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Levodopa Brand Names- INBRIJA | Larodopa
What is Levodopa
Levodopa (L-dopa) is an aromatic amine that is metabolized to dopamine. Levodopa is available in an oral inhalation formulation (Inbrija) that is used “as needed” up to 5 times daily for ‘off’ episodes in Parkinson’s patients receiving levodopa/carbidopa.
Oral levodopa formulas are combined with carbidopa (Sinemet, Sinemet CR, Duopa) for treating motor symptoms associated with Parkinson’s disease or parkinsonism.
Levodopa revolutionized the treatment of Parkinson’s disease when it was introduced in the 1960s and it is still considered a first-line treatment option when combined with carbidopa.
Levodopa can significantly decrease motor symptoms, thereby increasing quality of life in patients with Parkinson’s disease.
Due to low bioavailability of levodopa into the CNS, combined use with carbidopa is considered the standard of care due to the ability of carbidopa to increase the amount of levodopa available for transport into the CNS.
Because of various central nervous system effects that may occur during levodopa administration, patients receiving levodopa should be monitored for depression, suicidality, hallucinations, psychosis, and other cognitive or behavioral changes.
Indications
- Parkinson’s disease
For use as intermittent treatment for ‘off’ episodes in those with Parkinson’s disease treated with carbidopa and levodopa
Side Effects
- abdominal pain
- abnormal dreams
- agitation
- agranulocytosis
- akathisia
- akinesia
- alopecia
- angioedema
- anorexia
- anxiety
- asthenia
- ataxia
- back pain
- blepharospasm
- blurred vision
- bronchospasm
- bullous rash
- chest pain (unspecified)
- confusion
- constipation
- cough
- delirium
- depression
- diarrhea
- diplopia
- dizziness
- drowsiness
- dysgeusia
- dyskinesia
- dyspepsia
- dysphagia
- dyspnea
- dystonic reaction
- edema
- elevated hepatic enzymes
- euphoria
- fatigue
- flatulence
- flushing
- GI bleeding
- glycosuria
- hallucinations
- headache
- hematuria
- hemolytic anemia
- hiccups
- hoarseness
- hot flashes
- hyperbilirubinemia
- hyperhidrosis
- hypersalivation
- hypertension
- hypotension
- impulse control symptoms
- increased urinary frequency
- infection
- insomnia
- involuntary movements
- leukopenia
- malaise
- memory impairment
- muscle cramps
- mydriasis
- myocardial infarction
- myoclonia
- nausea
- neuroleptic malignant syndrome-like symptoms
- nightmares
- ocular hypertension
- orthostatic hypotension
- palpitations
- paranoia
- paresthesias
- peptic ulcer
- peripheral neuropathy
- pharyngitis
- phlebitis
- priapism
- proteinuria
- pruritus
- psychosis
- purpura
- rash
- restlessness
- seizures
- sinus tachycardia
- skin cancer
- skin laceration
- sudden sleep onset
- suicidal ideation
- syncope
- teeth grinding (bruxism)
- thrombocytopenia
- tremor
- trismus
- urinary incontinence
- urinary retention
- urine discoloration
- urticaria
- vitamin B6 deficiency
- vomiting
- weight gain
- weight loss
- xerostomia
Monitoring Parameters
- CBC
- LFTs
- neurologic function
Contraindications
- abrupt discontinuation
- asthma
- behavioral changes
- breast-feeding
- cardiac disease
- children
- chronic obstructive pulmonary disease (COPD)
- closed-angle glaucoma
- coadministration with other CNS depressants
- depression
- diabetes mellitus
- driving or operating machinery
- dyskinesia
- ethanol ingestion
- geriatric
- hepatic disease
- hypotension
- impulse control symptoms
- infants
- laboratory test interference
- MAOI therapy
- orthostatic hypotension
- pheochromocytoma
- pregnancy
- psychosis
- pulmonary disease
- renal disease
- suicidal ideation
- surgery
- syncope
Interactions
- Alfentanil
- Amantadine
- Amoxapine
- Amphetamine; Dextroamphetamine Salts
- Angiotensin II receptor antagonists
- Angiotensin-converting enzyme inhibitors
- Atropine
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Atropine; Edrophonium
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- atypical antipsychotic
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Belladonna; Opium
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benzphetamine
- Benztropine
- Beta-blockers
- Bupropion
- Bupropion; Naltrexone
- Calcium-channel blockers
- Cenobamate
- Central-acting adrenergic agents
- Cetirizine
- Cetirizine; Pseudoephedrine
- Chlorpromazine
- Chlorthalidone; Clonidine
- Clonidine
- Cocaine
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Dacarbazine, DTIC
- Darifenacin
- Dexmethylphenidate
- Dextromethorphan; Promethazine
- Dicyclomine
- Doxazosin
- Droperidol
- Enflurane
- Eplerenone
- Epoprostenol
- Esketamine
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Fenfluramine
- Fluphenazine
- food
- Fosphenytoin
- Furazolidone
- Gabapentin
- Glycopyrrolate
- Glycopyrrolate; Formoterol
- Guanabenz
- Guanfacine
- Haloperidol
- Halothane
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hyoscyamine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Iloprost
- Indacaterol; Glycopyrrolate
- Iron
- Iron Salts
- Isocarboxazid
- Isoflurane
- Isoniazid, INH
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Isoproterenol
- Lasmiditan
- Lemborexant
- Levocetirizine
- Linezolid
- Lisdexamfetamine
- Loop diuretics
- Loxapine
- Macimorelin
- Maprotiline
- Mecamylamine
- Meperidine; Promethazine
- Mesoridazine
- Methamphetamine
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methscopolamine
- Methyldopa
- Methylphenidate
- Metoclopramide
- Metyrosine
- Molindone
- Nabilone
- Oxybutynin
- Papaverine
- Perphenazine
- Perphenazine; Amitriptyline
- Phenelzine
- Phenothiazines
- Phenoxybenzamine
- Phenylephrine; Promethazine
- Phenytoin
- Pimozide
- Polysaccharide-Iron Complex
- Potassium-sparing diuretics
- Pramipexole
- Prazosin
- Pregabalin
- Procarbazine
- Prochlorperazine
- Promethazine
- Propantheline
- Propofol
- Pyridoxine, Vitamin B6
- Rasagiline
- Reserpine
- Rotigotine
- Safinamide
- Sapropterin
- Scopolamine
- Selegiline
- Sevoflurane
- Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate
- Solifenacin
- Solriamfetol
- Tedizolid
- Tetrabenazine
- Thiazide diuretics
- Thiethylperazine
- Thioridazine
- Thiothixene
- Tranylcypromine
- Treprostinil
- Tricyclic antidepressants
- Trifluoperazine
- Trihexyphenidyl
- Vasodilators
