Optimizing extended-release carbidopa/levodopa in Parkinson disease

Alberto J. Espay, Fernando L. Pagan, Benjamin L. Walter, John C. Morgan, Lawrence W. Elmer, Cheryl H. Waters, Pinky Agarwal, Rohit Dhall, William G. Ondo, Kevin J. Klos, Dee E. Silver

Research output: Contribution to journalReview articlepeer-review

18 Scopus citations


Purpose of review: To help clinicians optimize the conversion of a patient's Parkinson disease pharmacotherapy from immediate-release carbidopa/levodopa (IR CD/LD) to an extended-release formulation (ER CD/LD). Recent findings: Eleven movement disorders specialists achieved consensus positions on the modification of trial-based conversion guidelines to suit individual patients in clinical practice. Summary: Because the pharmacokinetics of ER CD/LD differ from those of IR CD/LD, modification of dosage and dosing frequency are to be expected. Initial regimens may be based on doubling the patient's preconversion levodopa daily dosage and choosing a division of doses to address the patient's motor complications, e.g., wearing-off (warranting a relatively high ER CD/LD dose, possibly at a lower frequency than for IR CD/LD) or dyskinesia (warranting a relatively low dose, perhaps at an unchanged frequency). Patients should know that the main goal of conversion is a steadier levodopa clinical response, even if dosing frequency is unchanged.

Original languageEnglish (US)
Pages (from-to)86-93
Number of pages8
JournalNeurology: Clinical Practice
Issue number1
StatePublished - Feb 1 2017

ASJC Scopus subject areas

  • Clinical Neurology


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