Modest increase in plasma homocysteine follows levodopa initiation in Parkinson's disease

Movement Disorders : Official Journal of the Movement Disorder Society
Padraig E O'SuilleabhainRamon Diaz-Arrastia

Abstract

Levodopa, typically ingested chronically at high daily doses, is predictably methylated by means of a series of reactions using B vitamins, which convert methionine to homocysteine. Elevated total plasma homocysteine (tHcy), a risk factor for dementia, has been found in PD patients using levodopa. We prospectively measured the effects on plasma tHcy and B vitamins of levodopa initiation, and measured the effects of dose changes and of treatment with dopamine agonists and entacapone. We collected paired plasma samples, at baseline and again after several months treatment, from patients initiating levodopa (n = 30), from patients whose levodopa dose was doubled (n = 15), halved or stopped (n = 14), from patients starting or stopping entacapone (n = 15) and from patients initiating or doubling dopamine agonist monotherapy (n = 16). Vitamin B12, folate, and tHcy concentrations were measured. Baseline tHcy concentration of 8.7 (2.8) micromol/L increased to 10.1 (3.1) micromol/L (P = 0.004) an average of 94 (range 36 to 200) days after initiation of 604 (240 to 1050) mg/day of L-dopa. Average concentration of vitamin B12 fell from 380 to 291 pmol/ L (P = 0.01). Patients who doubled their daily levodopa dose experienced tHcy elevation...Continue Reading

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Citations

Jun 8, 2006·European Journal of Clinical Pharmacology·Thomas Müller, Wilfried Kuhn
May 14, 2010·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Martin NevrlyPetr Hlustik
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Nov 26, 2009·Movement Disorders : Official Journal of the Movement Disorder Society·Seung Hun LeeSun Ju Chung

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