More than 50 years after its discovery, levodopa is still the most effective treatment for Parkinson’s, but some people experience “off” periods or dyskinesias with oral medications. Dr. Mark Guttman describes new delivery methods that promise to help with some of these problems, especially for people who have had Parkinson’s for many years. For example, levodopa infusions directly into the gut are currently available, and skin patches and special pills that stay in the stomach and release drug over a period of time are in development. Download
- Parkinson’s Disease: Medications
- Managing Parkinson's Mid-Stride: A Treatment Guide to Parkinson's
- Carbidopa-Levodopa: What Are the Facts?
- How to Manage Parkinson’s “Off” Time?
For all of our Substantial Matters podcast episodes, visit parkinson.org/podcast.
About this episode
Host Dan Keller and Dr. Guttman discuss several levodopa delivery methods that are designed to help reduce “off” time. Everyone’s Parkinson’s journey is unique, so whether these methods are right for you will be a decision for you and your health care team. There is a PD myth that levodopa works for a few years and then stops. This is not true; you just need to work with your doctor to find the right frequency, dosing, and delivery methods. In general, the delivery methods Dr. Guttman describes are for people who have had Parkinson’s for years and experience “on-off” fluctuations.
Here is some more information on many of the topics Dr. Guttman brings up:
- A continuous gel infusion of levodopa is available in the U.S. as Duopa (it is called Duodopa in other countries). This fact sheet has more information on Duopa for you if you are considering it, as well as information for health care providers treating you if you are already on Duopa therapy. Carbidopa is included in the formulation to prevent the nausea that can be caused by levodopa alone.
- What you eat and when can affect the absorption of levodopa. Listen to our nutrition podcast with Dr. Bas Bloem for more information.
- Rytary is carbidopa-levodopa that has both immediate-release and extended-release forms in one pill and is supposed to reduce “off” time. It is not interchangeable with dosages of other carbidopa-levodopa products, so share this Rytary dosing guide with your provider.
- This interview was recorded at the World Parkinson Congress. Dr. Guttman mentions a presentation by Dr. Jay Nutt: Levodopa Over the Last 50 Years: Where We’ve Come and Where We Are Going? (Free registration to watch.)
If you have questions about this or anything else Dr. Guttman mentioned, let us know at Parkinson.org/feedback, and we will provide answers in future podcast episodes.
Mark Guttman, MD
Dr. Guttman is a movement disorder neurologist at the Centre for Movement Disorders in Toronto, Canada. He provides specialized neurological services to people with movement disorders and is involved with clinical research at the Centre and at the University of Toronto.