1. Pharmacokinetics of levodopa, carbidopa, and 3-O-methyldopa following 16-hour jejunal infusion of levodopa-carbidopa intestinal gel in advanced Parkinson's disease patients.
- Author
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Nyholm D, Odin P, Johansson A, Chatamra K, Locke C, Dutta S, and Othman AA
- Subjects
- Aged, Antiparkinson Agents adverse effects, Antiparkinson Agents blood, Antiparkinson Agents chemistry, Biotransformation, Carbidopa adverse effects, Carbidopa blood, Carbidopa chemistry, Chemistry, Pharmaceutical, Drug Combinations, Female, Gels, Germany, Humans, Infusion Pumps, Intubation, Gastrointestinal instrumentation, Levodopa adverse effects, Levodopa blood, Levodopa chemistry, Male, Middle Aged, Parkinson Disease blood, Parkinson Disease diagnosis, Sweden, Tyrosine blood, Tyrosine pharmacokinetics, Antiparkinson Agents administration & dosage, Antiparkinson Agents pharmacokinetics, Carbidopa administration & dosage, Carbidopa pharmacokinetics, Intestinal Absorption, Jejunum metabolism, Levodopa administration & dosage, Levodopa pharmacokinetics, Parkinson Disease drug therapy, Tyrosine analogs & derivatives
- Abstract
Motor complications of Parkinson's disease (PD) are a consequence of pulsatile dopaminergic stimulation from standard oral levodopa therapy. Levodopa-carbidopa intestinal gel (LCIG) is infused continuously via an intrajejunal percutaneous gastrostomy tube. This was the first study designed to characterize the full pharmacokinetic profiles of levodopa, carbidopa, and levodopa metabolite, 3-O-methyldopa (3-OMD) with 16-h LCIG infusion. Nineteen advanced PD patients (mean age, 65 years) who were on LCIG therapy for ≥30 days were enrolled. Patients received their individualized LCIG infusion doses, and serial pharmacokinetic samples were collected. Eighteen patients completed the study; 19 were assessed for safety. Mean (SD) total levodopa and carbidopa doses were 1,580 (403) and 395 (101) mg, respectively. Mean (SD) C(avg) (μg/mL) were 2.9 (0.84) for levodopa, 17.1 (4.99) for 3-OMD, and 0.22 (0.08) for carbidopa. The degree of fluctuation [defined as (C(max)-C(min))/C(avg)] in levodopa, 3-OMD, and carbidopa plasma concentrations was very low (0.52, 0.21, and 0.96, respectively) during hours 2-16 of infusion. Accordingly, the within-subject coefficients of variation in levodopa, 3-OMD, and carbidopa concentrations were low (13%, 6%, and 19%, respectively). Three patients (16%) reported ≥1 treatment-emergent adverse event; none were considered severe. Continuous intrajejunal LCIG infusion maintained stable plasma levodopa levels over 16 h. Consistent exposure has been shown to reduce motor and nonmotor complications associated with oral medications. LCIG was well tolerated, consistent with previous reports.
- Published
- 2013
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