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NERVOUS SYSTEM › ANTI-PARKINSON DRUGS › DOPAMINERGIC AGENTS › Dopa and dopa derivatives
levodopa
N04BA01
Forms & Strengths
- Oral tablets: 100 mg, 250 mg
- Oral capsules: 100 mg, 250 mg
- Carbidopa/levodopa combination tablets: 10/100 mg, 25/100 mg, 25/250 mg
- Carbidopa/levodopa extended-release tablets: 25/100 mg, 50/200 mg
- Carbidopa/levodopa/entacapone combination tablets
- Intestinal gel suspension: 20 mg/mL levodopa with 5 mg/mL carbidopa
Adult Dosing
- Parkinson's disease: Initiate with carbidopa/levodopa 25/100 mg PO TID
- Titrate upward by 1 tablet every 1-2 days as necessary
- Maximum daily dose: 200 mg of carbidopa and 2000 mg of levodopa
- Intestinal gel: Individualized continuous intraduodenal administration via PEG-J
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
- Not recommended for use in children or adolescents under 18 years of age
Indications
- Treatment of idiopathic Parkinson's disease
- Parkinsonism following carbon monoxide intoxication
- Parkinsonism following manganese intoxication
Mechanism of Action
- Metabolic precursor of dopamine
- Crosses the blood-brain barrier and is converted to dopamine by aromatic L-amino acid decarboxylase (DOPA decarboxylase)
- Replenishes depleted striatal dopamine stores in the central nervous system
Contraindications
- Hypersensitivity to levodopa or any component of the formulation
- Concurrent use of non-selective monoamine oxidase (MAO) inhibitors
- Use in patients with narrow-angle glaucoma
- Suspicious undiagnosed skin lesions or a history of melanoma
Adverse Reactions
- Dyskinesias and choreiform movements
- Nausea, vomiting, and anorexia
- Orthostatic hypotension and dizziness
- Psychiatric disturbances including hallucinations, confusion, and depression
- Somnolence and sudden onset of sleep
Drug Interactions
- Non-selective MAO inhibitors (risk of hypertensive crisis)
- Dopamine D2 receptor antagonists and antipsychotics (antagonize therapeutic effects)
- Antihypertensive agents (potentiate orthostatic hypotension)
- Iron salts (may chelate levodopa and decrease gastrointestinal absorption)
Curated Content: Needs Vetting Before Put to Clinical Use