Madopar Dispersible in the Treatment of Advanced Parkinson's Disease

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Since 1992 we have been treating a total of 195 patients suffering from advanced Parkinson's disease with the dispersible formulation of levodopa plus benserazide 4:1 (Madopar Dispersible). The main indication for changing from standard to dispersible levodopa was the patients' difficulty in swallowing the standard formulation. According to assessments by patients (n = 63) and by the medical and nursing staff, 84% of the patients found that the dispersible form was easier to take than the standard formula. In addition to the greater ease of administration, the symptoms of the disease improved significantly at the same dosage, probably owing to more effective absorption of the active substance. We statistically evaluated this improvement retrospectively in 19 patients. We also administered Madopar Dispersible in patients being fed via NG tube or gastrostomy. After improvement of akinesia and removal of the tube we continued oral Madopar Dispersible in some of these cases. Published data and our own experience have indicated a significantly shorter response time (latency to “on”) of Madopar Dispersible than of Madopar standard. Therefore, we treated patients suffering from early morning akinesia, “delayed-on,” “wearing off,” and “random-off” symptoms with the dispersible formulation. We rarely found any advantages of the dispersible formulation in patients suffering from random fluctuations. Changing from standard to Madopar Dispersible in fluctuating patients did not produce any noteworthy improvement. However, patients suffering from early morning akinesia, “delayed-on,” and “wearing-off” benefitted considerably from the accelerated response. As a result we studied the efficacy of four different forms of Madopar (capsule, tablet, HBS, and Dispersible) in a single-dose experiment on 4 subsequent days in a group of 20 patients suffering from early morning akinesia. We evaluated the parameters of latency to “on,” duration of effect, motor benefit, and dyskinesias in patients receiving the medication in the early morning on an empty stomach. We found that the dispersible formulation had the shortest response time, which can probably be explained by the lack of disintegration in the stomach gastric fluid and by the accelerated resorption.

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