Should levodopa dose be reduced when switched to stalevo?

European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies
Gurutz LinazasoroSpanish Stalevo Study Group

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...Continue Reading

References

Jun 1, 1988·Journal of Neurology, Neurosurgery, and Psychiatry·W R Gibb, A J Lees
Aug 17, 2000·Journal of Neurology, Neurosurgery, and Psychiatry·A SchragN Quinn
Oct 26, 2000·Brain : a Journal of Neurology·A Schrag, N Quinn
Jan 18, 2002·Journal of Neurology, Neurosurgery, and Psychiatry·J MarinusA M Stiggelbout
Jul 24, 2003·Journal of Neurology, Neurosurgery, and Psychiatry·D J BrooksUNKNOWN UK-Irish Entacapone Study Group
Mar 9, 2006·JAMA : the Journal of the American Medical Association·Gilda PiaggioUNKNOWN CONSORT Group
Jul 5, 2006·Annals of Internal Medicine·Sanjay Kaul, George A Diamond

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Citations

Jul 11, 2009·Expert Review of Neurotherapeutics·Lauren C Seeberger, Robert A Hauser
May 8, 2020·Lipids in Health and Disease·Nicolas PouporeThomas I Nathaniel

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