STANDARD CARBIDOPA-LEVODOPA VERSUS CONTROLLED-RELEASE CARBIDOPA-LEVODOPA IN PARKINSONS-DISEASE - A POSTMARKET ANALYSIS

We evaluated patient acceptance and adverse effects when patients with Parkinson's disease (PD) stabilized on standard carbidopa-levodopa (Std-CL; Sinemet) were converted to controlled-release carbidopa-levodopa (CR-CL; Sinemet CR). The rational for the use of CR-CL is that continuous dopamine stimulation may delay the onset of motor fluctuations. Data were analyzed on 40 patients with PD who were on Std-CL and then were converted to CR-CL. Parkinsonian evaluations were done utilizing the Unified Parkinson's Disease Rating Scale (UPDRS), the Mini-Mental State Examination, and the Hamilton Depression Scale (HDS) while the patients were on Std-CL and following conversion to CR-CL. The median number of daily doses on Std-CL was four; on CR-CL it was two. The daily dose of levodopa during treatment with CR-CL was 29% higher than the dose during the treatment with Std-CL. A statistically significant difference existed in the dosages of Std-CL and CR-CL between stable PD patients and those with motor fluctuations. Statistically significant differences in scores on HDS and on items I, II, and III of UPDRS existed between Stages I-II and III-IV. The difference in adverse effects of CR-CL compared with those of Std-CL was insignificant. Forty percent of patients preferred CR-CL over Std-CL; 37.5% had no preference. Selection of the initial dosage of CR-CL is an important factor m therapeutic management of parkinsonism. The initial dose of CR-CL should be equivalent to 130% of the Std-CL dose. The patient acceptance rate of conversion to CR-CL was high.