Controlled-release levodopa/benserazide (Madopar HBS): clinical observations and levodopa and dopamine plasma concentrations in fluctuating parkinsonian patients.
In five levodopa (L-dopa)-treated patients with Parkinson's disease with severe fluctuations of motor performance, plasma L-dopa as well as dopamine levels were measured during 2 days, first under optimal standard L-dopa with peripheral decarboxylase inhibitor (PDI) and then after a dose adjustment period using slow-release L-dopa/benserazide (Madopar HBS) in an open inpatient trial. Three patients benefited from the slow-release preparation; two patients deteriorated with a tendency to have an unpredictable response, a delay to turn "on" with the first dose in the morning, as well as an increase in dyskinesia corresponding to L-dopa cumulation during the day. These problems were subsequently also seen during the follow-up period of 1 year in those patients who benefited from Madopar HBS as inpatients. This might indicate that patient compliance is more difficult with the new formulation. After 1 year all patients had returned to their previous standard L-dopa/PDI treatment. L-Dopa levels continued to fluctuate, but to a lesser degree with Madopar HBS. The equivalent L-dopa dosage had to be increased by 56% (29-100%) with Madopar HBS while mean dopamine levels increased in four patients (by 47-257%) without the occurrence of peripheral side-effects. This implies that with the new formulation more L-dopa is metabolized to dopamine and explains the necessity to increase the equivalent L-dopa dosage.
Ceballos-Baumann
A O
AO
Neurologische Klinik, Universität Heidelberg, Federal Republic of Germany.
von Kummer
R
R
Eckert
W
W
Weicker
H
H
D000368:Aged; D001545:Benserazide / Q000627:therapeutic use*; D002262:Carboxy-Lyases / Q000037:antagonists & inhibitors*; D002986:Clinical Trials as Topic; D003692:Delayed-Action Preparations; D004298:Dopamine / Q000097:blood; D004338:Drug Combinations / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D006834:Hydrazines / Q000627:therapeutic use*; D007980:Levodopa / Q000097:blood / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000097:blood / Q000188:drug therapy*
D003692:Delayed-Action Preparations; D004338:Drug Combinations; D006834:Hydrazines; C005177:benserazide, levodopa drug combination; D007980:Levodopa; D001545:Benserazide; D002262:Carboxy-Lyases; D004298:Dopamine