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(FETT) Dopamine precursors/L-Amino Acid Decarbocylase Inhibitors

FC
von Felix C.

List adverse effects of Carbidopa-Levodopa.

  • Becomes less effective over time: may require a shorter interval between doses

  • Autonomic symptoms

    • Nausea and vomiting

    • Orthostatic hypotension

    • Carbidopa reduces the risk of orthostatic hypotension, nausea, and vomiting.

  • Psychiatric symptoms [6][7]

    • Hallucinations (often visual) and other psychotic symptoms → treat with clozapine

    • Anxiety, insomnia, agitation, and aggressive behavior

    • Increased risk in elderly patients, women, concurrent dementia or other psychiatric disorders (e.g., depression), long duration of levodopa treatment, and high doses

  • Motor fluctuations

    • Hypokinesia

      • End-of-dose akinesia/wearing-off phenomenon

      • Freezing

      • On-off phenomenon: Phases of good mobility (“on” phases) alternate with phases of poor mobility (“off” phases) as a result of reduced reaction to L-DOPA or wearing off of medication.

    • Dyskinesia (hyperkinesia)

      • On-period dystonia

      • Off-period dystonia

      • Diphasic dyskinesias

  • Increased intraocular pressure

    • Open-angle glaucoma: Levodopa (and anticholinergics) should be used with caution.

    • Closed-angle glaucoma: Levodopa (and anticholinergics) are not recommended.

  • Akinetic crisis

    • Definition: condition caused by severe dopamine deficiency (e.g., after discontinuation of L-DOPA therapy or insufficient L-DOPA absorption)

    • Clinical features: complete inability to move , incomprehensible speech, possibly hyperthermia → increased risk of dehydration, deep-vein thrombosis, and pneumonia

    • Treatment: intensive medical care, volume substitution, administration of L-DOPA, apomorphine, amantadine


Author

Felix C.

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