Improvement of the results of the therapy of Parkinson’s disease with the use of the drug levodopa of prolonged action

February 24, 2023
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Approximately 60–80% of patients with Parkinson’s disease (PD) develop motor complications (fluctuations and dyskinesias) caused by levodopa, with 30% developing after only 3 years of treatment. Pulsatile stimulation of receptors is the main mechanism involved in the occurrence of these complications, so it is more appropriate to consider them as a result of the method of administration, rather than as an intrinsic effect of levodopa. Thus, with the development of the disease, its effectiveness decreases due to a short half-life and constant fluctuations in plasma concentration. More stable and longer concentrations of levodopa in plasma compared to other forms is provided by oral extended-release formulation of carbidopa-levodopa. Although the onset of clinical response is slower, it reduces the peak dose responses and «wearing-out» that occurs with conventional carbidopa/levodopa. According to the results of a multicenter, double-blind study, treatment with a long-acting formulation significantly reduced the daily duration of «off» periods and prolonged the «on» phase, providing a significant clinical improvement. At the same time, the frequency with which medicines should be taken, was more lower. Other studies show an improvement in the quality of sleep and long-term maintenance of its effect for years. Moreover, the extended-release formulation is able to prevent the appearance of motor complications. Levodopa of prolonged action is recommended for all stages of PD. In the early phase — as monotherapy, in the late, especially in patients with «exhaustion» phenomena, dyskinesias of peak doses and at night — in combination with other antiparkinson drugs.

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