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Levodopa is used alone or in combination with carbidopa to treat Parkinson's disease, sometimes referred to as shaking palsy.

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Bromocriptine/levodopa combined versus levodopa alone for early Parkinson's disease

Parkinson's disease is a disabling condition characterised by slowness of movement, trembling (tremors) and stiffness. Currently, the best treatment is levodopa. However, according to the number of levodopa treatment years, new disabling fluctuations of movement occur. To overcome this problem, bromocriptine has been tried in combination with levodopa. This review of relevant published trials found no evidence that early use of combined bromocriptine/levodopa prevents or delays such fluctuations of movement in patients with Parkinson's disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Lisuride for levodopa‐induced complications in Parkinson's disease

Background: Long‐term levodopa therapy in Parkinson's disease is associated with the development of motor complications including abnormal involuntary movements and a shortening response to each dose (wearing off phenomenon). It is thought that dopamine agonists can reduce the duration of immobile off periods and the need for levodopa therapy whilst maintaining or improving motor impairments and only minimally increasing dopaminergic adverse events.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Pergolide versus bromocriptine for levodopa‐induced complications in Parkinson's disease

Background: Long‐term levodopa therapy in Parkinson's disease is associated with the development of motor complications including abnormal involuntary movements and a shortening response to each dose (wearing off phenomenon). It is thought that dopamine agonists can reduce the duration of immobile off periods and the need for levodopa therapy whilst maintaining or improving motor impairments and only minimally increasing dopaminergic adverse events.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Lisuride versus bromocriptine for levodopa‐induced complications in Parkinson's disease

Background: Long‐term levodopa therapy in Parkinson's disease is associated with the development of motor complications including abnormal involuntary movements and a shortening response to each dose (wearing off phenomenon). It is thought that dopamine agonists can reduce the duration of immobile off periods and the need for levodopa therapy whilst maintaining or improving motor impairments and only minimally increasing dopaminergic adverse events.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Bromocriptine for levodopa‐induced motor complications in Parkinson's disease

Background: Motor Complications are an important issue in the management of patients with Parkinson's disease and dopamine agonists have been introduced to ameliorate this problem.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Bromocriptine versus levodopa in early Parkinson's disease

Parkinson's disease is a disabling disease characterised by slowness of movement, trembling (tremors) and stiffness. Currently, the best treatment for Parkinson's disease is levodopa. However, with the number of levodopa treatment years, new disabling fluctuations of movement occur. To overcome this problem, bromocriptine has been tried as an alternative drug. The review of six trials (850 participants) found that bromocriptine may be helpful in delaying such fluctuations of movement problems in patients with Parkinson's disease who can tolerate the drug.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

The COMT inhibitors entacapone and tolcapone show similar benefits in relieving levodopa‐induced complications in Parkinson's disease but more data on the safety of tolcapone is required.

As Parkinson's disease progresses the control of the symptoms often requires the addition of other drugs to levodopa. The principle aim of COMT inhibitor therapy is to increase the duration of effect of each levodopa dose and thus reduce the time patients spend in the relatively immobile 'off' phase. Tolcapone and entacapone can be used to reduce off time, reduce levodopa dose, and modestly improve motor impairment and disability. This is based on, at best, medium term evidence. However some participants on tolcapone had raised liver enzymes. Post‐marketing surveillance identified three cases of fatal hepatic toxicity in patients treated with tolcapone. As a result, tolcapone has been withdrawn from some countries and severe restrictions on its use have been imposed in others.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Pergolide for levodopa‐induced complications in Parkinson's disease

Background: In later Parkinson's disease, long‐term treatment with levodopa therapy is associated with the development of motor complications which include abnormal involuntary movements (dyskinesia) and a shortening response to each dose (wearing off phenomenon). Dopamine agonists have been used in such patients in the hope that they can reduce the duration of immobile off periods and the need for levodopa therapy whilst maintaining or improving motor impairments and only minimally increasing dopaminergic adverse events.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Ropinirole versus bromocriptine for levodopa‐induced complications in Parkinson's disease

In the later stages of Parkinson's disease, side effects occur because of the use of levodopa treatment. These consist of involuntary writhing movements (dyskinesia), painful cramps in the legs (dystonia) and a shortened response to each dose referred to as 'end‐of‐dose deterioration' or the 'wearing‐off effect'. Dopamine agonist drugs act by mimicking dopamine in the brain, but they do not cause these long‐term treatment complications. For this reason, dopamine agonists have for some years been added once these problems develop in the hope of improving them. Ropinirole is a new dopamine agonist recently licensed in the UK for the treatment of early and later Parkinson's disease. In this review, we will examine the trials performed with this drug to see how it compares with one of the older agonists bromocriptine.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

In the later stages of Parkinson's disease, side effects occur because of the use of levodopa in its treatment.

