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SEVERE PARKINSONS Tx: L-DOPA

Neurology

SEVERE PARKINSONS Tx: L-DOPA

1. L-dopa acts as a precursor for dopamine synthesis in the basal ganglia.

2. Carbidopa blocks conversion of L-dopa to dopamine in the periphery, desirable as peripheral dopamine does not cross the BBB & causes autonomic SE.

3. Most effective drug, but delay its use in the young to reduce side-effects.

4. Dopamine receptor agonists (ropinirole, pramipexole, rotigotine) and COMT inhibitors (entacapone) are added to reduce the overall daily dose of L-dopa.

5. SE: postural hypotension, on-off effects (unpredictable therapeutic levels), psychosis (particularly in the elderly).

6. Neuroleptic malignant syndrome - switching L-Dopa causes malignant hyperthermia, delirium, autonomic instability.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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