From the Guidelines
Progressive Parkinson's disease patients should be advised to take their levodopa-containing medications at least 30 min before meals and consider a protein-redistribution dietary regimen to maximize levodopa absorption and efficacy. This approach is based on the strongest and most recent evidence, which suggests that dietary protein can interfere with levodopa absorption, leading to reduced efficacy and increased motor fluctuations 1.
Key Considerations
- The protein-redistribution dietary regimen involves consuming a low-protein breakfast and lunch, and a higher protein dinner, to minimize interference with levodopa absorption 1.
- Patients should aim to meet their daily protein requirements, which can be set to 0.8-1.0 g/kg of body weight, while avoiding excessive protein intake that may interfere with levodopa absorption 1.
- Regular monitoring by a neurologist is essential to adjust treatment and dietary regimens as needed to manage motor fluctuations and other symptoms of Parkinson's disease.
Additional Treatment Options
- Dopamine agonists like pramipexole (0.125-1.5mg three times daily) or ropinirole (0.25-8mg three times daily) may be added to the treatment regimen to manage motor symptoms and reduce levodopa dosage 1.
- MAO-B inhibitors such as selegiline (5-10mg daily) or rasagiline (1mg daily) may be used to extend levodopa's effectiveness and manage motor fluctuations 1.
- COMT inhibitors like entacapone (200mg with each levodopa dose) can help manage "wearing-off" symptoms in advanced stages of Parkinson's disease 1.
Non-Pharmacological Interventions
- Physical therapy, occupational therapy, and speech therapy are crucial components of treatment to manage motor and non-motor symptoms of Parkinson's disease 1.
- Regular exercise and physical activity can help improve motor function, balance, and overall quality of life for patients with Parkinson's disease.
From the FDA Drug Label
Parkinson's disease is a progressive, neurodegenerative disorder of the extrapyramidal nervous system affecting the mobility and control of the skeletal muscular system. The FDA drug label does not provide information on how to stop or reverse the progression of Parkinson's disease.
- Key points:
From the Research
Progressive Parkinson's Disease Treatment
- The most efficacious agent for the treatment of motor features of Parkinson's disease is levodopa, but its chronic use is associated with the development of motor complications 5.
- Levodopa combined with carbidopa is still the most effective treatment for symptoms of Parkinson's disease, and dopamine agonists can be used alone before the introduction of levodopa or as an adjunct to levodopa 6.
- The addition of a peripherally-acting COMT inhibitor or an MAO-B inhibitor to levodopa can reduce motor fluctuations in patients with advanced disease 6.
Treatment Options
- Dopamine agonists, such as pramipexole and ropinirole, are less likely to cause motor fluctuations and dyskinesias but are not as efficacious for control of motor symptoms as levodopa 5.
- Monoamine oxidase type B inhibitors (MAOBI) can be used as initial treatment for Parkinson's disease and have been shown to be at least as effective as dopamine agonists 7.
- Deep brain stimulation is an option for patients with levodopa-induced motor complications and relatively intact cognition 6.
Pharmacokinetics and Pharmacodynamics
- Long-term application of oral levodopa/decarboxylase inhibitor formulations can lead to fluctuations of movement and impair human methylation capacity, increasing oxidative stress 8.
- Inhibition of monoamine oxidase-B reduces generation of oxidative stress in the brain, and constraint of catechol-O-methyltransferase reduces homocysteine synthesis due to diminished consumption of methyl groups for levodopa turnover 8.
Initial Treatment
- The decision of when to initiate treatment is based on the patient's level of disability, and the choice of a specific drug is sometimes dictated by the patient's symptoms 9.
- Patient education and counseling concerning prognosis, future symptoms, future disability, and treatment are essential before initiating pharmacologic treatment 9.