Continuous intraduodenal infusion of a stabilized levodopa/carbidopa suspension (Duodopa) gives significantly reduced plasma levodopa variability as compared to Sinemet® CR Nyholm, D. Askmark, H. Knutson, T. Gomes-Trolin, C. Nyström, C. Aquilonius S.-M.
Poster presenterad vid The Movement Disorder Society's 6th International Congress of Parkinson's Disease and Movement Disorders, Barcelona, juni, 2000.
Publicerad sammanfattning i: Movement Disorders 2000; 15(Suppl 3):114
Experience of long-term duodenal infusion of a levodopa/carbidopa suspension in 28 patients with very advanced Parkinsons disease. Nilsson, D. Aquilonius, S M.
Poster presenterad på Movement Disorder Society's 5th International Congress of Parkinson's Disease and Movement disorders, New York, oktober, 1998.
Long-term intraduodenal infusion of a water based levodopa-carbidopa dispersion in very advanced Parkinson's disease. Nilsson D, Hansson LE, Johansson K, Nystrom C, Paalzow L, Aquilonius SM.
Acta Neurol Scand 1998;97:175-183.
OBJECTIVE: To evaluate the effects of continuous duodenal infusion of levodopa over time on the disabling fluctuations in motor performance in advanced parkinsonian patients. It has earlier been demonstrated that these fluctuations can be reduced by keeping the plasma concentration of levodopa constant. MATERIAL AND METHODS: In view of the low water solubility of levodopa a stable dispersion of the drug was developed and used for continuous intraduodenal infusion in patients with advanced Parkinson's disease. Nine patients were evaluated with respect to an optimal oral treatment, during nasoduodenal infusion by a portable pump and then followed for 6 months to 2 1/2 years when treated via transabdominal infusion. Upon each test occasion, over 2 non-consecutive days, objective movement analysis by means of an opto-electronic system was applied every 15-20 min and video recordings performed twice every h. On several test occasions plasma levodopa concentrations were analysed every 15 min. RESULTS: The patients showed improvement and decreased variance of their motor function. In the 2 patients followed over a period of 2 1/2 years levodopa plasma concentration showed reduced fluctuations on infusion and the levodopa consumption as well as mean levodopa plasma concentration decreased. CONCLUSION: Continuous duodenal infusion of levodopa is an alternative treatment strategy for patients with advanced Parkinson's disease when conventional therapy has failed.
Bredberg, E. Nilsson, D. Johansson, K. Aquilonius, S M. Johnels, B. Nystrom, C. Paalzow, L.
Eur J Clin Pharmacol 1993 (45(2)) pp 117-122
Motor performance of five patients with advanced Parkinson's disease was investigated during their optimum oral therapy (conventional tablets and/or depot capsules) and during a continuous duodenal infusion of levodopa. Due to the low water solubility of the drug, conventional tablets of levodopa+carbidopa (Sinemet) were milled and dispersed in a 1.8% aqueous methylcellulose solution. The dispersion was delivered nasoduodenally by a portable pump. The effect of levodopa in the two dosing regimens was estimated optico-electronically every 15 min and was also evaluated from videorecordings every 30 min and plasma levels of levodopa was regularly measured. Each dosage regimen the was studied twice, at a 2-4 day interval. Duodenal infusion improved motor function in all five patients and the fluctuations were reduced when compared to the oral therapy. Variation in plasma levodopa concentrations was 3-10 fold during oral therapy, while during the infusion a stable concentration was obtained. The therapeutic concentration varied from 0.3-3 ml-1 between patients. The relative bioavailability of levodopa in the solid preparation compared to the dispersion was in all patients 100%. Our results encourage further development of a duodenal infusion system with a levodopa dispersion for clinical use in parkinsonian patients who show severe fluctuation.