One trial compared pramipexole with bromocriptine but this was not designed to examine differences between the two treatments as there were too few patients included. However, there was a larger reduction in the time patients spent in the immobile off state with pramipexole therapy compared with bromocriptine by an average of 1.4 hours. No differences occurred in dyskinesia rating scale, dyskinesia as a side effect or Unified Parkinson's Disease Rating Scale (UPDRS) complication score. The UPDRS activities of daily living and motor scores showed similar improvements compared to placebo with both agonists. Levodopa dose reduction was similar with both agonists. Subscales of a quality of life measure, the Functional Status Questionnaire, showed significant improvements compared to placebo with both agonists. The finding that another quality of life scale, the EuroQol, improved significantly compared with placebo with pramipexole but not bromocriptine should be treated with caution. Side effects such as nausea, vomiting, and faintness were similar with each agonist, as was the withdrawal from treatment rate.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

In the later stages of Parkinson's disease, side effects occur because of the use of levodopa in its treatment.

Four trials have compared pramipexole with placebo in 669 patients with later Parkinson's disease. Two studies were medium term (24 weeks) and 2 studies were short term (4 weeks). Pramipexole significantly reduced the time patients spent in the immobile off state compared with placebo by an average of 1.8 hours. No changes occurred in a dyskinesia rating scale in any of the studies, but dyskinesia recorded as a side effect was reported more frequently with pramipexole. A significant improvement occurred in the Unified Parkinson's Disease Rating Scale (UPDRS) complication score in 2 studies but not in the remaining trials. Significant improvements in UPDRS activities of daily living score occurred with pramipexole in all studies. Significant improvements in UPDRS motor scores in the mobile on state were reported in 3 of the 4 studies. Levodopa dose reduction was allowed in 3 studies and meta‐analysis showed a significant difference in favour of pramipexole. There was a suggestion of more side effects such as nausea, vomiting and dizziness with pramipexole and a definite increase in hallucinations in those given pramipexole. There were significantly fewer withdrawals from pramipexole.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Cabergoline versus bromocriptine for levodopa‐induced complications in Parkinson's disease

In the later stages of Parkinson's disease, side effects occur because of the use of levodopa treatment. These consist of involuntary writhing movements (dyskinesia), painful cramps in the legs (dystonia) and a shortened response to each dose referred to as 'end‐of‐dose deterioration' or the 'wearing‐off effect'. Dopamine agonist drugs act by mimicking levodopa in the brain, but they do not cause these long‐term treatment complications when used as initial therapy. For this reason, dopamine agonists have for some years been added once these problems develop in the hope of improving them. Cabergoline is a new dopamine agonist recently licensed in the UK for the treatment of later Parkinson's disease. In this review, we will examine the trials performed with this drug to see how effective it is compared with the older drug bromocriptine and what side effects it causes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Cabergoline for levodopa‐induced complications in Parkinson's disease

In the later stages of Parkinson's disease, side effects occur because of the use of levodopa treatment. These consist of involuntary writhing movements (choreoathetosis), painful cramps in the legs (dystonia) and a shortened response to each dose referred to as 'end‐of‐dose deterioration' or the 'wearing‐off effect'. Dopamine agonist drugs act by mimicking levodopa in the brain, but they do not cause these long‐term treatment complications when used as initial therapy. For this reason, dopamine agonists have for some years been added once these problems develop in the hope of improving them. Cabergoline is a new dopamine agonist recently licensed in the UK for the treatment of later Parkinson's disease. In this review, we will examine the trials performed with this drug to see how effective it is and what side effects it causes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Levodopa for restless legs syndrome

We could include nine trials in the meta‐analysis which compared levodopa treatment to placebo or to other active treatments in RLS and varied from one to eight weeks. Patients suffered from moderate to severe RLS and were treated with doses of 100 mg levodopa/25 mg dopamine decarboxylase up to 400 mg levodopa/100 mg dopamine decarboxylase. The studies were performed in European and Northern American countries.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Ropinirole for levodopa‐induced complications in Parkinson's disease

