Treatment of Chronic Parkinson's Disease With Controlled-Release Carbidopa/Levodopa

Practice Parameter: Treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): [RETIRED]

“…The daily dose of levodopa was higher with the sustained release preparation, but there was a significant decrease in the number of doses per day with sustained release. Dyskinesia was only described in one study, 27 which was similar in the sustained release and immediate release groups. The adverse effects of both drugs were the same.…”

“…Four Class III single center, double masked, crossover studies examining 97 total patients failed to demonstrate any difference in off time with sustained release carbidopa/levodopa compared to the immediate release preparation. [26][27][28][29] Baseline characteristics and allocation concealment were not described for any of the studies. The daily dose of levodopa was higher with the sustained release preparation, but there was a significant decrease in the number of doses per day with sustained release.…”

Motor complications in Parkinson disease: Clinical manifestations and management

“…In addition, the initiation of dopamine agonists before the development of wearing off has been shown to delay the onset of motor complications [12,13,88,89]. -Use a sustained-release formulation of levodopa: In clinical trials, sustained-release levodopa has been shown to reduce "off" time by 20-70%, increased the total daily dose of levodopa by 20%, and decrease the number of doses by 30% [90][91][92][93]. Therefore, substituting sustained-release levodopa for the standard formulation will typically add 60-90 min to the "on" time, but the bioavailability of sustained-release levodopa is less than regular levodopa, which may necessitate a dose increase of 20-30% [90].…”

International (NL-UK) double-blind study of Sinemet CR and standard Sinemet (25/100) in 170 patients with fluctuating Parkinson's disease

“…One such preparation of levodopa and carbidopa, Sinemet CR (50 mg carbidopa, 200 mg levodopa), has proven successful at ameliorating motor fluctuations [6,17] and, importantly, has been shown to 236 be safe and as well tolerated as conventional formulations [1, 2, 4, 5,7, 9-11, 14, 16, 18, 19], The clinical efficacy of Sinemet CR has been found to be superior to that of the standard preparation of Sinemet (Sinemet STD; 25 mg carbidopa, 100 mg levodopa) in both open and double blind preliminary studies [1,2,4,5,7,10,11,14,16,18,19].…”