Early morning akinesia in Parkinson's disease: effect of standard carbidopa/levodopa and sustained-release carbidopa/levodopa.
We examined the effects of supplemental standard carbidopa/levodopa (Std-L) on early morning akinesia in patients with Parkinson's disease (PD) who were being treated with sustained-release carbidopa/levodopa (L-CR). We compared plasma dopa levels and clinical response in 15 PD patients after a dose of Std-L and L-CR (2 hours later) and after a dose of L-CR and placebo in a double-blind, placebo-controlled, crossover study. Plasma dopa levels, total motor score, walking time, and finger tapping time were assessed every 15 minutes for the first 2 hours and then every 30 minutes for the next 3 hours. The time of onset in clinical benefit was significantly earlier with Std-L (47 minutes, range 15 to 75 minutes) as the first dose as compared with L-CR (58 minutes, range 30 to 105 minutes). Similarly, there was a significant difference in the peak plasma dopa levels (Cmax) and the time to reach peak plasma dopa levels (Tmax) with administration of Std-L (Tmax 36 minutes; Cmax 1,501 micrograms/ml) as compared with L-CR (Tmax 111 minutes, Cmax 1,260 micrograms/ml). There was no significant difference in dyskinesias between the two treatment arms. An initial morning dose of Std-L alleviates the problem of delayed-onset clinical response that commonly occurs with L-CR.
Pahwa
R
R
Department of Neurology, University of Kansas Medical Center, Kansas City 66160-7314, USA.
Lyons
K
K
McGuire
D
D
Dubinsky
R
R
Hubble
J P
JP
Koller
W C
WC
D000368:Aged; D002230:Carbidopa / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D002940:Circadian Rhythm; D018592:Cross-Over Studies; D003692:Delayed-Action Preparations; D004295:Dihydroxyphenylalanine / Q000097:blood; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology* / Q000503:physiopathology*; D010300:Parkinson Disease / Q000150:complications*
D003692:Delayed-Action Preparations; D004338:Drug Combinations; D007980:Levodopa; D004295:Dihydroxyphenylalanine; D002230:Carbidopa