Levodopa use while Breastfeeding

Drugs containing Levodopa: Sinemet, Stalevo, Sinemet CR, Parcopa, Stalevo 200, Stalevo 100, Stalevo 150, Dopar, Larodopa, Stalevo 125, Show all 13 »Atamet, Stalevo 50, Stalevo 75

Levodopa Levels and Effects while Breastfeeding

Summary of Use during Lactation

Limited data indicate that levodopa is poorly excreted into breastmilk and that the sustained-release product may result in a smaller amount of drug transferred to the breastfed infant than with the immediate-release product. Several studies indicate that levodopa can decrease serum prolactin during lactation. The prolactin level in a mother with established lactation may not affect her ability to breastfeed. The effect of long-term use of levodopa on breastfeeding has not been adequately evaluated, although one mother was able to successfully breastfeed her infant without apparent harm while using relatively low doses of levodopa and carbidopa for Parkinson's disease.

Drug Levels

Maternal Levels. One mother with Parkinson's disease took sustained-release levodopa 200 mg and carbidopa 50 mg 4 times daily. At 4.5 months postpartum, milk levodopa levels were measured after a morning dose of the drug. The peak levodopa milk level occurred 3 hours after the dose at a concentration of 315 mcg/L and returned to baseline of about 200 mcg/L 6 hours after the dose. On a different day, the same mother was given a single dose of immediate-release levodopa 200 mg and carbidopa 50 mg. The peak levodopa milk level occurred 3 hours after the dose at a concentration of 683 mcg/L and returned to baseline of about 220 mcg/L 6 hours after the dose. The infant was breastfed and weighed before and after each feeding. The infant ingested 0.127 mg and 0.181 mg of levodopa after maternal intake of the sustained- and immediate-release products, respectively. [1] Using data in the article, the infant would received an average of about 0.3% of the maternal weight-adjusted dosage with the sustained release product and 0.5% of the maternal weight-adjusted dosage with the immediate-release product.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

One mother with Parkinson's disease took sustained-release levodopa 200 mg and carbidopa 50 mg 4 times daily. She successfully breastfed her infant whose development was normal at 2 yr of age.[1]

Effects on Lactation and Breastmilk

Levodopa decreases serum prolactin in normal women and those with hyperolactinemia[2][3][4][5][6][7][8][9][10] and can suppress inappropriate lactation in galactorrhea,[2] although not consistently.[7]

On postpartum day 3, 5 women were given a single oral dose of 500 mg of levodopa or bromocriptine 5 mg followed by a single oral dose of metoclopramide 10 mg 3 hours later. Bromocriptine suppressed basal serum prolactin to a greater extent than levodopa. Over the next 3 hours, serum prolactin increased after metoclopramide in the patients who received levodopa, but not in those who received bromocriptine.[11]

Six women who were 2 to 4 days postpartum but were not nursing were given 500 mg of levodopa orally on one day and 100 mg of levodopa plus 35 mg of carbidopa orally on the next day. Both regimens suppressed basal serum prolactin levels. However, levodopa alone caused an 78% decrease in prolactin while the lower dose combination produced only a 51% decrease. The maximal effect occurred about 2 hours after the dose with both regimens.[6]

Seven women in the first week postpartum who were breastfeeding about 7 times daily were given levodopa 500 mg orally and their serum prolactin responses was studied. The following day, they started carbidopa 50 mg orally every 6 hours for 2 days. On the third day, they received a single dose of carbidopa 50 mg plus levodopa 125 mg orally. Decreases in basal serum prolactin occurred by 30 minutes after the levodopa and afer 45 minutes with the combination. Decreases were maximum at 120 minutes after the dose and were 62% with levodopa alone and 48% with the combination, although the difference between the 2 regimens was not statistically significant.[12]

The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

References

1. Thulin PC, Woodward WR et al. Levodopa in human breast milk: clinical implications. Neurology. 1998;50 :1920-1. PMID: 9633767

2. Ayalon D, Peyser MR et al. Effect of L-dopa on galactopoiesis and gonadotropin levels in the inappropriate lactation syndrome. Obstet Gynecol. 1974;44:159-70. PMID: 4418555

3. Leblanc H, Yen SS. The effect of L-dopa and chlorpromazine on prolactin and growth hormone secretion in normal women. Am J Obstet Gynecol. 1976;126:162-4. PMID: 961756

4. Board JA, Fierro RJ et al. Effects of alpha- and beta-adrenergic blocking agents on serum prolactin levels in women with hyperprolactinemia and galactorrhea. Am J Obstet Gynecol. 1977;127:285-7. PMID: 556882

5. Kaulhausen H, Oney T, Leyendecker G. Inhibition of the renin-aldosterone axis and of prolactin secretion during pregnancy by L-dopa. Br J Obstet Gynaecol. 1982;89:483-8. PMID: 7044409

6. Rao R, Scommegna A, Frohman LA. Integrity of central dopaminergic system in women with postpartum hyperprolactinemia. Am J Obstet Gynecol. 1982;143:883-7. PMID: 7102764

7. Malarkey WB, Jacobs LS, Daughaday WH. Levodopa suppression of prolactin in nonpuerperal galactorrhea. N Engl J Med. 1971;285:1160-3. PMID: 5107027

8. Rapoport B, Refetoff S, Fang VS, Friesen HG. Suppression of serum thyrotropin (TSH) by l-dopa in chronic hypothyroidism: interrelationships in the regulation of TSH and prolactin secretion. J Clin Endocrinol Metab. 1973;36:256-62. PMID: 4630270

9. Refetoff S, Fang VS, Rapoport B, Friesen HG. Interrelationships in the regulation of TSH and prolactin secretion in man: effects of l-dopa, TRH and thyroid hormone in various combinations. J Clin Endocrinol Metab. 1974;38:450-7. PMID: 4205563

10. Masala A, Alagna S, Devilla L et al. Muscarinic receptor blockade by pirenzepine: effect on prolactin secretion in man. J Endocrinol Invest. 1982;5:53-5. PMID: 6808052

11. Nappi C, Mercorio F et al. [Effect of oral administration of metoclopramide on blood levels of prolactin in the puerperium]. Arch Ostet Ginecol. 1981;86:75-85. PMID: 7201788

12. Petraglia F, De Leo V et al. Prolactin changes after administration of agonist and antagonist dopaminergic drugs in puerperal women. Gynecol Obstet Invest. 1987;23:103-9. PMID: 3583091

Levodopa Identification

Substance Name

Levodopa

CAS Registry Number

59-92-7

Drug Class

Antiparkinson Agents

Dopamine Agents

Administrative Information

LactMed Record Number

462

Last Revision Date

20130907

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