What is the role of levodopa and dopamine agonists in the management of Parkinson-plus syndromes?

Updated: Sep 24, 2018
  • Author: Stephen M Bloomfield, MD; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Answer

In general, patients with Parkinson-plus syndromes do not tolerate dopamine agonists well. The mainstay is a trial of levodopa at doses higher than those commonly used in Parkinson disease. A typical regimen begins with carbidopa/levodopa 25/100 twice daily, with the dose increased by 0.5-1 tablet every week to a target daily dose of approximately 1000 mg of levodopa.

If adverse effects occur at any point in the titration, lower the dose and reassess the plan. Although most patients do not have a positive response, some may respond to high doses, with reduced rigidity, easing of transfers, or mild improvements in balance or gait. If high doses of levodopa do not help the patient, gradually lower the dose with an aim to discontinue the medication. Some patients may find that a low dose helps them stay mobile or improve rigidity, and this dose can be maintained. The patient and caregiver should have easy access to the physician during the trial of levodopa.


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