Reconsideraciones en el tratamiento de la enfermedad de Parkinson con levodopa: evidencias farmacodinámicas

Abstract

To review the current literature on the use of levodopa in the treatment of Parkinson's disease (PD), with an emphasis on pharmacodynamical aspects. Levodopa has been used successfully for treatment of PD since its discovery, being still the drug of choice. It has shown decreasing motor disability and reduce mortality in PD patients, however, still maintains long-term problems, particularly in relation to the motor response, the onset of dyskinesias and apparent neurotoxicity. The pharmacodynamical evidence indicates that pharmacological effects such as short-term response (SDR) and the long-term response (LDR) are an integral part of the therapeutic response to levodopa. Both responses have pharmacodynamical changes in time and its effects are expressed in terms of amplitude, duration and onset latency of pharmacological action. Investigations in this area, show that LDR would the expression of the physiological release of dopamine, and the treatment of PD should be based on LDR and its pharmacological characteristics. The pharmacodynamics of levodopa is complex. However, the available evidence suggests that a therapeutic strategy based on the use of the LDR is better than those based on the control of the SDR. The knowledge of the pharmacological characteristics of levodopa is central to the therapeutic decision, which should be effective in reducing symptoms and have minimal side effects.