Optimising levodopa therapy for the management of Parkinson's disease

Levodopa remains unrivalled in providing symptomatic benefit for the treatment of Parkinson's disease (PD). However, wearing-off and dyskinesia have been associated with chronic therapy using traditional levodopa formulations. The onset of these motor complications arises, in part, due to the limited pharmacokinetic profile of traditional levodopa and not as a direct consequence of levodopa per se. Clinical trials addressing these issues have suggested that providing less pulsatile and more continuous dopaminergic stimulation by improving the pharmacokinetic profile of levodopa may overcome the onset of these motor complications. It can, therefore, be suggested that the onset of dyskinesia may be prolonged if levodopa is administered in a more continuous manner by administering it as a combination of levodopa/DDCI and COMT inhibitor.