Levodopa
About Levodopa
Levodopa is an inhaled medicine used to provide rapid relief from the sudden return of Parkinson's disease symptoms. Use this medicine only when you experience the sudden return of your Parkinson's symptoms, up to the maximum daily limit advised by your doctor. Because you inhale this powder directly into your lungs, it can be taken with or without food, as its uptake is not affected by dietary protein in your stomach. Staying hydrated and eating a balanced diet can also support your physical well-being.
While taking this medicine, you may experience mild side effects like a temporary cough, throat irritation, or nausea. However, you must contact your doctor immediately if you experience serious symptoms such as chest tightness, severe dizziness, or unusual changes in your mood.
Talk to your doctor before starting Levodopa if you have a history of asthma, chronic obstructive pulmonary disease (COPD), or other breathing disorders, as this inhaled powder can narrow your airways. Do not take this medicine if you have used monoamine oxidase inhibitors (MAOIs) for depression within the past 14 days.
This treatment can interact with certain blood pressure medications, iron supplements, and alcohol, potentially increasing your risk of dizziness or decreasing the medicine's effectiveness. If you are pregnant, planning to breastfeed, or are an older adult, consult your doctor or pharmacist to ensure safe use.
Important Note: Inhaled Levodopa is intended for people with Parkinson's disease who are already receiving a regular oral carbidopa/Levodopa treatment regimen. It is not used as a substitute for daily maintenance therapy but as a rescue treatment for intermittent 'off' episodes.
Uses of Levodopa
Medicinal Benefits
Levodopa offers quick symptom relief during unexpected 'off' periods, helping people with Parkinson's disease regain mobility and continue their daily activities with greater confidence.
- Fast-acting relief: Because the powder is inhaled directly into your lungs, it enters your bloodstream quickly to relieve returning Parkinson's symptoms faster than waiting for an extra oral dose to digest.
- Improved mobility: By targeting sudden stiffness and tremors, this medication helps you regain control over your movements, allowing you to return to daily activities with greater ease.
- Convenience during 'off' times: The portable inhalation design makes it easy to use whenever a sudden 'off' episode occurs, helping you manage unexpected symptom flare-ups away from home.
Directions for Use
Please follow your doctor's exact instructions when using Levodopa. Use the specific inhaler device provided with the medication and follow these general steps:
- Wash and dry your hands thoroughly before handling the device and capsules.
- Open the inhaler cap and pull the mouthpiece back to expose the chamber.
- Remove a capsule from its packaging right before use and place it into the chamber; do not swallow the capsule.
- Close the mouthpiece until it clicks, then press the buttons on the sides of the device to pierce the capsule.
- Breathe out fully away from the inhaler, then place the mouthpiece between your lips and breathe in deeply and steadily.
- Hold your breath for about 5 seconds to allow the powder to settle in your lungs, then breathe out slowly.
- Check the capsule to make sure all the powder has been inhaled; if not, repeat the inhalation steps.
Always consult your doctor or pharmacist if you are unsure about the correct way to use your inhalation device.
Storage
Side Effects of Levodopa
Common Side Effects (Usually mild):
- Coughing or throat irritation
- Nausea or stomach upset
- Change in the color of your saliva, sweat, or urine (often turning dark)
- Mild dizziness or sleepiness
Serious Side Effects (Call a doctor right away):
- Sudden difficulty breathing, wheezing, or chest tightness
- Uncontrolled, involuntary muscle movements (dyskinesia)
- Feeling unusually dizzy, faint, or lightheaded, especially when standing up
- Hallucinations, confusion, or unusual changes in mood and behavior
- Extreme sleepiness or falling asleep suddenly during daily activities
Drug Warnings
- Do not swallow the capsules: The capsules provided with Levodopa are designed exclusively for inhalation through the specialised inhaler device. Swallowing them orally will not provide the rapid relief needed for 'off' episodes.
- Inspect the inhaler regularly: Ensure the inhalation device is clean, dry, and free of cracks or blockages before each use. Never wash the inhaler with water; clean it only with a dry cloth.
