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Brush up your understanding of Parkinson's Disease

Rachel Luther

After noticing an increase of my patient load with Parkinson’s Disease, I decided it was time to brush up my knowledge on the new and existing therapies.

Did you know that crushing or chewing Levocarb and taking it with carbonated water will increase its absorption? This is especially useful if your patient has severe early morning symptoms.[1]

Did you know that protein can decrease the absorption of levocarb? Elevated plasma concentrations of large neutral amino acids are also known to impair effectiveness by reducing its absorption and influx into the brain. To combat this, some patients may benefit from a low-protein diet (LPD) or a protein-redistribution diet (PRD). The PRD loads the protein intake at the end of the day, allowing a more predictable response to levocarb over the day. Keep in mind that LPD and PRD have side effects as well like dyskinesia, weight loss and protein and calcium insufficiency.[2]

Did you know that when you add Levocarb CR that it is only increasing the duration of action by 25%? So, if you have a patient who is having their levocarb wear off after 4 hours, adding CR will only extend its action by 1 hour. [3]

Did you know that when you add (or subtract) entacapone you need to adjust the dose of Levocarb? Entacapone allows levocarb to remain in the plasma longer by keeping the metabolic pathway busy thereby enhancing the effects of levocarb.[4] So when you add entacapone to the regimen, reduce the dose of levocarb so adverse reactions like dyskinesias, nausea, vomiting and hallucinations are reduced. A dose reduction of 25% of levocarb is recommended. If withdrawing entacapone, remember to adjust the dose of levocarb upward.[5]

[2] Wang L, Xiong N, Huang J, et al. Protein-Restricted Diets for Ameliorating Motor Fluctuations in Parkinson's Disease. Front Aging Neurosci. 2017;9:206. Published 2017 Jun 28. doi:10.3389/fnagi.2017.00206

[5] (accessed June 15, 2022)

Rachel Luther is a graduate from Memorial University of Pharmacy. She owns Centre Wellington Remedy’s Rx in Fergus, Ont. where she lives with her husband and two kids. Rachel’s focus is on patient centred care and professional services. When not at work, she is out looking for mushrooms or sewing.


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