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Should levodopa dose be reduced when switched to stalevo?
Eur J Neurol. 2008 Mar; 15(3):257-61.EJ

Abstract

The addition of entacapone to levodopa-carbidopa (LC) or the switch from LC to a tablet containing levodopa-carbidopa-entacapone (LCE) improves the wearing-off phenomenon, increases the 'on' time and decreases the 'off' time, but the appearance or exacerbation of dyskinesias is the more frequent side-effect. Thus, a reduction of the total levodopa dosage would be recommended. However, this could result in a lack of efficacy against the wearing-off. We report on the results of a clinical trial conducted to determine the best way in terms of efficacy, tolerability and safety of switching from LC to LCE in patients with Parkinson's disease (PD) and end of dose wearing-off. 39 patients with PD and wearing-off without or with mild dyskinesias were randomly assigned to either a group receiving the same LC dosage or to a group in which the total LC amount was reduced by 15-25%. Four weeks after the change, both groups showed an increase in daily 'on' time and a reduction in the daily time spent in 'off'. Two patients in each group experienced an increase in basal dyskinesias. No differences in clinical assessment between groups were found. Tolerance was excellent. This study suggests that switching from LC to LCE in patients with mild-to-moderate wearing-off can be done safely with or without reducing the total LD amount, but in the clinical setting it would be more practical to keep the dosage of LC unchanged unless severe dyskinesias are present.

Authors+Show Affiliations

Centro Investigación Parkinson, Policlínica Gipuzkoa, San Sebastián, Spain. glinazasoro@terra.esNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18215153

Citation

Linazasoro, G, et al. "Should Levodopa Dose Be Reduced when Switched to Stalevo?" European Journal of Neurology, vol. 15, no. 3, 2008, pp. 257-61.
Linazasoro G, Kulisevsky J, Hernández B, et al. Should levodopa dose be reduced when switched to stalevo? Eur J Neurol. 2008;15(3):257-61.
Linazasoro, G., Kulisevsky, J., & Hernández, B. (2008). Should levodopa dose be reduced when switched to stalevo? European Journal of Neurology, 15(3), 257-61. https://doi.org/10.1111/j.1468-1331.2007.02047.x
Linazasoro G, et al. Should Levodopa Dose Be Reduced when Switched to Stalevo. Eur J Neurol. 2008;15(3):257-61. PubMed PMID: 18215153.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Should levodopa dose be reduced when switched to stalevo? AU - Linazasoro,G, AU - Kulisevsky,J, AU - Hernández,B, AU - ,, Y1 - 2008/01/22/ PY - 2008/1/25/pubmed PY - 2008/4/4/medline PY - 2008/1/25/entrez SP - 257 EP - 61 JF - European journal of neurology JO - Eur J Neurol VL - 15 IS - 3 N2 - The addition of entacapone to levodopa-carbidopa (LC) or the switch from LC to a tablet containing levodopa-carbidopa-entacapone (LCE) improves the wearing-off phenomenon, increases the 'on' time and decreases the 'off' time, but the appearance or exacerbation of dyskinesias is the more frequent side-effect. Thus, a reduction of the total levodopa dosage would be recommended. However, this could result in a lack of efficacy against the wearing-off. We report on the results of a clinical trial conducted to determine the best way in terms of efficacy, tolerability and safety of switching from LC to LCE in patients with Parkinson's disease (PD) and end of dose wearing-off. 39 patients with PD and wearing-off without or with mild dyskinesias were randomly assigned to either a group receiving the same LC dosage or to a group in which the total LC amount was reduced by 15-25%. Four weeks after the change, both groups showed an increase in daily 'on' time and a reduction in the daily time spent in 'off'. Two patients in each group experienced an increase in basal dyskinesias. No differences in clinical assessment between groups were found. Tolerance was excellent. This study suggests that switching from LC to LCE in patients with mild-to-moderate wearing-off can be done safely with or without reducing the total LD amount, but in the clinical setting it would be more practical to keep the dosage of LC unchanged unless severe dyskinesias are present. SN - 1468-1331 UR - https://www.unboundmedicine.com/medline/citation/18215153/Should_levodopa_dose_be_reduced_when_switched_to_stalevo L2 - https://doi.org/10.1111/j.1468-1331.2007.02047.x DB - PRIME DP - Unbound Medicine ER -