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Sustained-release of levodopa: single dose study of a new formulation

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Summary

Motor fluctuations and dyskinesias in Parkinsonian patients may be at least partially due to fluctuations of levodopa plasma concentrations. Sustained-release (SR) formulations of levodopa may present a promising, effective solution of this problem. Therefore we performed a 4-fold, crossover double-blind trial with a new SR preparation, tested in healthy volunteers (Gerlach et al., 1988) before, in 12 Parkinsonian subjects. Two different dosages of the pure new levodopa SR-preparation, a composition of 70% SR and 30% levodopa immediate release (IR) and a conventional IR levodopa preparation were compared by their pharmacokinetic behaviour and their clinical effects. The relative bioavailability of levodopa in plasma was 69% for the combination of SR and IR levodopa release, for the pure SR formulations (100mg levodopa) 54% and (200 mg levodopa) 55%, compared to the 100% of the standard form of IR release of 100 mg levodopa. In contrast to the conventional IR formulation the pharmacokinetic behaviour of the SR preparations showed no initial sharp peak, but more continuous and longer maintaining plasma concentrations of levodopa. Due to the small numbers of cases and the missing homogenity of the selected patients no statistical significant differences between the four preparations regarding the clinical response were observed. But the described pharmacokinetic behaviour gives hope, that these newly developed SR-preparations may lead to progress in the treatment of Parkinson's disease (prolongation of dosage intervals, reduction of motor fluctuations).

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References

  • Agid Y, Bonnet AM, Ruberg M, Javoy-Agid F (1985) Pathophysiology of L-Dopa-induced abnormal involuntary movements. In: Chase C, Gerlach C (eds) Dyskinesia — research and treatment. Springer, Berlin Heidelberg New York Tokyo, pp 145–159 (Psychopharmacology [Suppl] 2)

    Google Scholar 

  • Benetello P, Furlanut M, Zara G, Baraldo M, Hassan E (1993) Plasma levels of levodopa and its main metabolites in Parkinsonian patients after conventional and controlled-release levodopa-carbidopa associations. Eur Neurol 33: 69–73

    PubMed  Google Scholar 

  • Bergemann N, Baas H, Fischer PA (1994) Slow-release L-dopa vs. standard L-dopa in Parkinson patients in various stages of the disease. Studies of pharmacokinetics and motor effectiveness. Nervenarzt 65: 250–257

    PubMed  Google Scholar 

  • Cedarbaum JM, Breck L, Kutt H, McDowell FH (1987) Controlled-release levodopa/carbidopa II. Sinemet CR 4 treatment of response fluctuations in Parkinson's disease. Neurology 37: 1607–1612

    PubMed  Google Scholar 

  • Chrevoisier CH, Hoevels B, Zurcher G, Da Prada M (1987) Bioavailability of L-Dopa after Madopar HBS administration in healthy volunteers. In: Marsden CD, Rinne UK, Koella WP, Dubius R (eds) (Madopar) HBS. Karger, Basel, pp 36–46 (Eur Neurol 27 [Suppl] 1)

    Google Scholar 

  • Contin M, Riva R, Martinelli P, Cortelli P, Albani F, Baruzzi A (1993) Pharmacodynamic modeling of oral levodopa: clinical application in Parkinson's disease. Neurology 43: 367–371

    PubMed  Google Scholar 

  • England AC, Schwab RS (1956) Postoperative evaluation of 26 selected patients with Parkinson's disease. J Am Geriatr Soc 4: 1219–1232

    PubMed  Google Scholar 

  • Eriksson T, Magnusson T, Carlsson A, Granerus AK (1984) “On-off” phenomenon in Parkinson's disease: correlation to concentration of dopa in plasma. J Neural Transm 59: 229–240

    PubMed  Google Scholar 

  • Evans MA, Triggs EJ, Broe GA, Saines N (1980) Systemic availability of orally administered L-Dopa in the elderly Parkinsonian patient. Eur J Clin Pharmacol 17: 215–221