- Avoid driving if sleepy: This medication can cause sudden drowsiness or make you fall asleep unexpectedly during daily tasks. Do not drive or operate heavy machinery until you know how it affects you.
- Check your blood pressure: Monitor your blood pressure regularly, especially when starting this treatment or increasing your use, as it can cause sudden drops when standing up.
- Prepare for a mild cough: It is normal to experience a mild, temporary cough immediately after inhaling the powder. If the cough becomes severe or is accompanied by wheezing, stop using the medicine and contact your doctor.
Drug Interactions
Drug-Drug Interactions
Levodopa can interact with certain medications, which may affect how well it works or increase the risk of side effects. Inform your doctor about all medicines you are taking before starting treatment.
- Monoamine Oxidase Inhibitors (MAOIs): Combining Levodopa with certain older antidepressants can lead to a dangerous, sudden spike in blood pressure. Do not use this medicine within 14 days of taking an MAOI.
- Dopamine Antagonists: Medicines used to treat severe mental health conditions or certain stomach issues (like metoclopramide) can block the effects of Levodopa, making it less effective.
- Blood Pressure Medications: Taking this medicine with blood pressure-lowering drugs can increase your risk of severe dizziness, lightheadedness, or fainting.
Drug-Food Interactions
Certain foods, beverages, and supplements may influence the effectiveness of Levodopa or increase the likelihood of side effects.
- Alcohol: Avoid drinking alcohol while using this medicine, as it can increase the risk of extreme drowsiness and dizziness.
- Iron Supplements: Taking iron supplements close to your regular oral treatments can decrease their absorption, though inhaled Levodopa is less affected. Consult your doctor for optimal timing.
Drug-Disease Interactions
Some existing medical conditions may affect whether Levodopa is suitable for you or require additional monitoring during treatment.
- Asthma and COPD: If you have chronic lung conditions, inhaling this powder can cause severe bronchospasms (sudden narrowing of the airways) and worsen your breathing.
- Glaucoma: As with other Levodopa-based medicines, caution may be required in people with glaucoma. Levodopa may increase eye pressure in susceptible individuals, particularly those with narrow-angle glaucoma. Regular eye monitoring may be recommended by your doctor.
- Mental Health Conditions: If you have a history of depression, hallucinations, or psychosis, this medicine may worsen these symptoms.
Drug-Drug Interactions Checker List:
Safety Advice
Alcohol
unsafeAvoid consumption of alcohol with Levodopa as it may increase the risk of adverse effects such as drowsiness, dizziness or difficulty in concentrating.
Pregnancy
cautionLevodopa is a Category B3 pregnancy drug and is given to a pregnant woman only if the doctor thinks benefits outweigh risks.
Breast Feeding
cautionLevodopa is excreted in human milk, but the effect of Levodopa on an infant is unknown. So, Levodopa is given to a breastfeeding mother only if the doctor thinks benefits outweigh risks.
Driving
unsafeLevodopa may cause drowsiness and make you fall asleep suddenly. Therefore, avoid driving if you feel drowsy after taking Levodopa.
Liver
cautionTake Levodopa with caution, especially if you have a history of Liver diseases/conditions. The dose may be adjusted by your doctor as required.
Kidney
cautionTake Levodopa with caution, especially if you have a history of Kidney diseases/conditions. The dose may be adjusted by your doctor as required.
Children
unsafeLevodopa is not recommended for children as the safety and efficacy were not established.
Habit Forming
Diet & Lifestyle Advise
- Manage your protein intake: While Levodopa inhalation bypasses the digestive tract, your regular oral Parkinson's medications can be affected by high-protein meals. Try to eat high-protein foods later in the day to prevent them from interfering with your regular oral medication absorption.
- Stay hydrated: Drink plenty of water throughout the day to help manage dry mouth, ease coughing after inhalation, and prevent sudden drops in blood pressure.
- Incorporate gentle physical therapy: Engage in regular, doctor-approved exercises like stretching or walking to maintain muscle strength, flexibility, and balance during your 'on' times.
