Objective: To report on use of CVT-301 (inhaled LD) to treat PD patients with complicated OFF period symptoms who present to the emergency department (ED).
Background: OFF periods occur in patients with PD and can lead to ED visits and extensive workups to identify precipitating illness. LD treatment can resolve OFF period symptoms. Oral carbidopa/levodopa (CD/LD) has limited utility as a treatment medication in patients with severe akinesia involving oropharyngeal muscles and impaired swallowing, and in patients with gastroparesis, can lead to delayed LD absorption.
Method: Case studies of PD patients who attended a clinic or an ED will be presented.
Results: Case 1: 81-year-old male with dementia attended clinic for a routine visit suffering from an OFF episode with significant motor and nonmotor presentations: severe freezing and rigidity in all extremities, tremor, severe confusion, hyperpyrexia, drenching sweat, sinus severe hypertension (BP 205/170), tachycardia (HR 125), and dyspnea (RR 22). Last dose of LD medication was >5 hrs earlier. 15 min after CVT-301 administration, his BP was 155/95, HR 95, and RR 18. Gait, tremor, and rigidity improved significantly, and nonmotor symptoms resolved within 10 min. Case 2: 70-year-old patient on LD/CD intestinal gel (LCIG) presented to ED with altered mental status, respiratory distress, autonomic instability, and severe rigidity, BP 185/110, HR 120, RR 25, O2 sats 90%. Source was interrupted delivery of LCIG due to tube failure. Neurology consultation found patient to be in an OFF episode and was successfully treated within 15 min with CVT-301. Vital signs stabilized and respiratory distress improved. Patient was discharged within 24 hrs without complication after PEG tube elective replacement and resumed LCIG treatment. Case 3: A 78-year-old male, post deep brain stimulation (DBS) and on extended-release CD/LD therapy, presented to ED in an OFF period and with no response to routine CD/LD dose. Patient had accidentally turned off DBS at home. After resuming DBS, severe motor symptoms continued. The CVT-301 dose improved motor symptoms rapidly and he was successfully discharged.
Conclusion: CVT-301 (inhaled LD) administration in patients with acute complicated OFF episodes rapidly improved their OFF symptoms and prevented an ED visit, unnecessary and costly acute workup, or hospital admission.
To cite this abstract in AMA style:
S. Miri, S. Nakano, A. Carwin, M. Anjum, Y. Torres-Yaghi, F. Amjad, F. Pagan. Inhaled levodopa (LD) as a treatment for Parkinson’s disease (PD) patients in an emergency setting [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/inhaled-levodopa-ld-as-a-treatment-for-parkinsons-disease-pd-patients-in-an-emergency-setting/. Accessed May 17, 2025.« Back to MDS Virtual Congress 2020
MDS Abstracts - https://www.mdsabstracts.org/abstract/inhaled-levodopa-ld-as-a-treatment-for-parkinsons-disease-pd-patients-in-an-emergency-setting/