Levodopa is one of the main drugs used to treat Parkinson's symptoms. It can be used at all stages of the condition.
My Parkinson's nurse has been marvellous – very knowledgeable, encouraging and helpful about medication.
Caroline, diagnosed in 2003
Levodopa is a chemical building-block that your body converts into dopamine. It replaces the dopamine that is lost in Parkinson's.
There are branded and unbranded forms of levodopa available. These include:
- co-beneldopa (Madopar, Madopar CR)
- co-careldopa (Caramet CR, Duodopa, Sinemet, Sinemet Plus, Sinemet CR, Half Sinemet CR, Lecado, unbranded form)
- co-careldopa plus entacapone (Stalevo)
Levodopa is given with benserazide or carbidopa, to make sure it can enter the brain more efficiently. Benserazide plus levodopa is known as co-beneldopa. Carbidopa plus levodopa is known as co-careldopa.
If you're having, or have had, treatment for melanoma, tell your GP, specialist or Parkinson's nurse (if you have one) if you're taking medication that contains levodopa.
Madopar and Sinemet
Most people can take Madopar and Sinemet without experiencing sickness or nausea.
Most people taking these drugs will experience considerable long-term improvement, especially in stiffness and slowness of movement.
Treatment will usually start on a low dose. This is gradually increased until you and your GP, specialist or Parkinson's nurse agree that your symptoms are under control.
Madopar is available in capsules, which should not be broken, or dispersible tablets, which can be dissolved in water.
Sinemet can be taken in pill form.
Both Madopar and Sinemet come in different strengths, depending on the dose your GP, specialist or Parkinson's nurse thinks you need.
Visit the electronic Medicines Compendium (eMC) website for independent, up to date information about these medicines:
Controlled release Madopar and Sinemet
Controlled release preparations have the letters CR after the drug name.
These let the levodopa enter your body slowly instead of all at once. They can increase the time between doses.
They may be used when the dose of standard levodopa starts to wear off and the person taking it no longer feels the treatment is effective.
Controlled release options can sometimes reduce involuntary movements (dyskinesia). They can be taken before going to bed to reduce stiffness during the night.
Madopar has a dispersible form that may be swallowed whole or dissolved in water.
It takes effect more quickly because it doesn't need to be broken down in your stomach to release the active ingredient. This may be a good option if you have problems swallowing tablets or capsules.
Non-dispersible tablets or capsules should not be crushed and put into water.
Duodopa is a gel that is pumped continuously through a tube that is inserted into the intestine, where it is absorbed by the blood.
This option is only suitable for a small number of people, whose symptoms can't be controlled with more common treatments.
Because it's given continuously, if you are prescribed duodopa you are less likely to experience involuntary movements. You might have fewer 'off' periods. And it may also help you control your symptoms at night.
Stalevo combines levodopa with carbidopa and entacapone in one tablet.
See the Stavelo page on the eMC website for independent, up to date information about this medicine.
Levodopa and protein
If I have food and particularly protein, I find that levodopa doesn't work and I experience freezing.
Paul, diagnosed in 2001
Taking levodopa with food can sometimes help to reduce feelings of sickness. However, for some people, protein (found mainly in meat, fish, eggs, cheese and beans) seems to interfere with how well levodopa medication works, by stopping how well the drug is absorbed by the body.
This may mean the drug is less effective if taken with, or after, a protein-rich meal.
Some people may benefit from taking their medication at least 30 minutes before they eat.
If this doesn't help, you may benefit from trying a protein redistribution diet, where you take most of your daily protein in the evening.
This can help the levodopa treatment to be more effective in the daytime, when you are likely to need it more.
As protein is essential for a healthy diet, before you make any changes you should speak to your your GP, specialist or Parkinson's nurse. They can advise you on timing your dose and can help you to get advice from a registered dietitian.
Side effects and problems with levodopa
In the early days of taking levodopa, you may feel sickness or nausea. But in most people this is mild and will pass as your body adjusts to the drug.
One of the main problems with levodopa is a side effect called dyskinesia. These are involuntary movements and can increase over time.
Over time, levodopa can become less effective. You may get 'off' periods where you feel weak and can't move well. The effect of your dose may wear off quickly.
Other side effects include:
- hallucinations and delusions
- mood swings
- psychological changes
- sleepiness, fainting or dizziness
Side effects of levodopa can sometimes be improved by changing your dose, the form of the drug or how often you take it. If this doesn't work, other types of drug may be combined with levodopa.
Speak to your GP, specialist or Parkinson's nurse about the right treatment for you.
Impulsive and compulsive behaviour
Some people taking levodopa have problems controlling impulsive and compulsive behaviour.
Find out more about Parkinson's drugs and impulsive and compulsive behaviour.