- Log your 'off' episodes: Keep a daily diary tracking when your 'off' episodes happen, what you ate, and when you used Levodopa. Share this log with your doctor to help optimise your overall treatment plan.
Special Advise
Do not exceed more than 1 dose (2 capsules) for any off period (recurring symptoms in between regular doses).
If you have unusual urges like gambling, spending money, over eating or increased sexual urges, please inform your doctor before taking Levodopa.
Patients Concern
Disease/Condition Glossary
Parkinson’s disease: It is a disorder of central nervous system that affects movement due to damage of nerve cells in the brain which reduces the levels of dopamine and leads to symptoms such as stiffness, tremor in one hand, shaking, difficulty in walking, coordination and balance. This condition can last for many years or life-long. Treatment with medicines along with physiotherapy may help to control the symptoms and provide a quality life for as long as possible.
FAQs
Levodopa is used in the treatment of Parkinson's disease. It may also be used in combination with carbidopa.
Yes, Levodopa may cause low blood pressure in some patients especially while standing up suddenly from a sitting or lying down position and cause symptoms such as dizziness, sweating, nausea or fainting. Therefore, to avoid such side effects, you are recommended to get up slowly after lying down or sitting.
No, Levodopa is not recommended for glaucoma (damage of optic nerve that is essential for good vision) patients as it may increase the fluid pressure inside the eye. However, regular monitoring of pressure in the eyes is recommended while on treatment with Levodopa.
No, you are not recommended to stop taking Levodopa without consulting your doctor as it may lead to a severe condition called withdrawal-emergent hyperpyrexia with symptoms such as confusion, fever, muscle stiffness, changes in heartbeat and breathing. Therefore, take Levodopa for as long as your doctor has prescribed it and if you experience any of these symptoms while taking Levodopa, please consult your doctor so that the dose may be gradually reduced.
Store Levodopa at room temperature in a dry place and keep the capsules in the blister pack. Open the capsules only just before using the inhaler. Do not store capsules inside the inhaler device. Always keep capsules and inhaler dry. You are advised to throw away the inhaler after finishing all the capsules and use a new device that comes with each new prescription. Keep Levodopa out of sight and reach of children.
No, Levodopa does not cure Parkinson’s disease. Levodopa is only used to reduce the symptoms of Parkinson’s disease.
Yes, in some cases prolonged intake of Levodopa may lead to a decrease of Vitamin B12 in the body. So, your doctor might recommend regular tests for the Vitamin B12 while using Levodopa.
No, you should never swallow the capsules. They are specifically formulated to be inhaled into the lungs using the provided inhaler device. Swallowing them will not give you the rapid relief required during an 'off' episode. If you have trouble using the inhaler, talk to your doctor.
Because the powder is inhaled directly into the lungs, it typically begins to work much faster than oral medications, often within 10 to 30 minutes. However, individual response times can vary. Talk to your doctor if your symptoms do not improve after use.
A mild, brief cough is a common reaction to inhaling the dry powder. Taking a sip of water before or after inhalation can help. If your cough is severe, does not go away, or is accompanied by wheezing or chest tightness, stop using the medicine and talk to your doctor.
People with chronic lung diseases like asthma or COPD should generally avoid using this inhaled medication, as it can cause sudden breathing difficulties and airway spasms. Always talk to your doctor about your lung health before starting this treatment.
Yes, because Levodopa is inhaled and absorbed through your lungs, its absorption is not affected by food or protein in your stomach. However, high-protein meals can still interfere with your regular oral Parkinson's medications. Talk to your doctor or pharmacist for advice on managing your diet.
Yes, this medicine can cause your saliva, urine, or sweat to turn a dark color, such as reddish, brown, or black. This is a common, harmless side effect of the medicine breaking down in your body. If you have concerns, talk to your doctor.
Use only the dose prescribed by your doctor for each 'off' episode. Do not take additional doses unless your healthcare provider has instructed you to do so. If your symptoms do not improve or your 'off' episodes become more frequent, contact your doctor, as your overall Parkinson's treatment plan may need adjustment.
