Optimization of levodopa therapy

While there is no single correct starting dose for levodopa therapy, many individuals can be started on either the 25/100 or controlled-release formula following the general rule not to attempt to titrate carbidopa-levodopa to the point of “normality” which can lead to toxicity. The physician should also determine the proper use ofany adjunctive medications such combined therapy has become the standard approach to treatment. Following the initial period of therapy, emerging difficulties require a reassessment of therapeutic approaches such as dosage adjustment or introduction of a dopamine agonist. Other possible adverse effects—such as gastrointestinal disorders orthostatic hypotension levodopa-induced psychosis sleep disturbances or parasomnias or drug interactions—also require carefully monitored individual treatment. Nonpharmacologic concerns can help the Parkinson's disease patient achieve and maintain optimal functioning including daily exercise, physical therapy, and involvement with support groups.