    PubMed  Google Scholar 

  • Fabbrini G, Mouradian MM, Juncos JL, Schlegel J, Mohr E, Chase TN (1988) Motor fluctuations in Parkinson's disease: central pathophysiological mechanisms, part I. Ann Neurol 24: 366–371

    PubMed  Google Scholar 

  • Fahn S (1974) “On-off” phenomenon with levodopa therapy in parkinsonism. Neurology 24: 431–441

    PubMed  Google Scholar 

  • Gerlach M, Klaunzer N, Przuntek H (1986) Determination of L-Dopa and 3-O-methyl-dopa in human plasma by extraction using C18- cartridges followed by high-performance liquid Chromatographic analysis with electrochemical detection. J Chromatogr 380: 379–385

    Google Scholar 

  • Gerlach M, Gebhardt B, Kuhn W, Przuntek H (1988) Pharmacokinetic studies with sustained-release formulations of levodopa in healthy volunteers. In: Obeso JA, Horowski R, Marsden CD (eds) Continuous dopaminergic stimulation in Parkinson's disease. Springer, Wien New York, pp 211–218 (J Neural Transm [Suppl] 27)

    Google Scholar 

  • Gerlach M, Kuhn W, Przuntek H (1989) Pharmacokinetic investigations of various levodopa formulations. In: Przuntek H, Riederer P (eds) Early diagnosis and preventive therapy in Parkinson's disease. Springer, Wien New York, pp 313–323 (Key Topics in Brain Research)

    Google Scholar 

  • Groppetti A, Flanto C, Parati E, Vescovi A, Ruscioni L, Parenti M (1986) Dopamine receptor changes in response to prolonged treatment with L-Dopa. J Neural Transm [Suppl] 22: 33–45

    Google Scholar 

  • Goetz CG, Tanner CM, Klawans HL, Shannon KM, Caroll VS (1987) Parkinson's disease and motor flutuations: long-acting carbidopa/levodopa (CR-4-Sinemet). Neurology 37: 875–878

    PubMed  Google Scholar 

  • Gundert-Remv UR, Hildebrandt R, Stiehl A, Weber E, Zürcher G, Da Prada M (1983) Intestinal absorption of levodopa in man. Eur J Clin Pharmacol 25: 69–72

    PubMed  Google Scholar 

  • Harder S, Baas H, Bergemann N, Demisch L, Rietbrock S (1995) Concentration-effect relationship of levodopa in patients with Parkinson's disease after oral administration of an immediate release and a controlled release formulation. Br J Clin Pharmacol 39: 39–44.

    PubMed  Google Scholar 

  • Hardie RJ, Lees AJ, Stern GM (1986) Pharmacokinetics of levodopa and motor fluctuations. In: Yahr MD, Bergmann KJ (eds) Parkinson's disease. Raven Press, New York, pp 487–492 (Adv Neurol 45)

    Google Scholar 

  • Hardie RJ, Malcolm SL, Lees AJ, Stern GM, Allen JG (1986) The pharmacokinetics of intravenous and oral levodopa in patients with Parkinson's disease who exhibit on-off fluctuations. Br J Clin Pharmacol 22: 429–436

    PubMed  Google Scholar 

  • Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17: 427–442

    PubMed  Google Scholar 

  • Hutton JT, Morris JL (1992) Long acting carbidopa-levodopa in the management of moderate and advanced Parkinson's disease. Neurology 42 [Suppl 1]: 51–56

    PubMed  Google Scholar 

  • Jenner P, Boyse S, Marsden CD (1986) Effect of repeated L-Dopa administration on striatal dopamine receptor function in the rat. In: Fahn S, Marsden CD, Jenner P, Teychenne P (eds) Recent developments in Parkinson's disease. Raven Press, New York, pp 189–203

    Google Scholar 

  • Juncos JL, Fabbrini G, Mouradian MM, Chase TN (1987) Controlled-release levodopa-carbidopa (CR-5) in the management of Parkinsonian motor fluctuations. Arch Neurol 44: 1010–1012

