L-Dopa always given with a peripheral decarboxylase inhibitor. Never prescribe L-Dopa alone.
- Check BNF or equivalent for UpToDate prescribing advice
Mode of action
- Increases CNS L-Dopa
- Decarboxylase inhibitor (Carbidopa) prevents the peripheral breakdown of Dopamine
- Parkinson's disease: L-Dopa 50 mg TDS or QDS along with Carbidopa 12.5 mg.
- Titrate dose up to clinical effect. Max L-Dopa is 800 mg/day.
- Divide the doses to try and smooth out the dosing with higher levels when active.
- Madopar 62.5 mg = L-Dopa 50 mg + Carbidopa 12.5 mg
- Cautions in renal and liver failure
- Impulse control disorders with loss of control - involves eating, sexuality, gambling. Patients and carers should be warned
- Dreams, confusion, anorexia, anxiety, depressions, dizziness, euphoria
- Chorea, tremor, dyskinesias, dystonias syncope, psychosis, malaise, cramps
- Sudden onset of sleepiness with driving machinery risks
- Neuroleptic malignant syndrome, leucopenia, Henoch-Schonlein purpura
- Constipation, Nausea, Vomiting, Diarrhoea, dyspepsia, ulcer disease