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Optimize the Efficacy of Parkinson’s Disease Medication

Your medication should help you maintain your home, work, social and recreational activities. You can optimize the efficacy of your Parkinson’s medication and get the most out of it.

You are the expert of your Parkinson’s medication efficacy. You are the only one who knows whether your medication is improving your symptoms. You can improve the efficacy of Parkinson’s medication and reduce its side effects by adopting a few lifestyle habits. 

You should also talk to your neurologist about the expected and adverse effects of the medication

Certain questions are frequently asked in the Parkinson’s community, especially about levodopa . The following points will help you communicate more effectively with your neurologist who will then be able to prescribe the treatment best suitable for you.

Do not adjust your medications and dosage on your own. Contact your neurologist or nurse for further advice.

The maximum efficacy of levodopa/carbidopa is reached 60 to 90 minutes after medication intake. This is when your symptoms should be minimized. 

Levodopa is absorbed in the intestine, right after the stomach. The stomach of people living with Parkinson’s disease tends to become “lazy” over time. It does not empty completely, especially when the amount ingested is as small as a tablet. Your medication may then stay in your stomach and be ineffective.

You can improve the response time of your medication by drinking at least half a glass of water. This water will send your pill into the intestine, where it will be effective.

You can also try drinking sparkling water since the carbonation in this drink causes your stomach to empty quicker.

Do not take food with protein or soft drinks, especially diet sodas, with your levodopa.

Taking levodopa improves Parkinson’s symptoms, especially tremors. 

Some involuntary movements occur right after taking levodopa. These are sometimes confused with the typical tremors of the disease.

These involuntary movements are dyskinesias. They are defined as movements with the following characteristics:

  • Disorderly and chaotic
  • Do not have a regular pattern that repeats itself
  • Not stereotypical
  • Look like fast dance moves
  • Usually little to no pain
  • Do not cause muscle tension

Dyskinesias are often caused by excessive levodopa. They usually appear after several years of treatment and are more common in people diagnosed at a young age.

Your neurologist can adjust the dose of each intake so that you no longer suffer from this adverse effect. Dyskinesias do not depend on your total daily dose.

This dose adjustment is a careful balance between the effectiveness of levodopa on your symptoms and the onset of dyskinesias.

Once your neurologist finds the optimal levodopa dose suitable for
each intake , this dose usually remains the same for the entirety of your treatment but your total daily dose will increase over time.  

If levodopa was your only form of treatment for several years, the ineffectiveness of your treatment can be resolved by increasing each individual dose.

Take your levodopa at least 60 minutes before or after meals and snacks. Make sure not to take any protein (dairy products, meat, nuts, soy, etc.) with your medication.

After a few years of treatment, levodopa tends to get less effective. This is especially noticeable in the morning, when you haven’t taken medication for a long time (i.e., all night). Your motor and non-motor symptoms reappear at these times. 

This phenomenon is called motor fluctuations. You need to pay careful attention and note the times at which these symptoms surface and when you take levodopa. Your neurologist will then be able to adjust your treatment by adding more levodopa throughout the day. 

Parkinson’s medication often causes nausea in the first months of treatment or after a dose increase. 

You can take your levodopa with a light snack and at least half a glass of water to help reduce nausea. Make sure this snack does not have protein. Apple sauce or nut-free crackers are great choices for your levodopa intake.

A change in levodopa dosage can also cause nausea, especially if the dose of your other medication, usually carbidopa, was reduced.

You can also try to take your other medication at a different time than your levodopa. Your diet does not affect the absorption of most other Parkinson’s medication. Speak with your pharmacist.

If you develop nausea when you have never had it before, it might not be associated with the use of levodopa

Levodopa does not usually cause stomach cramps.

Sleep disorders are common in people living with Parkinson’s disease. Some better habits can help you sleep better, and your doctor can also help by prescribing sleeping pills. 

If rigidity and restlessness are affecting your sleep, your neurologist may prescribe an extra dose of levodopa one hour before bedtime or other additional doses.

In the first few years, your ability to store levodopa is high. Your intake schedule, while relatively stable, can tolerate some shortcomings. 

As Parkinson’s disease progresses, your body’s levodopa storage capacity decreases. You are permanently on the same supply from your previous dose.

  • Taking levodopa too early could cause overdose and dyskinesias
  • Delaying the intake could plunge you into an OFF state, where all your symptoms will appear

In advanced Parkinson’s disease, effective levodopa dosage requires a careful balance to achieve maximum control with minimum secondary effects. The balance built up over several months can quickly be destroyed by missing doses. Rebuilding this balance can then take time and sometimes requires hospitalization.

Protein found in meat, fish, eggs, dairy products, legumes and more interfere with your body’s capacity to absorb levodopa. Take your levodopa at least 60 minutes before or after your meals. 

Avoid taking aspartame, found in “diet” soft drinks, coffee sweeteners and in “sugar-free” chewing gum, with your levodopa. Aspartame may slow down the absorption of your medication.

Sugar found in food causes a faster assimilation of levodopa. However, regular intake of sugar-rich foods is not good for your health.

Iron supplements can reduce the absorption of levodopa. Avoid taking them unless suggested by your doctor.

Drinking one glass of wine per day during meals seems to have a positive effect on Parkinson’s disease.

Levodopa sometimes causes drowsiness in the afternoon. Drowsiness is most often related to the poor quality of sleep of people living with Parkinson’s disease. 

”Stars” and dizziness are symptoms of Parkinson’s disease caused by a drop in blood pressure during changes in position (standing after sitting or lying down). 

Medications that replenish your dopamine supply tend to worsen this pressure-reducing effect. Their effect should only last a few hours. Speak to your doctor about this effect to review your complete list of medications and assess your blood pressure. You may be at risk of falls.

Your medication must be effective for you to be physically active. Regular physical activity seems to increase the effectiveness of Parkinson’s medications. By optimizing your medication intake and exercising at least 30 minutes a day, you enter a virtuous circle where you take control of the disease. 


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