"pro-levodopa" management approach
Last reviewed 11/2021
The evidence that levodopa accelerates the pathology of Parkinson's disease is not conclusive.
The "pro-levodopa" managment approach is outline below:
- delay drug treatment as long as possible
- introduce levodopa with a decarboxylase inhibitor:
- 100 mg levodopa dose 3-4 times per day may control early disease
- the combination of levodopa with a dopamine agonist may provide control with fewer side-effects:
- a regimen for more advanced disease might comprise:
- levodopa/decarboxylase inhibitor combined 500-800 mg daily in divided doses
- bromocriptine 20 mg, or pergolide 2 mg, or lisuride 2 mg
- the combination of levodope with a COMT inhibitor reduces motor fluctuations:
- entacapone is licensed in the UK
- anticholinergic agents
- amantadine
- apomorphine
levodopa and dopamine decarboxylase inhibitors
dopamine agonists in parkinsonism
catechol-O-methyltransferase inhibitors