Comparison of standard carbidopa-levodopa and sustained-release carbidopa-levodopa in Parkinson's disease: pharmacokinetic and quality-of-life measures.
We compared clinical, pharmacokinetic, and quality-of-life measures in patients with Parkinson's disease (PD) who were on standard carbidopa-levodopa (Std-L) and after conversion to sustained-release carbidopa-levodopa 50/200 (L-CR). A total of 20 PD patients with motor fluctuations participated in the study and 18 completed it. There were 10 women and eight men, with a mean age of 67.5 years and a mean disease duration of 9.9 years. All patients underwent 10-h pharmacokinetic and clinical evaluations while on Std-L and again while on L-CR. The patients maintained diaries for 2 days before the 10-h evaluations and completed a sickness impact profile (SIP) while on Std-L and again while on L-CR. The total daily levodopa intake was significantly greater with L-CR because of the reduced bioavailability of the L-CR. The mean daily levodopa dosage was 569 mg for Std-L compared with 751 mg for L-CR. The patients performed better in walking time, Unified Parkinson's Disease Rating Scale (motor score), and tapping total with L-CR, although the improvement was not statistically significant. There was no significant difference in dyskinesias between the two preparations. The plasma levodopa levels and the areas under the curve were significantly greater with L-CR. "On" time as measured by patient diaries was significantly greater for L-CR. There was no significant difference in the total SIP scores for patients on the two preparations, but patients had significantly better home management and mobility while on L-CR. In conclusion, L-CR resulted in more "on" time with greater plasma levodopa levels, which resulted in better home management and mobility.
Pahwa
R
R
Department of Neurology, University of Kansas Medical Center, Kansas City 66160, USA.
Lyons
K
K
McGuire
D
D
Silverstein
P
P
Zwiebel
F
F
Robischon
M
M
Koller
W C
WC
D000203:Activities of Daily Living; D000368:Aged; D000704:Analysis of Variance; D000978:Antiparkinson Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D019540:Area Under Curve; D002230:Carbidopa / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007980:Levodopa / Q000493:pharmacokinetics / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D016555:Matched-Pair Analysis; D009048:Motor Skills / Q000187:drug effects; D010300:Parkinson Disease / Q000188:drug therapy* / Q000378:metabolism; D011788:Quality of Life; D018434:Sickness Impact Profile
D000978:Antiparkinson Agents; D003692:Delayed-Action Preparations; D007980:Levodopa; D002230:Carbidopa