Abstract
Levodopa continues to be the most efficacious and widely used treatment for Parkinson’s disease. Levodopa dosing is understood to be critical for the optimal control of symptoms, and increasing the levodopa dose is a common method to treat advancing disease. Escalating levodopa dosages coupled with disease progression is associated with increasing likelihood of developing levodopa-induced dyskinesia. Moreover, frequent and complicated dosing schemes, combined with limited dose availability, leads to increasing pill burden and its associated impairment of patient adherence issues. Levodopa/carbidopa/entacapone has been shown to improve the pharmacokinetic profile of levodopa and provide superior symptomatic control compared with conventional levodopa/dopa decarboxylase inhibitor therapy. We report four case histories describing clinical experience of using levodopa/carbidopa/entacapone 200/50/200 mg, one of the latest doses of this formulation, in a range of patients with Parkinson’s disease. These cases illustrate that levodopa/carbidopa/entacapone 200/50/200 mg provides improvements in symptomatic control and convenience, and that switching to this dose was not associated with safety concerns.
Highlights
After 40 years, levodopa remains the most efficacious and widely used treatment for Parkinson’s disease (PD), with the majority of patients requiring levodopa therapy at some point during the course of their disease [1,2,3]
Levodopa/carbidopa/entacapone has been shown to improve the pharmacokinetic profile of levodopa and provide superior symptomatic control compared with conventional levodopa/dopa decarboxylase inhibitor therapy
Conventional levodopa formulations are most commonly administered with a dopa decarboxylase (DDC) inhibitor (DDCI), such as benserazide (Madopar®) or carbidopa (Sinemet®) [6,7]
Summary
After 40 years, levodopa remains the most efficacious and widely used treatment for Parkinson’s disease (PD), with the majority of patients requiring levodopa therapy at some point during the course of their disease [1,2,3]. The patient experienced wearing-off, characterized by a return of tremor and restlessness, sweating and anxiety Based on both the physician’s and the patient’s assessment, treatment was switched to one LCE 200 tablet five times per day (levodopa 1000 mg/day), with the aim of improving convenience and compliance. Male 69 14 OFF 3/ON 2.5 12 Dyskinesia, wearing-off, delayed ON time, morning akinesia Yes Yes No. AEs, adverse events; LCE 200, levodopa/carbidopa/entacapone 200/50/200 mg. The patient experienced significant OFF time after his 07:00 and 14:00 dose, almost every day, and physical examination elicited some dyskinesias For these reasons, the patient’s treatment was switched to LCE (a total of 1000 mg levodopa/day), administered as a combination of LCE 150 and LCE 200, divided into six doses as follows: LCE 200 at 07:00 and 14:00, LCE 150 at 05:00, 12:00, 17:00, and 21:00. The patient reports a significant improvement in ON time, with no worsening of dyskinesias
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