Plasma levodopa peak delay and impaired gastric emptying in Parkinson's disease
Abstract
Objectives Whereas delayed gastric emptying is believed to be a causative factor for producing delayed-on and motor fluctuation in Parkinson's disease (PD), few studies have directly measured levodopa pharmacodynamics and gastric emptying together. In order to determine the relationship, we measured these two parameters in a single PD patients cohort.Methods Thirty-one patients with PD were enrolled in the study. They were 11 men and 20 women; age, 68.1 ± 7.8 years; disease duration, 4.2 ± 3.8 years; Unified Parkinson's Disease Rating Scale Part 3 Motor Score 18.37 ± 8.60; bowel movement <3 times a week in 20; all taking 301 mg ± 94 mg/day levodopa/carbidopa. All patients underwent levodopa pharmacokinetic study and the gastric emptying study using (13)C-octanoic acid expiration breath test. Statistical analysis was performed by Student's t-test and Mann-Whitney's U test.Results Pharmacokinetic study showed that the plasma levodopa peak was at 2 hours in 42% (13/31 patients) whereas at 1 hour in 58% (18/31 patients), total of 50.7 ± 16.4 min (mean ± standard deviation) in all 31 patients. The gastric emptying study showed that T(max) ((13)C)>60 min was more common in patients with a plasma levodopa peak at 2 hours (14/18, 69%) than in those with a plasma levodopa peak at 1 hour (4/13, 22%) (p<0.05), total of 50.7 ± 16.4 min in all 31 patients.Conclusion We found a significant relationship between levodopa pharmacokinetics and gastric emptying in PD patients, suggesting that delayed gastric emptying is a causative factor for producing delayed-on in PD. Therefore, studies of improved gastric emptying in order to ameliorate delayed-on in PD are warranted.
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Delayed gastric emptying in Parkinson's disease patients dampens the proper absorption of levodopa or dopamine agonists, causing lower peak plasma concentrations and on-off fluctuations of the drug.
“Delayed gastric emptying in PD patients dampens the proper absorption of levodopa or dopamine agonists, causing lower peak plasma concentrations and on-off fluctuations of the drug (Doi et al., 2012;Hardoff et al., 2001;Marrinan et al., 2013).”
From The Gut-Brain Axis in Parkinson’s Disease: Possibilities for Food-Based Therapies (2017) · cites this paper as Doi et al., 2012
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- Authors
- Doi, H., Sakakibara, R., Sato, M., Masaka, T., Kishi, M., Tateno, A., Tateno, F., Tsuyusaki, Y., & Takahashi, O.
- Affiliations
- Toho University (JP)
- Venue
- Journal of the Neurological Sciences
- Publisher
- Elsevier BV
- Published
- 2012-08
- Volume
- 319
- Issue
- 1-2
- Pages
- 86-88
- ISSN
- 0022-510X (ISSN-L)
- OpenAlex
- W2089640267
- Cited by
- 117
- References
- 12
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 7 · 2023: 12 · 2022: 9 · 2021: 14 · 2020: 10 · 2019: 8 · 2018: 8 · 2017: 9 · 2016: 6 · 2015: 10 · 2014: 8 · 2013: 4
- FWCI
- 4.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the Neurological Sciences (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Japan Society for the Promotion of Science (23590203)
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Keywords
- Parkinson's disease, levodopa pharmacokinetics, gastric emptying, motor fluctuations, levodopa/carbidopa
- MeSH terms
- Aged, Antiparkinson Agents, Breath Tests, Female, Gastric Emptying, Humans, Levodopa, Male, Middle Aged, Parkinson Disease, Gastroparesis
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