Objective: Food interferes with gastrointestinal absorption of levodopa which requires spacing with meals. Study evaluated how many patient were spacing  levodopa correctly, its effect on  clinical response and proposes methods to improve patient compliance on spacing with meals.

Background: Levodopa is a cheap and  effective drug in Parkinson’s. Clinical efficacy and plasma levels are affected by  food intake. Meals delay and decrease the absorption from gut. Few studies have studied awareness levels of patients regarding spacing Levodopa with meals.

Method: 56 patients of Parkinson’s disease who were on Levodopa before first contact with our institution were evaluated. Diagnostic criteria used were the U.K. Brain Bank criteria. Only those patients were evaluated who were not taking  dopamine agonists or amantadine. Details about  previous specialty consulted, advised dosing Schedule and clinical response were evaluated. In those who were not spacing Levodopa with meals, clinical response was evaluated both before spacing with meals and after patients had started spacing levodopa with meals.

Results: Sex distribution was 41 males, 15 females. Age ranged from 47  to 84  years .[Table 1]. Only 17/56 [30.35%] had been advised spacing with meals. Spacing advice rates according to specialty were – Psychiatrists – 21%, Internal Medicine -41%, General Practitioners-33%, Neurosurgeons– 25% and Neurologists 80%. In 39 patients  who were not spacing Levodopa with meals, 21 patients [54%] had improved clinical response after proper spacing with meals[Table 2].

Conclusion: Awareness levels regarding spacing of Levodopa with meals are dismal both in prescribing clinicians and patients.70% patients had not been advised spacing of levodopa by their doctors and even in those advised spacing, many patients were not following instructions. Decreased clinical response resulted which improved after proper spacing was adhered. In developing countries, few patients can afford dopamine agonists. Levodopa is the cheapest and most effective.We propose that for effective utilization of levodopa, pictographs should be provided on packaging. Pictographs were effective in restricting use of thalidomide in pregnant females [Figure 1].Proposed pictograph for levodopa spacing is shown[Figure 2]. Pictographs are understood by both illiterates and literates.

References: 1. Nutt JG, Woodward WR, Carter JH, Trotman TL. Influence of fluctuations of plasma large neutral amino acids with normal diets on the clinical response to levodopa. J Neurol Neurosurg Psychiatry. 1989;52(4):481–7. 2. Barichella M, Cereda E, Pezzoli G. Major nutritional issues in the management of Parkinson’s disease. Mov Disord. 2009;24(13):1881–92.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/awareness-of-levodopa-carbidopa-spacing-with-meals-in-patients-of-idiopathic-parkinsons-disease-insights-from-an-indian-parkinsons-registry/