    PubMed  Google Scholar 

  • Kleedorfer B, Poewe W (1992) Comparative efficacy of two oral sustained-release preparations of L-dopa in fluctuating Parkinson's disease. Preliminary findings in 20 patients. J Neural Transm [P-D Sect] 4: 173–178

    Google Scholar 

  • Kraus PH, Przuntek H (1989) Motor performance test. In: Przuntek H, Riederer P (eds) Early diagnosis and preventive therapy in Parkinson's disease. Springer, Wien New York, pp 75–83 (Key Topics in Brain Research)

    Google Scholar 

  • Kurth MC, Tetrud JW, Irwin I, Lyness WH, Langsten JW (1993) Oral Levodopa/carbidopa solution versus tablets in Parkinson's patients with severe fluctuations: a pilot study. Neurology 43: 1036–1039

    PubMed  Google Scholar 

  • Leenders K, Palmer A, Turton D (1986) Dopa uptake and dopamine receptor-binding visualized in the human brain in vivo. In: Fahn S, Marsden CD, Jenner P, Teychenne P (eds) Recent developments in Parkinson's disease. Raven Press, New York, pp 103–113

    Google Scholar 

  • Le Witt PA (1993) Levodopa therapeutics: new treatment strategies. Neurology 43 [Suppl 6]: 31–37

    Google Scholar 

  • Marion MH, Stocchi F, Quinn P, Jenner P, Marsden CD (1987) Single-dose study of slow release preparation of levodopa and benserazide (Madopar HBS) in Parkinson's disease. In: Yahr MD, Bergmann KJ (eds) Parkinson's disease. Raven Press, New York, pp 493–496 (Adv Neurol 45)

    Google Scholar 

  • Marsden CD, Parkes JD, Quinn N (1982) Fluctuation of disability in Parkinson's disease — clinical aspects. In: Marsden CD, Fahn S (eds) Movement disorders. Butterworth, London, pp 96–122

    Google Scholar 

  • McPartland RJ, Kupfer DJ, Foster FG, Reisler RG, Mathews G (1975) Objective measurement of human motor activity. Biotelemetry 2: 317–323

    PubMed  Google Scholar 

  • Meier J, Rettig H, Hess H (1981) Biopharmazie — Theorie und Praxis der Pharmakokinetik. G Thieme, Stuttgart New York

    Google Scholar 

  • Mouradian MM, Chase TN (1988) Central mechanisms and levodopa response fluctuations in Parkinson's disease. Clin Neuropharmacol 11: 378–385

    PubMed  Google Scholar 

  • Mouradian MM, Juncos JL, Fabbrini G, Schlegel J, Bartko JJ, Chase TN (1988a) Motor fluctuations in Parkinson's disease: central pathophysiological mechanisms, part II. Ann Neurol 24: 372–378

    PubMed  Google Scholar 

  • Nutt JG (1987) On-off phenomenon: relation to levodopa pharmacokinetics and pharmacodynamics. Ann Neurol 22: 535–540

    PubMed  Google Scholar 

  • Nutt JG, Woodward WR (1986) Levodopa pharmacokinetics and pharmacodynamics in fluctuating Parkinsonian patients. Neurology 36: 739–744

    PubMed  Google Scholar 

  • Nutt JG, Woodward WR, Hammerstad JP, Carter JH, Anderson JL (1984) The “On-off” phenomenon in Parkinson' s disease: correlation to levodopa absorption and transport. N Engl J Med 310: 483–488

    PubMed  Google Scholar 

  • Nutt JG, Woodward WR, Carter JH (1986) Clinical and biochemical studies with controlled-release levodopa/carbidopa. Neurology 36: 1206–1211

    PubMed  Google Scholar 

  • Pahwa R, Busenbark RN, Michalek D, Hubble JP, Koller WC (1993) Clinical experience with controlled-release carbidopa/levodopa in Parkinson's disease. Neurology 43: 677–681

    PubMed  Google Scholar 

  • Pezzoli G, Tesei S, Ferrante C, Cossutta E, Zecchinelli A, Scarlata G (1988) Madopar HBS in fluctuating Parkinsonian patients: two-year treatment. Mov Disord 3: 37–45

