From the Guidelines
Madopar, a combination of levodopa and benserazide, is associated with significant metabolic effects, including weight loss, hyperhomocysteinemia, and impaired nutritional status, particularly with increasing doses and long-term use 1. When considering the use of Madopar for Parkinson's disease treatment, it is crucial to weigh these potential risks against the benefits of improved motor symptom control. Key points to consider include:
- The mechanism of drug-related weight changes is not well understood and requires further investigation 1.
- Higher doses of levodopa, as found in Madopar, have been linked to an increased risk of malnutrition, as assessed by the Mini-nutritional Assessment (MNA) 1.
- Levodopa use may induce metabolic effects, including disturbances in lipid and carbohydrate metabolism, potentially leading to glucose intolerance 1.
- Long-term treatment with levodopa can cause hypersecretion of insulin and growth hormone, and may lead to hyperhomocysteinemia, particularly in patients with lower serum levels of vitamin B12 and folate 1. Given the potential for these significant side effects, it is essential to closely monitor patients on Madopar for signs of malnutrition, weight loss, and metabolic disturbances, and to consider supplementation with vitamins B6, B12, and folate to mitigate the risk of hyperhomocysteinemia 1.
From the Research
Madopar Overview
- Madopar is a medication used in the treatment of Parkinson's disease, specifically for nocturnal and early-morning disabilities 2.
- It is a sustained-release formulation of L-dopa, which is combined with benserazide, a peripherally acting decarboxylase inhibitor.
Efficacy of Madopar
- Studies have shown that Madopar can provide worthwhile improvement in patients with Parkinson's disease, particularly in relieving nocturnal bradykinesia, rigidity, and tremor 2.
- Madopar HBS, a slow-release formulation, has been found to be effective in patients with advanced Parkinson's disease who experience marked fluctuations in symptoms on standard L-dopa treatment 3.
Combination Therapy with Madopar
- The addition of L-deprenil, a selective irreversible inhibitor of monoamine oxidase (M.A.O.) "type B", to Madopar therapy has been found to potentiate the anti-kinetic properties of levodopa 4.
- Combination therapy with Madopar and other medications, such as dopamine agonists or COMT inhibitors, may be used to reduce motor fluctuations in patients with advanced Parkinson's disease 5, 6.