Objective: To assess tolerability, feasibility, safety and to assess outcome measures clinically as well as by serum levels over 24 hours, using the alternative maxillofacial route of delivery of levodopa over 24 hours in a Parkinson’s patient.

Background: Levodopa is generally administered through the oral route. In advanced PD cases, wherein the patient stops responding to oral levodopa or is unable to take orally, alternate routes like intra-duodenal, oral inhalation or sub-cutaneous are used. As these routes have limitations, a novel maxillofacial route was used in this study.

Method:

Low doses of levodopa were administered through a pulp extirpated upper second premolar tooth using a novel drug delivery system in a controlled manner. UPDRS scores were calculated at regular intervals. Blood samples were taken at regular intervals. The plasma samples were subjected to HPLC and the area under the curve was plotted for levodopa.

Results: Maxillofacial administration of levodopa at 9:45 AM resulted at a gradual rise in serum level with a dip at 10:40 AM and then rose again till 12:30 PM and started falling till 14:10 PM. The 13:15 PM administration of levodopa peaked at 16:15 PM and then started falling. The 16:45 pm administration of levodopa had a high serum level at 19.00 PM and then started falling which was alleviated by the 20:15 PM dosing. The falling levels never came to the pretreatment levels which was measured at 9AM. The motor component of UPDRS scores were best at 11:45 AM, 15:15 PM, 17:45PM and 00:15 AM which matched the corresponding serum levels of levodopa except at 1745PM. (Figure1)

Conclusion: The maxillofacial route of administration of levodopa is safe, effective, and well tolerated.

It can be used as an alternate route of administration in bed ridden patients, demented patients who are having Ryle’s tube and are refusing a duodenal pump. This route can be used a rescue therapy in patients who have early morning and unpredictable offs.an effective painless route for administering levodopa in low doses.

Figure 1

References: Thirunavukarasu S, Ramanan BBV, Suresh SK, Antonisamy VJ, Varadharaj D, Shanmugam P, Verma K, Elumalai C, Selvakumar G, Elumalai A, Prabahar L, Janardhanan HA, Ur A. The Administration of Levodopa in a Patient With Parkinson’s Disease Using a Novel Maxillofacial Route: A First-in-Human Report. Cureus. 2023 Oct 30;15(10):e48011. doi: 10.7759/cureus.48011. PMID: 38034171; PMCID: PMC10687491.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/24-hour-maxillofacial-administration-of-levodopa-in-a-parkinsons-patient-an-alternative-route-of-administration-in-parkinsons-disease/