title: Optimization of levodopa therapy.
abstract: While there is no single correct starting dose for levodopa therapy, many individuals can be started on either the 25/100 or controlled-release formula, following the general rule not to attempt to titrate carbidopa-levodopa to the point of "normality," which can lead to toxicity. The physician should also determine the proper use of any adjunctive medications; such combined therapy has become the standard approach to treatment. Following the initial period of therapy, emerging difficulties require a reassessment of therapeutic approaches, such as dosage adjustment or introduction of a dopamine agonist. Other possible adverse effects--such as gastrointestinal disorders, orthostatic hypotension, levodopa-induced psychosis, sleep disturbances or parasomnias, or drug interactions--also require carefully monitored individual treatment. Nonpharmacologic concerns can help the Parkinson's disease patient achieve and maintain optimal functioning, including daily exercise, physical therapy, and involvement with support groups.
authors.affiliation: Section of Neurology, University of Nebraska Medical School, Omaha 68198-2045.
authors.forename: R
authors.initials: R
authors.lastname: Pfeiffer
mesh_terms: D000978:Antiparkinson Agents / Q000627:therapeutic use; D002230:Carbidopa / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D007024:Hypotension, Orthostatic / Q000139:chemically induced; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001523:Mental Disorders / Q000139:chemically induced; D012893:Sleep Wake Disorders / Q000139:chemically induced
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa; D002230:Carbidopa