From the Guidelines
Madopar (Levodopa/Benserazide) is a crucial medication in the treatment of Parkinson's disease, but its use should be carefully managed due to potential metabolic effects and nutritional implications, as highlighted in the 2018 espen guideline clinical nutrition in neurology 1. The use of levodopa, a component of Madopar, may be associated with impaired nutritional status and risk for malnutrition, with increasing doses related to increased risk for malnutrition 1. Key considerations for the use of Madopar include:
- Potential for weight loss, particularly in women, and reduction in body fat mass 1
- Association between nutritional risk and levodopa use, with higher doses potentially contributing to weight loss and metabolic changes 1
- Metabolic effects, including disturbance of lipid and carbohydrate metabolism, reduction in muscle glucose uptake, and potential induction of glucose intolerance 1
- Hyperhomocysteinemia, which may be dependent on vitamin B status and require supplementation to maintain normal homocysteine levels 1 In clinical practice, the standard starting dose of Madopar is typically 50/12.5 mg (levodopa/benserazide) three times daily, gradually increasing as needed under medical supervision to an optimal therapeutic dose, usually 100/25 mg three to four times daily 1. It is essential to monitor patients regularly for potential side effects, including nausea, vomiting, and orthostatic hypotension, and to adjust dosing frequency or formulation as needed to maintain consistent symptom control 1. Regular follow-up with a healthcare provider is crucial to manage potential side effects and ensure the optimal use of Madopar in the treatment of Parkinson's disease.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Mechanism of Action Parkinson’s disease is a progressive, neurodegenerative disorder of the extrapyramidal nervous system affecting the mobility and control of the skeletal muscular system. Its characteristic features include resting tremor, rigidity, and bradykinetic movements. Symptomatic treatments, such as levodopa therapies may permit the patient better mobility Current evidence indicates that symptoms of Parkinson’s disease are related to depletion of dopamine in the corpus striatum. Administration of dopamine is ineffective in the treatment of Parkinson’s disease apparently because it does not cross the blood-brain barrier However, levodopa, the metabolic precursor of dopamine, does cross the blood-brain barrier, and presumably is converted to dopamine in the brain. This is thought to be the mechanism whereby levodopa relieves, symptoms of Parkinson’s disease INDICATIONS AND USAGE Carbidopa and levodopa orally disintegrating tablets are indicated in the treatment of Parkinson’s disease, post-encephalitic parkinsonism, and symptomatic parkinsonism that may follow carbon monoxide intoxication or manganese intoxication.
The role of Madopar (Levodopa/Benserazide) in the treatment of Parkinson's disease is to increase the availability of levodopa in the brain, which is then converted to dopamine, thereby relieving symptoms of the disease 2. Levodopa therapies, such as Madopar, may permit patients better mobility by increasing dopamine levels in the brain 2. Benserazide is a decarboxylase inhibitor that, like carbidopa, prevents the conversion of levodopa to dopamine outside the brain, allowing more levodopa to reach the brain and be converted to dopamine. The key points are:
- Levodopa crosses the blood-brain barrier and is converted to dopamine in the brain
- Benserazide inhibits decarboxylation of levodopa outside the brain, increasing its availability for transport to the brain
- Madopar (Levodopa/Benserazide) is used to treat Parkinson's disease by increasing dopamine levels in the brain 2 2
From the Research
Role of Madopar (Levodopa/Benserazide) in Parkinson's Disease Treatment
Madopar, a combination of Levodopa and Benserazide, plays a significant role in the treatment of Parkinson's disease. The key aspects of its role are:
- Most Effective Medication: Levodopa, a component of Madopar, is considered the most effective medication available for treating the motor symptoms of Parkinson's disease 3, 4, 5, 6.
- First-Line Therapy: Levodopa is often used as first-line therapy for Parkinson's disease, especially in cases where symptoms are prominent 4.
- Management of Motor Complications: Madopar can help manage motor complications such as end-of-dose wearing-off and dyskinesias, which are common in chronic levodopa treatment 7.
- Combination Therapy: Madopar can be used in combination with other medications, such as Monoamine Oxidase-B (MAO-B) inhibitors, catechol-O-methyltransferase (COMT) inhibitors, or dopamine agonists, to manage motor fluctuations and dyskinesias 7, 3, 5, 6.
- Personalized Management: The treatment goals for Parkinson's disease vary from person to person, emphasizing the need for personalized management, which may include Madopar as part of the treatment regimen 4.