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Treatment With Levodopa and Decarboxylase Inhibitor

Leonor Rivera-Calimlim, MD; Deepak Tandon, MD; Frank Anderson, MD; Robert Joynt, MD, PhD

Arch Neurol. 1977;34(4):228-232.

Abstract
• Three parkinsonian patients who were nonresponders to levodopa treatment did not improve when shifted to levodopa-decarboxylase inhibitor combination but, instead, experienced involumtary movements. Their plasma levodopa and metabolite profiles showed unusually high baseline 3-0-methyldopa concentrations that further increased significantly during the decarboxylase inhibitor regimen. All patients had 3-0-methyldopa to levodopa ratios greater than 1, even two hours after therapy. Patients who are responders to levodopa-decarboxylase inhibitor combination or to levodopa alone had 3-0-methyldopa to levodopa ratios of less than 1. We discuss the role of 3-0-methyldopa as a metabolite and the significance of the 3-0-methyldopa to levodopa ratio as a predictor of patients' response to levodopa.

Author Affiliations
From the Departments of Pharmacology, Toxicology (Drs Rivera-Calimlim and Tandon), and Neurology (Dr Joynt), University of Rochester School of Medicine and Dentistry, Rochester, New York, and the Department of Neurology (Dr Anderson), George Washington University, Washington, DC.

Footnotes
Accepted for publication Nov 15, 1976.

Reprint requests to the Department of Pharmacology and Toxicology, University of Rochester Medical Center, Rochester, NY 14642 (Dr Rivera-Calimlim).

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