title: Optimizing extended-release carbidopa/levodopa in Parkinson disease: Consensus on conversion from standard therapy.
abstract: OBJECTIVE
  To help clinicians optimize the conversion of a patient's Parkinson disease pharmacotherapy from immediate-release carbidopa/levodopa (IR CD/LD) to an extended-release formulation (ER CD/LD).
  
  
  RESULTS
  Eleven movement disorders specialists achieved consensus positions on the modification of trial-based conversion guidelines to suit individual patients in clinical practice.
  
  
  CONCLUSIONS
  Because the pharmacokinetics of ER CD/LD differ from those of IR CD/LD, modification of dosage and dosing frequency are to be expected. Initial regimens may be based on doubling the patient's preconversion levodopa daily dosage and choosing a division of doses to address the patient's motor complications, e.g., wearing-off (warranting a relatively high ER CD/LD dose, possibly at a lower frequency than for IR CD/LD) or dyskinesia (warranting a relatively low dose, perhaps at an unchanged frequency). Patients should know that the main goal of conversion is a steadier levodopa clinical response, even if dosing frequency is unchanged.
authors.affiliation: University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA.
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Espay
authors.affiliation: University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA.
authors.forename: Fernando L
authors.initials: FL
authors.lastname: Pagan
authors.affiliation: University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Walter
authors.affiliation: University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA.
authors.forename: John C
authors.initials: JC
authors.lastname: Morgan
authors.affiliation: University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA.
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Elmer
authors.affiliation: University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA.
authors.forename: Cheryl H
authors.initials: CH
authors.lastname: Waters
authors.affiliation: University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA.
authors.forename: Pinky
authors.initials: P
authors.lastname: Agarwal
authors.affiliation: University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Dhall
authors.affiliation: University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA.
authors.forename: William G
authors.initials: WG
authors.lastname: Ondo
authors.affiliation: University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Klos
authors.affiliation: University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA.
authors.forename: Dee E
authors.initials: DE
authors.lastname: Silver