About 90,000 people in the US are diagnosed with Parkinson’s disease each year...and you’ll need to sort through carbidopa/levodopa options.
Carbidopa/levodopa is the most effective option for tremor, rigidity, or slow movement...and often one of the first meds prescribed.
And we know the variety of formulations and dosages make this med rife for errors during transitions of care.
Use this table to see how oral carbidopa/levodopa products stack up.
During med histories, document exact formulations (immediate-release versus extended-release, etc) and home administration times.
Ensure carbidopa/levodopa is continued on admission. In rare cases, abruptly stopping these can lead to symptoms that resemble neuroleptic malignant syndrome.
Do NOT default to standard med admin times...use the patient’s home schedule. Small changes in dose timing may worsen symptoms.
Check to see if Parkinson’s meds are on your hospital’s “time-critical” list to help ensure on-time dosing. For example, consider allowing no more than 30 minutes for early or late administration.
Use caution if you switch extended-release Parkinson’s meds to immediate-release...such as for enteral administration. Consider working with neuro...equivalent doses and intervals can be tricky.
Be aware that ER capsules are not interchangeable. For example, Rytary capsules may be opened and the beads sprinkled on food...but Crexont capsules should NOT be opened.
Watch for interactions. For instance, avoid using meds that can worsen Parkinson’s symptoms by blocking dopamine...such as metoclopramide or haloperidol.
Get our resources, Drugs for Parkinson’s Disease and Parkinson’s Disease Therapy, for more on treatment options, cost, and a stepwise approach to treatment.
- Willis AW, Roberts E, Beck JC, et al.; Parkinson’s Foundation P4 Group. Incidence of Parkinson disease in North America. NPJ Parkinsons Dis. 2022 Dec 15;8(1):170.
- Pringsheim T, Day GS, Smith DB, et al. Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary: A Report of the AAN Guideline Subcommittee. Neurology. 2021 Nov 16;97(20):942-957.
- Zimmerman KM, Whitmire N. Parkinson’s disease and other movement disorders. In: Zeind CS, Carvalho MG, editors. Applied Therapeutics: the Clinical Use of Drugs. 11th ed. Philadelphia, PA: Wolters Kluwer Health, 2018: 1246-72.
- Freitas ME, Hess CW, Fox SH. Motor complications of dopaminergic medications in Parkinson’s disease. Semin Neurol. 2017 Apr;37(2):147-157.
- Chart: Drugs for Parkinson’s Disease
- Algorithm: Parkinson's Disease Therapy