In the later stages of Parkinson's disease, side effects occur because of the use of levodopa treatment. These consist of involuntary writhing movements (dyskinesia), painful cramps in the legs (dystonia) and a shortened response to each dose referred to as 'end‐of‐dose deterioration' or the 'wearing‐off effect'. Dopamine agonist drugs act by mimicking levodopa in the brain, but they do not cause these long‐term treatment complications. For this reason, dopamine agonists have for some years been added once these problems develop in the hope of improving them. Ropinirole is a new dopamine agonist recently licensed in the UK for the treatment of early and later Parkinson's disease. In this review, we will examine the trials performed with this drug to see how effective it is and what side effects it causes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Drugs for motor complications in people with Parkinson´s disease who are already taking levodopa

One of the complications of long‐term treatment of Parkinson's disease (PD) with levodopa is the development of motor complications e.g. dyskinesia; a jerky, dance‐like movement of the body. Generally clinicians add on drugs (to the levodopa regimen) from one of the other three classes of anti‐Parkinsonian treatments available (e.g. dopamine agonists, catechol‐O‐methyl transferase inhibitors (COMTIs) or monoamine oxidase type B inhibitors (MAOBIs)). However, despite trials having shown that these drugs are beneficial compared to placebo, it remains unclear as to the best way to treat patients experiencing motor complications and, in particular, whether one class of drug may be more effective than another.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Efficacy and tolerance of levodopa to treat amblyopia: a systematic review and meta-analysis

Purpose. Amblyopia is the leading cause of visual impairment in children, affecting up to 4% of the general population. Several clinical trials evaluated the efficacy of levodopa versus placebo in treating amblyopia. However, the results appeared contradictory, suggesting both beneficial and ineffective. The aim of this study was to address the efficacy and tolerance of levodopa on amblyopia. Methods. Randomized controlled trials were identified and extracted from PubMed, EMBASE, Web of Science, and the Cochrane library. The quality of included trials was assessed by using Jadad score and heterogeneity was analyzed using chi-square test. Both efficacy and tolerance endpoints were evaluated. Data were extracted and analyzed using standard meta-analysis. Results. A total of 6 trials were identified from the search strategy. The pooled mean difference of endpoint logMAR of levodopa versus placebo was -0.11 (95% confidence interval -0.19~-0.02, p=0.01). Amblyopic patients receiving levodopa did not show significantly higher frequent adverse events than those receiving placebo. Conclusions. The use of levodopa is an effective and safe option for the treatment of amblyopia, and levodopa can be considered as first-line treatment of amblyopia.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Dopamine agonist therapy in early Parkinson's disease

This 'umbrella' meta‐analysis assesses dopamine agonists as a drug class in early Parkinson's disease. Twenty‐nine eligible trials, involving 5247 participants, were identified. It confirms reports from individual trials that motor complications are reduced with dopamine agonists compared to levodopa, but also demonstrates that other important side‐effects are increased and symptom control is poorer with agonists. Unfortunately, the balance of risks and benefits remains unclear highlighting the need for further studies assessing patient‐rated overall quality of life and economic measures as their primary outcomes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Insufficient data are available on the benefits of the COMT inhibitor tolcapone compared with the dopamine agonists bromocriptine and pergolide in relieving the symptoms of later Parkinson's disease.

As Parkinson's disease progresses the control of the symptoms often requires the addition of other drugs to levodopa. The principle aim of COMT inhibitor therapy is to increase the duration of effect of each levodopa dose and thus reduce the time patients spend in the relatively immobile 'off' phase. However other drugs such as dopamine agonists can also be used at this stage of the disease. This review found that the COMT inhibitor tolcapone as an adjuvant to levodopa treatment had a similar level of benefits as two dopamine agonists, bromocriptine and pergolide. There was no significant difference in efficacy between the adjuvant tolcapone and adjuvant bromocriptine or pergolide in the medium‐term. Tolcapone produced nausea less often than these agonists but there was some evidence of liver function abnormalities with tolcapone. Post‐marketing surveillance identified three cases of fatal hepatic toxicity in patients treated with tolcapone. As a result, tolcapone has been withdrawn from some countries and severe restrictions on its use have been imposed in others.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

[Does eradication of the organism Helicobacter pylori from the gut of patients with Parkinson's disease improve the absorption of the main drug used to treat patients symptoms?]

Helicobacter pylori (H pylori) is a common infection of the gut and is often associated with duodenal and gastric ulcers. The exact mechanism is unknown but there is some evidence that infection with H pylori can interfere with the absorption of some drugs in the gut. One such drug is levodopa, the main drug used to treat the motor symptoms of Parkinson's disease. Whilst levodopa is very effective for treating Parkinson's symptoms, after time it can become less effective in some patients which may be due to variable absorption. If H pylori is eradicated with the use of antibiotics then absorption of levodopa may be improved and in turn the patient's motor symptoms may be improved.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

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