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Levodopa is the precursor to dopamine. Most commonly, clinicians use levodopa as a dopamine replacement agent for the treatment of Parkinson disease. It is most effectively used to control bradykinetic symptoms apparent in Parkinson disease. Levodopa is typically prescribed to a patient with Parkinson disease once symptoms become more difficult to control with other anti-parkinsonism drugs. The drug can also be used for postencephalitic parkinsonism and symptomatic parkinsonism due to carbon monoxide intoxication. This activity covers levodopa, including mechanism of action, pharmacology, adverse event profiles, eligible patient populations, and monitoring, and highlights the role of the interprofessional team in the management of conditions where levodopa therapy is helpful. Objectives: Identify the indications for initiating levodopa therapy. Describe the mechanism of levodopa as it pertains to parkinsonism and related conditions. Review the contraindications for levodopa. Summarize interprofessional team strategies for improving care coordination and communication to advance levodopa and improve outcomes. Access free multiple choice questions on this topic.

Studies have shown that levodopa toxicity can damage neuronal cells. The formation of free radicals once the body oxidizes levodopa can induce apoptosis. Also, dopamine, norepinephrine, and epinephrine levels can rise in the blood when levodopa undergoes decarboxylation in the periphery. The rise in catecholamines activates alpha and beta-adrenergic receptors and results in toxic effects. In pregnant women, levodopa does cross the placenta and can potentially be metabolized by the fetus. Unfortunately, there is insufficient information to make an appropriate decision regarding the use of levodopa in pregnant women. The drug is excreted in breast milk, and thus, caution is advised when administering the medication to nursing women. Supportive measures are necessary to treat toxicity, such as gastric lavage, maintenance of airways, and administering intravenous (IV) fluids.

While the initial treatment of a patient with Parkinson disease is by a neurologist, outpatient monitoring and continued care are often accomplished by the primary care provider or nurse practitioner/physician assistant; these and other caregivers need to function as an interprofessional team when managing patients on levodopa therapy. When patients start on L-dopa, Frequent monitoring of BUN, creatinine levels, and hepatic function is necessary. Additionally, the patient must obtain a referral to the ophthalmologist for glaucoma screening. Patients on L dopa may develop mood changes and should be closely followed by a mental health nurse. The primary care provider needs to know the Parkinson disease symptoms because L-dopa usually works for a short period, and patients may have to start on other medications. This situation is where ongoing monitoring by nursing can inform the clinician promptly of status changes so that additional interventions can commence. Also, the pharmacist should verify potential drug-drug interactions and dosing and consult with the clinician as more agents may be needed. Also, patients with Parkinson disease may develop a variety of autonomic symptoms and may need a referral to a gastroenterologist and urologist. Overall, there is no cure for Parkinson disease, and eventually, most patients succumb to the disorder, but interprofessional teamwork can optimize the outcome within these limitations.[18][19] [Level 5]