If you have Parkinson’s disease, you’ve probably heard of levodopa (Parcopa, Sinemet). It’s the most common medicine to control Parkinson’s symptoms, although there are many others that treat the condition. The right one for you depends on your age, symptoms, and overall health. But levodopa works best for most people. Even if you don’t take it now, chances are you might in the future.
But levodopa is linked to a serious side effect called dyskinesia, especially if you take a high dose for a long time. That makes many people question whether or not they should take the medicine at all. Learn all you can about levodopa and dyskinesia. That way, you can make an informed choice about your treatment.
Levodopa doesn’t slow down Parkinson’s or cure it. But it can help control symptoms that make it hard to move, like:
- Slowed movement, called bradykinesia. This means your body slows way down. Everyday tasks like walking, dressing, or even lifting your arm take longer than they used to. Sometimes things slow down so much that you “freeze” for a few seconds. You want to move, but your feet feel like they’re stuck to the floor.
- Stiff muscles, called rigidity. You might not be able to swing your arms when you walk. You could also have trouble getting out of a chair, turning over in bed, writing, or buttoning your shirt.
- Tremor. This is a small shaking movement you can’t control. It usually starts in one hand when you’re relaxed and still. It can spread up your arm or even to your foot or leg on the same side. Not everyone with Parkinson’s has tremor, and for some people, it’s not a problem. But it can get worse over time.
Dyskinesia causes strange, jerky movements you can’t control. These aren’t the same as the tremors that Parkinson’s can cause. With dyskinesia, you might twist, twitch, bob your head, or just feel like you can’t sit still. These movements may happen in one part of your body, like your arm or leg. Or they could spread over your whole body. They might be so mild you barely notice them. But they can also be severe. For some people, dyskinesia symptoms are worse than Parkinson’s.
Not everyone who takes levodopa has dyskinesia. You’re more likely to get it if you take levodopa for 5 years or more.
How to Decide to Start Levodopa
The time may come when you have to decide whether to take levodopa. The main thing to think about is whether your Parkinson’s is getting in the way of your normal life. Is it hard to exercise, do your job, socialize, or do daily tasks? If so, it may be time to start levodopa.
Here are some other things to keep in mind:
- Not everyone may need or want to take medicine for Parkinson’s, especially in the early stages. Talk to your doctor about exercise, physical and speech therapy, and other treatments that could help your symptoms.
- Ask your doctor about other types of Parkinson’s medicines. Options include a type of antidepressant called MAO-B inhibitors, dopamine agonists, anticholinergic agents, and COMT inhibitors. But these drugs don’t work as well as levodopa and have side effects, too.
- If you get dyskinesia, you and your doctor have a few treatment options. One is a medicine called amantadine (Gocovri, Osmolex ER). It might also help to lower your dose of levodopa or take it less often. Another is clozaril (Clozapine), a drug typically used to treat mood disorders. The trick is to take enough to control your Parkinson's symptoms but not enough to cause dyskinesia. You could also try taking an extended-release form of levodopa. This type keeps the level of the drug in your body more constant, so it might keep your dopamine levels more even and keep dyskinesia at bay.
Your doctor can help guide your decision to start levodopa. Talk to them about your concerns about the drug and how to find the right balance between dyskinesia and PD symptoms. Together, you can decide what’s most likely to help you feel your best.
The Michael J. Fox Foundation for Parkinson’s Research.
UptoDate: “Parkinson disease treatment options – medications (Beyond the Basics).”
Parkinson’s Disease Clinic and Research Center, University of California, San Francisco.
Parkinson Foundation of the National Capital Area.
National Institute of Neurological Disorders and Stroke.
Journal of Parkinson’s Disease and Alzheimer’s Disease:"The Role of Vitamin D in Disease Progression in Early Parkinson’s Disease."
Joseph Rudolph, MD, Cleveland Clinic Center for Neuro-Restoration.