From the FDA Drug Label
If general anesthesia is required, carbidopa and levodopa orally disintegrating tablets may be continued as long as the patient is permitted to take fluids and medication by mouth. If therapy is interrupted temporarily, the patient should be observed for symptoms resembling NMS, and the usual daily dosage may be administered as soon as the patient is able to take oral medication. Sporadic cases of hyperpyrexia and confusion have been associated with dose reductions and withdrawal of carbidopa and levodopa. Patients should be observed carefully if abrupt reduction or discontinuation of carbidopa and levodopa orally disintegrating tablets is required, especially if the patient is receiving neuroleptics.
Parkinson's drugs, such as levodopa, should be temporarily stopped in the following situations:
- General anesthesia: The drug may be continued if the patient can take fluids and medication by mouth.
- Abrupt reduction or discontinuation: Patients should be observed carefully, especially if they are receiving neuroleptics, due to the risk of hyperpyrexia and confusion or neuroleptic malignant syndrome (NMS) 1.
- Significant daytime sleepiness or episodes of falling asleep during activities: Consider discontinuing the drug to avoid harm 1.
From the Research
Parkinson's medications should be temporarily stopped in specific situations to prevent complications, such as before surgery requiring general anesthesia, when experiencing severe side effects, during certain medical tests, or when starting medications that interact dangerously with Parkinson's drugs. These situations include before surgery requiring general anesthesia (typically stopped 12-24 hours before and resumed as soon as possible after), when experiencing severe side effects like hallucinations or psychosis, during certain medical tests like some MRI procedures requiring contrast agents, or when starting medications that interact dangerously with Parkinson's drugs (particularly MAO inhibitors with levodopa) 2. Common Parkinson's medications that might need temporary discontinuation include levodopa/carbidopa (Sinemet), dopamine agonists (pramipexole, ropinirole), MAO-B inhibitors (selegiline, rasagiline), and COMT inhibitors (entacapone) 3. However, abrupt discontinuation can trigger severe symptoms including the potentially life-threatening Parkinson hyperpyrexia syndrome, characterized by fever, confusion, muscle rigidity, and elevated creatine kinase 4. Therefore, medication changes should always be supervised by a healthcare provider who can create a tapering schedule if needed and monitor for withdrawal effects 5. Patients should never stop these medications independently without medical guidance. Some key considerations for managing Parkinson's disease and its treatment include the use of COMT inhibitors, such as entacapone and opicapone, which can help reduce motor fluctuations and improve quality of life 2. Additionally, dopamine agonists and MAO-B inhibitors can be effective in managing motor symptoms and reducing the risk of dyskinesia 6. Overall, the management of Parkinson's disease requires careful consideration of the potential benefits and risks of different treatments, as well as close monitoring and supervision by a healthcare provider.