Levodopa

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

  1. abdominal pain
  2. abnormal dreams
  3. agitation
  4. agranulocytosis
  5. akathisia
  6. akinesia
  7. alopecia
  8. angioedema
  9. anorexia
  10. anxiety
  11. asthenia
  12. ataxia
  13. back pain
  14. blepharospasm
  15. blurred vision
  16. bronchospasm
  17. bullous rash
  18. chest pain (unspecified)
  19. confusion
  20. constipation
  21. cough
  22. delirium
  23. depression
  24. diarrhea
  25. diplopia
  26. dizziness
  27. drowsiness
  28. dysgeusia
  29. dyskinesia
  30. dyspepsia
  31. dysphagia
  32. dyspnea
  33. dystonic reaction
  34. edema
  35. elevated hepatic enzymes
  36. euphoria
  37. fatigue
  38. flatulence
  39. flushing
  40. GI bleeding
  41. glycosuria
  42. hallucinations
  43. headache
  44. hematuria
  45. hemolytic anemia
  46. hiccups
  47. hoarseness
  48. hot flashes
  49. hyperbilirubinemia
  50. hyperhidrosis
  51. hypersalivation
  52. hypertension
  53. hypotension
  54. impulse control symptoms
  55. increased urinary frequency
  56. infection
  57. insomnia
  58. involuntary movements
  59. leukopenia
  60. malaise
  61. memory impairment
  62. muscle cramps
  63. mydriasis
  64. myocardial infarction
  65. myoclonia
  66. nausea
  67. neuroleptic malignant syndrome-like symptoms
  68. nightmares
  69. ocular hypertension
  70. orthostatic hypotension
  71. palpitations
  72. paranoia
  73. paresthesias
  74. peptic ulcer
  75. peripheral neuropathy
  76. pharyngitis
  77. phlebitis
  78. priapism
  79. proteinuria
  80. pruritus
  81. psychosis
  82. purpura
  83. rash
  84. restlessness
  85. seizures
  86. sinus tachycardia
  87. skin cancer
  88. skin laceration
  89. sudden sleep onset
  90. suicidal ideation
  91. syncope
  92. teeth grinding (bruxism)
  93. thrombocytopenia
  94. tremor
  95. trismus
  96. urinary incontinence
  97. urinary retention
  98. urine discoloration
  99. urticaria
  100. vitamin B6 deficiency
  101. vomiting
  102. weight gain
  103. weight loss
  104. 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
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