa is a medication that helps counteract the shortage of dopamine in the brain that’s associated with Parkinson's disease. Levodopa, which doesn't actually contain dopamine, is a chemical that's converted into dopamine in the brain.
Levodopa is usually prescribed as a combination therapy with the drug carbidopa, which prevents the chemical from being broken down before it gets to the brain. The combination therapy allows you to get more benefits from levodopa with fewer side effects.
2. How is levodopa taken?
Most people take levodopa as tablets or capsules, some of which are slow-release formulations; some are swallowed with water, and some dissolve in your mouth.
While you should never crush or divide doses, if you have trouble swallowing pills, talk to your doctor about emptying the contents of your capsule into a spoonful of something youcanswallow, like applesauce. Depending on what form of the medication you’re prescribed, you may need to take anywhere from two to five doses a day.
3. What are the benefits of levodopa?
"Without question, levodopa is the most potent medication for the motor symptoms of Parkinson's disease," says Alex Pantelyat, MD, a neurologist who is the director of the Johns Hopkins Atypical Parkinsonism Center in Baltimore. "Nothing else comes close."
When levodopa was first developed in the 1960s, it was a breakthrough in the treatment of the disease, according to the Parkinson’s Foundation. Even today, it's considered the most effective drug for controlling the motor symptoms of Parkinson's, including tremors, stiffness, and slow movement thought to be caused by a lack of dopamine in the brain.
4. What are the downsides or side effects of levodopa?
While levodopa can be highly effective at treating Parkinson's symptoms, it can have side effects, including nausea, vomiting, loss of appetite, light-headedness, confusion, and dyskinesia, or uncontrolled movements.
Dyskinesia is estimated to affect about half of people who take levodopa for five years, according to a research review published in 2012 in theJournal of Parkinson’s Disease, but Dr. Pantelyat says that lower doses of the medication (below 600 milligrams a day) are not associated with dyskinesias.
In addition, dyskinesia isn’t a side effect of levodopa “in the traditional sense," Pantelyat says. Rather, it’s is a symptom of the disease progression. For example, he says, think of your body as if it were a car: With or without the drug, Parkinson's disease creates a dysregulation between the gas and brakes — that is, extra movement (dyskinesia) or not enough movement (tremor or slowness). As their disease worsens, people with Parkinson’s can need more levodopa to manage their tremors or slowness.
"For most people, too much ‘brake’ is much more of a problem as far as quality of life," says Pantelyat. "It takes a tremendous amount of dyskinesia for patients to notice it and feel like quality of life is affected."
5. How should I manage dyskinesia? What are some steps that I can take?
The main way to manage dyskinesia is to work with your doctor to find the right dose and combination of medications to keep your dopamine levels as steady as possible.
When you start taking levodopa, your doctor will usually prescribe a low dose and gradually increase it, stopping when it becomes effective. (The goal is to take as little levodopa as possible.) While it may be tempting to skip doses in order to avoid side effects, it's important to stick with the dosing schedule recommended by your doctor.
As the disease progresses, your doctor may prescribe different medications in addition to levodopa to decrease what’s known as "off times": occasions when the drug wears off and Parkinson's symptoms reemerge. If those medications don’t work, or stop working, your doctor may propose more advanced therapies, including a type of brain surgery called deep brain stimulation.
6. Are there any special dietary precautions I should take while using levodopa?
There are some important ways in which your diet can affect how levodopa works in your body — for example, taking it with a meal may help minimize side effects like nausea.
For some people, eating protein like meat, dairy, and legumes can interfere with the way the body absorbs the drug. If that's true for you, talk to your doctor about meal-timing strategies to maximize absorption while minimizing uncomfortable side effects. You might plan to eat, say, 30 to 60 minutes before or after taking your medication, or you might take it with a low-protein snack.
7. Should I wait until I’m older to take levodopa? How do I know when to start?
While doctors used to believe that starting levodopa earlier in the course of Parkinson’s accelerated the development of dyskinesia, that thinking is now outdated, says Pantelyat. Delaying treatment, he says, “will not be the primary reason for developing dyskinesia.”
As with any drug or therapy, the decision to take levodopa is a personal choice. To manage your Parkinson's symptoms, work closely with your doctor and weigh the side effects and benefits.
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