Objective: Advanced Parkinson’s disease manifests with  “on-off” phenomenon, dyskinesias and increasing symptom severity . Managing it in developing countries is difficult given the low per capita incomes and expensive drugs.

Background: Liquid levodopa/carbidopa is a cheap modality not widely used in developed world as they can afford other drugs and deep brain stimulation[DBS]. However patients in developing countries do not have access to either and have to rely on oral levodopa – the cheapest drug available which however is not very effective in advanced stages of the disease.

Method: 58 year old male with Idiopathic Parkinson’s disease of 5 years duration presented with increasing symptoms . He was on oral Levodopa tablets [ 125 mg 5 times /day] and symptoms were not controlled leading to poor quality of life. He was started on liquid levodopa/carbidopa/ascorbic acid combination.

Results: Patient had good response to liquid levodopa. [Table 1]. There was improvement in various parameters leading to improved ambulation , greater independence and improvement in quality of life. Patient was not averse either to frequent dosing of liquid levodopa or to carrying the liquid levodopa bottle constantly.[ Figure 1]

Conclusion: Advanced Parkinson’s disease is a therapeutic challenge . Treatment is in form of polypharmacy which usually includes levodopa/ dopamine agonists/amantadine/ rasagiline or selegiline. However cost factors prevent wide availability of these drug combinations in the developing world to a majority of population [Table 2] . Liquid levodopa/carbidopa/ascorbic acid solution is a cheap  and effective way to treat advanced Parkinson’s. This is because of faster gastric emptying, better levodopa absorption , smoother blood levodopa concentrations and resultant clinical benefits like fewer dyskinesias, less on-off phenomenon and a better quality of life. Patients can ambulate independently more frequently which leads to lesser depression and better bone mass. Liquid levodopa may be redundant and outdated in the Western world where patients have higher incomes and better access to health insurance and other facilities like DBS   but it remains a promising yet underutilized treatment in the developing world.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/liquid-levodopa-carbidopa-an-underutilized-cost-effective-treatment-of-advanced-parkinsons-disease-in-the-developing-world/