Since 1967, Levodopa has been the most powerful medicine we have for treating Parkinson’s, and it still is!

It helps improve slowness, stiffness, tremor, and gait by replenishing dopamine levels in the brain.

What is levodopa?

Since 1967, Levodopa has been the most powerful medicine we have for treating Parkinson’s, and it still is!

Dopamine-producing cells in the brain cannot keep up with demand in Parkinson’s, which leads to symptoms (similar to how diabetics lose insulin production and struggle to regulate blood sugar unless it is replaced). Dopamine replacement is the first-line and most effective treatment for Parkinson’s.

Levodopa, an amino acid supplement, actually becomes dopamine inside your brain. That’s why it’s considered the “gold standard” and is the most effective treatment for tremor, stiffness, and slowness. Like all medications, levodopa may have potential side effects, but these can often be managed with medication adjustments or other therapies.

Levodopa works well, but it doesn’t stay in the body for long on its own. That’s why it’s paired with a helper medication called a dopa decarboxylase inhibitor (DDI), protecting the levodopa in your body and helping it reach the brain. Common DDIs include Carbidopa (found in Kinson® and Sinemet®) and Benserazide (in Madopar®). For example, Kinson® 125 contains 100 mg of Levodopa and 25 mg of Carbidopa.

Levodopa turning to dopamine in the brain is great, but it also needs some neurons there to soak it up.

More specifically, levodopa treats motor symptoms like:

  • Bradykinesia (slow movement)
  • Rigidity (stiff muscles)
  • Tremor (shaking)
  • Postural instability (balance problems)
  • Shuffling walk
  • Trouble starting movements
  • Freezing episodes.

Delaying levodopa treatment can actually make overall motor function worse. Starting early can help you move better, feel better, and enjoy life more.

In 2024, the PBS data shows 154,850 Australians were taking levodopa. Among 154,850 Australians prescribed levodopa, more than one in four (27%) required an additional Parkinson’s medication during the study period. Before an add-on therapy was introduced, many people were already taking substantial doses of levodopa, with around 40% prescribed 600 mg per day or more. In most cases, decisions to add another treatment were made by a neurologist as Parkinson’s symptoms became more difficult to manage with levodopa alone.

Levodopa & non-motor symptoms

Non-motor symptoms levodopa may also help with:

  • Sleep disturbances: May improve sleep by reducing nighttime rigidity or tremor.
  • Fatigue: Can help if fatigue is linked to motor effort or “off” periods.
  • Mood (depression/anxiety/apathy): Sometimes improves mood indirectly by enhancing mobility and independence.
  • Cognitive fluctuations: May stabilise attention and alertness during “ons”.
  • Pain: Can reduce pain caused by rigidity or dystonia.
  • Urinary urgency: Occasionally improves if urinary issues are linked to motor fluctuations.
  • Drooling (sialorrhea): May help by improving swallowing and facial muscle control.

What symptoms levodopa doesn’t typically help with:

  • Constipation
  • Orthostatic hypotension (low blood pressure/dizziness when sitting to standing)
  • REM sleep behaviour disorder (acting out your dreams, shouting out while asleep)
  • Hallucinations or delusions
  • Dementia or significant cognitive decline.

NOTE: Symptoms still do vary from person to person, can fluctuate throughout the day and do change over time. Not every person will experience every symptom listed here.

Key Statistics

  1. Levodopa remains the most effective medication for treating motor symptoms of Parkinson’s.
    It helps improve slowness, stiffness, tremor, and gait by replenishing dopamine levels in the brain[1].
  2. Levodopa must be combined with a Dopa Decarboxylase Inhibitor (DDI, e.g. carbidopa/benserazide) to prevent nausea and ensure it reaches the brain effectively.
    DDIs block the premature conversion of levodopa into dopamine outside the brain, improving absorption and reducing side effects [1].
  3. A slow or dysfunctional gut can delay levodopa absorption and lead to motor fluctuations.
    Constipation and gastroparesis are common in Parkinson’s and can interfere with how well levodopa works [1].
  4. Levodopa does not accelerate the progression of Parkinson’s.
    Despite myths, studies show that levodopa does not cause faster cell loss or worsen the condition over time [1].

Levodopa, also known as L-DOPA, has a rich history dating back to the early 20th century. Here’s a brief timeline:

  • 1913: The German chemist Casimir Funk first synthesises levodopa, a precursor to dopamine, while working at the University of Berlin.
  • 1950s: Researchers begin investigating levodopa’s potential in treating Parkinson’s disease, which was then considered a rare condition.
  • 1957: Arvid Carlsson, a Swedish neuroscientist, discovers that levodopa can increase dopamine levels in the brain, leading to improved motor function in animals with Parkinson’s-like symptoms.
  • 1960: The Austrian neurologist Oleh Hornykiewicz, building on Carlsson’s work, demonstrates that levodopa can effectively treat Parkinson’s disease in humans.
  • 1967: George Cotzias, a Greek-American neurologist, conducts a landmark study showing that high doses of levodopa can significantly improve motor symptoms in Parkinson’s patients.
  • 1970s: Levodopa becomes widely accepted as a treatment for Parkinson’s disease, revolutionising the management of the condition.
  • 1980s: Researchers develop controlled-release formulations and combination therapies to improve levodopa’s efficacy and reduce side effects.
  • Present day: Levodopa remains the most effective treatment for Parkinson’s disease, often used in combination with other medications and therapies.
Levodopa’s discovery and development have had a profound impact on the understanding and management of Parkinson’s, improving the lives of millions of people worldwide.

Infosheet under review

References

(1) American Parkinson Disease Association. (2023). Levodopa: Fact & fiction. Retrieved from https://www.apdaparkinson.org/wp-content/uploads/2023/02/2023LevodopaFactFictionAPDA.pdf 2023_Levodopa_Fact_Fiction_APDA

Evans A, Waterhouse BJ. Levodopa use in Australia: an analysis of Pharmaceutical Benefits Scheme 10% data. BMJ Neurology Open. 2024;6:e000484. https://doi.org/10.1136/bmjno-2023-000484

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