Levodopa Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Parkinson's Disease

Initial: 250 to 500 mg orally twice a day with meals.
Maintenance: 3000 to 6000 mg/day in 3 or more divided doses.

Usual Adult Dose for Restless Legs Syndrome

50 mg orally 1 to 2 hours before bedtime (administered with a dopa-decarboxylase inhibitor)

Renal Dose Adjustments

No data available

Liver Dose Adjustments

No data available

Dose Adjustments

Dosage in Parkinson's disease may be titrated in increments not exceeding 750 mg every 3 to 7 days to a daily maximum of 8000 mg. A dose of 8000 mg is usually intolerable.

A rebound episode of restless legs syndrome during the night can be managed with an additional dose of levodopa.

For augmentation of symptoms, over a short period, the dosage may adjusted by increasing the frequency of administration to cover the symptomatic period.

In the case of an increase in rebound episodes or augmentation of restless legs syndrome, the dosage may need to be withdrawn and alternative drug substituted.

Precautions

If levodopa is to be discontinued, gradual dosage reductions are recommended to reduce the risk of sudden worsening of parkinsonism.

Concomitant use of monoamine oxidase inhibitors and levodopa is contraindicated. Monoamine oxidase inhibitors should be discontinued at least two weeks before levodopa is started.

Levodopa is contraindicated in patients with narrow angle glaucoma (and should be used with caution in patients with wide angle glaucoma).

Levodopa may activate malignant melanoma. Levodopa should therefore not be used in patients with a history of melanoma or in patients with suspicious undiagnosed skin lesions.

Pyridoxine hydrochloride (Vitamin B6) rapidly reverses the toxic and therapeutic effects of levodopa. Oral doses of 10 to 25 mg may cause this effect. Caution should therefore be used in recommending pyridoxine-containing vitamins.

Levodopa may cause or worsen certain psychiatric illnesses. Patients should be closely monitored for the development of depression or psychosis.

Levodopa should be administered with caution to patients with pulmonary disease (including reactive airways disease) and renal, hepatic or endocrine dysfunction.

Levodopa should be administered with caution to patients with a history of cardiac disease. In patients with a history of myocardial infarction who have residual atrial, nodal, or ventricular arrhythmias, the manufacturer recommends that initial administration and titration of levodopa occur under close cardiac monitoring in a facility equipped for intensive cardiac care.

Levodopa should be administered with caution to patients with a history of depression or psychosis because it can exacerbate these illnesses.

Levodopa has been reported to cause postural hypotension in some patients and should therefore be used with caution in patients on antihypertensive therapy and in patients for whom postural hypotension may be particularly likely or dangerous.

Levodopa has been reported to increase the frequency of gastrointestinal hemorrhage. Levodopa should therefore be used with caution in patients with a history of peptic ulcer disease or gastrointestinal hemorrhage.

Levodopa therapy should not be discontinued abruptly. Abrupt discontinuation may result in a sudden worsening of parkinsonism or, less frequently, a symptom complex resembling the neuroleptic malignant syndrome.

The manufacturers recommend periodic evaluations of hepatic, hematopoietic, cardiovascular and renal function during extended therapy.

Dialysis

No data available

Other Comments

The administration of levodopa concomitantly with carbidopa is preferred. Administration of a dopamine agonist (bromocriptine or pergolide) is also recommended to reduce the need for such a high levodopa dose. The optimal therapeutic effect may not occur for 3 to 6 months.

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