Patient-controlled variable dosing of levodopa for Parkinson's disease

Medication for idiopathic Parkinson's disease (PD) is for symptomatic relief, and typically, patients are advised to take their medication at agreed regular times. Here, we present a lady with moderate PD and superimposed anxiety for whom this management strategy did not work well as it increased her anxiety significantly around dosing times. She was switched to an PRN regime and although taking the same total dose of levodopa with similar symptom control was overall much happier. Although there are sound reasons behind regular dosing of levodopa (its short duration of action and relationship of clinical response to plasma concentration), a holistic co-created management plan against classical advice but taking into account the psychological burden of disease and medication may in many cases be more appropriate.