    PubMed  Google Scholar 

  • Poewe WH, Lees AJ, Stern GM (1986) Treatment of motor fluctuations in Parkinson's disease with an oral sustained-release preparation of L-dopa: clinical and pharmacokinetic observations. Clin Neuropharmacol 9: 430–439

    PubMed  Google Scholar 

  • Quinn NP, Marion MH, Marsden CD (1987) Open study of Madopar HBS, a new formulation of levodopa with benserazide, in 13 patients with Parkinson's disease and “On-Off” fluctuations. In: Marsden CD, Rinne UK, Koella WP, Dubius R (eds) (Madopar) HBS. Karger, Basel, pp 105–113 (Eur Neurol 27 [Suppl 1])

    Google Scholar 

  • Riederer P, Sofic E, Rausch WD, Hebenstreit G, Bruinvels J (1989) Pathobiochemistry of the extrapyramidal system: a “short note” review. In: Przuntek H, Riederer P (eds) Early diagnosis and preventive therapy in Parkinson' disease. Springer, Wien New York, pp 139–151 (Key Topics in Brain Research)

    Google Scholar 

  • Rodriguez M, Lera G, Vaamonde J, Luquin MR, Obeso JA (1994) Motor response to apomorphine and levodopa in asymmetric Parkinson's disease. J Neurol Neurosurg Psychiatry 57: 562–566

    PubMed  Google Scholar 

  • Rondot P, Ziegler M, Aymard N, Holzer J (1987) Clinical trial of Madopar HBS in Parkinsonian patients with fluctuating drug response after long-term levodopa therapy. In: Marsden CD, Rinne UK, Koella WP, Dubius R (eds) 〈Madopar〉 HBS. Karger, Basel, pp 114–119 (Eur Neurol 27 [Suppl 1])

    Google Scholar 

  • Schelowsky L, Poewe W (1992) Die Wertigkeit von L-Dopa-“slow release”-Präparaten in der Behandlung der Parkinson-Krankheit. In: Schimrigk K, Haaß A, Haman G (Hrsg) Verhandlungen der deutschen Gesellschaft für Neurologie 1992. Springer, Berlin Heidelberg New York Tokyo, S185–193

    Google Scholar 

  • Stocchi F, Quinn NP, Barbato L, Patsalos PN, O'Connel, Ruggieri S, Marsden CD (1994) Comparison between a fast and a slow release preparation of levodopa and a combination of the two: a clinical and pharmacokinetic study. Clin Neuropharmacol 17: 38–44

    PubMed  Google Scholar 

  • Sweet RD, Fletcher H, Dowell MC (1974) Plasma dopa concentrations and the “on-off” effect after chronic treatment of Parkinson's disease. Neurology 24: 953–956

    PubMed  Google Scholar 

  • Tolosa ES, Martin WE, Cohen HP, Jakobsen RL (1975) Patterns of clinical response and plasma dopa levels in Parkinson's disease. Neurology 25: 177–183

    PubMed  Google Scholar 

  • van Hilten JJ, Hoogland G, van der Velde EA, van Dijk JG, Kerkhof GA, Roos RA (1993a) Quantitative assessment of parkinsonian patients by continuous wrist activity monitoring. Clin Neuropharmacol 16: 36–45

    PubMed  Google Scholar 

  • van Hilten JJ, Middelkoop HA, Kuiper SI, Kramer CG, Roos RA (1993b) Where to record motor activity: an evaluation of commonly used sites of placement for activity monitors. Electroencephalogr Clin Neurophysiol 89: 359–362

    PubMed  Google Scholar 

  • Webster DD (1968) Critical analysis of the disability in Parkinson's disease. Modern Treatment 5: 257–282

    PubMed  Google Scholar 

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Gerlach, M., Kuhn, W., Müller, T. et al. Sustained-release of levodopa: single dose study of a new formulation. J. Neural Transmission 103, 717–727 (1996). https://doi.org/10.1007/BF01271231

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