Effects of dietary factors on levodopa pharmacokinetics

Fernández, Nélida; García, José Alejos; Diez, M. José; Sahagún, Ana M.; Díez, Raquel; Sierra, Matilde

doi:10.1517/17425251003674364

Cited by 10 publications

(6 citation statements)

References 89 publications

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“…Salicylic acid has been shown to facilitate the absorption of levodopa after rectal administration in rats by a mechanism that requires its presence in the rectal membrane [ 38 ]. Studies have shown that exogenous administration of ascorbic acid improves levodopa absorption ( C max and AUC) in PD patients with poor levodopa bioavailability [ 39 , 40 ]. Therefore, one may speculate that tartaric acid cumulatively extends the window of levodopa absorption in the gastrointestinal tract by promoting an acidic milieu in regions of the intestine where levodopa is a substrate for pH-sensitive amino acid transporters or exchangers, by inhibiting P-gp-mediated efflux from the more distal regions of the intestine or by enhancing its mucosal permeation via paracellular pathways.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of Rytary®, An Extended-Release Capsule Formulation of Carbidopa–Levodopa

Mittur¹,

Gupta²,

Modi³

2017

Clin Pharmacokinet

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Parkinson’s disease (PD) is a chronic progressive neurological disorder characterized by resting tremor, rigidity, bradykinesia, gait disturbance, and postural instability. Levodopa, the precursor to dopamine, coadministered with carbidopa or benserazide, aromatic amino acid decarboxylase inhibitors, is the most effective and widely used therapeutic agent in the treatment of PD. With continued levodopa treatment, a majority of patients develop motor complications such as dyskinesia and motor ‘on-off’ fluctuations, which are, in part, related to the fluctuations in plasma concentrations of levodopa. A new extended-release (ER) carbidopa–levodopa capsule product (also referred to as IPX066) was developed and approved in the US as Rytary® and in the EU as Numient®. The capsule formulation is designed to provide an initial rapid absorption of levodopa comparable to immediate-release (IR) carbidopa–levodopa, and to subsequently provide stable levodopa concentrations with reduced peak-to-trough excursions in plasma concentrations in order to reduce motor fluctuations associated with pulsatile stimulation of dopamine receptors and to minimize dyskinesia. Phase III studies of this ER carbidopa–levodopa capsule formulation in patients with PD have shown a significant reduction in ‘off’ time compared with IR carbidopa–levodopa and carbidopa–levodopa–entacapone. We present a review of the clinical pharmacokinetics and pharmacodynamics of this ER product of carbidopa–levodopa in healthy subjects and in patients with PD.Electronic supplementary materialThe online version of this article (doi:10.1007/s40262-017-0511-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of Rytary®, An Extended-Release Capsule Formulation of Carbidopa–Levodopa

Mittur¹,

Gupta²,

Modi³

2017

Clin Pharmacokinet

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“…While some dietary patterns focus on the distribution of different food groups in an individual’s diet, other dietary patterns focus on the distribution of macronutrients, such as protein. Previous research linked dietary protein to levodopa bioavailability based on both substances utilizing the same large neutral amino acid transporter for absorption in the small intestine and transport across the blood–brain barrier [ 85 , 86 , 87 ]. The purpose of a PRD is to improve the bioavailability of levodopa by limiting protein consumption [ 87 , 88 ].…”

Section: Protein-restricted Dietmentioning

confidence: 99%

The Role of Diet and Dietary Patterns in Parkinson’s Disease

et al. 2022

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Parkinson’s Disease (PD) is a neurodegenerative disorder associated with diminished nutrition status and decreased quality of life. While the prevalence of PD is expected to increase, no preventative or curative therapy for PD exists at this time. Although nutrition and diet represent modifiable risk factors for reducing chronic disease risk, research on the impact of single nutrients on PD has yielded mixed results. As a result, this single-nutrient approach may be the driving force behind the inconsistency, and a holistic dietary approach may overcome this inconsistency by accounting for the interactions between nutrients. The following review aims to examine the impact of a generally healthy dietary pattern, the protein-restricted diet (PRD), the ketogenic diet (KD), the Mediterranean diet (MD), and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet on PD risk, progression, and severity. While most of the included studies support the role of diet and dietary patterns in reducing the risk of PD or alleviating PD severity, the inconsistent results and need for further evidence necessitate more research being conducted before making dietary recommendations. Research on the potential beneficial effects of dietary patterns on PD should also investigate potential risks.

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“…Intake of levodopa with foods, the time of ingestion of a meal, fat, fiber, ascorbic acid may change the effectiveness of drug in the body (Fernandez et al 2010). Patients receiving levodopa treatment should be monitored for food intake with the drug, carbohydrate and protein content of the meals, and associated micronutrient deficiencies.…”

Section: Dopaminergic Agentsmentioning

confidence: 99%

Role of food-drug interactions in neurological and psychological diseases

Karadağ¹,

Çelik²,

Kadayifçi³

et al. 2018

Acta Neurobiologiae Experimentalis

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Given that foods and nutrients have been shown to influence the pharmacokinetics of drugs, drugs may cause changes in the nutritional status of patients and their response to a given drug. Food-drug interactions are particularly relevant for drugs used to treat neurological and psychological diseases. This review provides an overview of food-drug interaction in the treatment of neurological and psychological diseases. A literature search was carried out by collecting data from different reviews, reports, and original articles on general or specific drug interactions with food, in patients with a variety of neurological and psychological diseases. Based on our review, we found that food-drug interactions may alter the expected impact of drug, or cause the development of a drug toxicity. Nutritional status of the patients may also be affected, particularly a change in body weight caused by a change appetite. Metabolism, absorption, and excretion of foods may also be altered, and nutritional insufficiencies may occur. Recent studies show that diet can have a strong influence on gut microbiota and thus, alter drug pharmacokinetics.Therefore, microbiota alterations should also be considered while assessing food-drug interactions. Knowledge of food-drug interactions is critical for improving health of patients with neurological and psychological diseases, and also for improving effectiveness of treatments.

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Effects of dietary factors on levodopa pharmacokinetics

Cited by 10 publications

References 89 publications

Pharmacokinetics of Rytary®, An Extended-Release Capsule Formulation of Carbidopa–Levodopa

Pharmacokinetics of Rytary®, An Extended-Release Capsule Formulation of Carbidopa–Levodopa

The Role of Diet and Dietary Patterns in Parkinson’s Disease

Role of food-drug interactions in neurological and psychological diseases

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