Adverse Reactions to Controlled Release Levodopa/Carbidopa in Older Persons: Case Reports

The use of dopamine agonists in very elderly patients with Parkinson's disease

“…In addition, the prevalence 11,17,18 and incidence 19 of dementia in PD increases with advancing age, increasing the risk of cognitive side effects of antiparkinsonian medications. [6][7][8]20 Altered pharmacodynamic response and age-related physiological changes of elderly patients 21 lend support to the concept that both levodopa and dopamine agonists are more difficult to administer and may be less beneficial in the very elderly. In particular, levodopa has been reported to induce visual hallucinations, delusions, and paranoia more frequently in elderly patients.…”

“…For example, the initial choice between levodopa or dopamine agonist monotherapy in early PD is often based on consideration of the patient's age with agonist monotherapy favored for younger patients and levodopa favored for older patients. [1][2][3] The rationale for avoiding dopamine agonists in the very elderly has included altered drug metabolism, 4,5 an increased risk of adverse effects, [6][7][8][9] increased comorbid conditions, and increased risk of drug interactions. There have been no reports that describe the experience of the very elderly receiving therapy with dopamine agonists.…”

Levodopa-induced dyskinesias detection based on the complexity of involuntary movements

“…DPD subjects were tested during their peak-dose period ON condition when LID symptoms were most prominent (Ghassemi et al, 2006). Testing took place in the afternoon because LID severity tends to increase later in the day due to the buildup of successive doses of levodopa/carbidopa (Joseph et al, 1995;Nutt, 2001). NonDPD subjects were also tested in the "best" ON condition.…”

Adverse Reactions to Sinemet Cr

“…All of the patients (except Patient 1) reported by Joseph et al 1 were given higher than standard doses of carbidopa; that may have more completely inhibited peripheral decarboxylation of Levodopa. Despite taking into account the decreased bioavailability of carbidopa in Sinemet CR compared with Standard Sinemet (60%) as reported by Yeh, 3 it has been shown that the trough plasma levodopa levels achieved with Sinemet CR tend to increase during the day, whereas this does not occur with Standard Sinemet.…”

“…To the Editor: The four case reports presented in a recent article by Joseph et al 1 are interesting and provocative. However, I am concerned that readers of this article may be inadvertently discouraged from using the Sinemet CR formulation in older patients with Parkinson's disease.…”