Levodopa

[Wanman4]

Any tried this? If so does it work?

[Joolsg]

It’s a dopamine agonist and more likely to cause Augmentation than Ropinirole or pramipexole.

If your doctor is considering prescribing it- there are other meds, like pregabalin or opioids, which are now more commonly prescribed.

[Hidden]

Sorry to contradict Jools, but Levodopa is not a Dopamine Agonist, it's a dopamine "precursor", the stuff dopamine is made from. It is mainly used for Parkinson's Disease (PD), because in PD there is a LACK of Dopamine in the substantia nigra part of the brain. Giving Levodopa allows the brain to make more Dopamine, thus counteracting the deficiency.

Levodopa has been used for RLS, but it's a bit like the strategy of throwing as much mud at a wall as possible in the hope that some of it will stick.

This is because that unlike PD there is NOT a lack of dopamine in RLS there is a lack of dopamine "receptors", i.e. where the dopamine can work. Adding more Dopamine then doesn't really help. An anology is the dopamine doesn't have enough places to go.

A Dopamine Agonist (DA), however helps the dopamine receptors work better, without raising dopamine levels. An anology is, it makes more places for the dopamine to go.

Levodopa has similar side effects to a DA e.g. restlessness, loss of efficacy and augmentation, but is not actually very effective in relieving RLS.

If anyone tries to prescribe you Levodopa for RLS or you're thinking of taking it, it's not really appropriate.?

[DicCarlson in reply to Hidden]

So - excellent explanation - on this same vein, just how does augmentation work? What is the process causing a DA to well, go the other way?

[Joolsg in reply to Hidden]

Many thanks Manerva- mea culpa!

[Tinabugsu in reply to Hidden]

Levodopa does work for RLS, it just is likely to cause augmentation faster than any other drug. Some ignorant doctors have prescribed levadopa for regular use but really, it should only be used for long plane /car rides. It is certainly effective, I've known some people that have used it for decades without a problem. I too used it in the interim before I saw my sleep specialist. That's when he told me about levadopa.

[Tinabugsu in reply to Hidden]

The Annals of Pharmacotherapy

Appropriate Use of Dopamine Agonists and Levodopa in Restless Legs Syndrome in an Ambulatory Care Setting

Ogochukwu Chidozie Molokwu, PharmD

DISCLOSURES

The Annals of Pharmacotherapy. 2008;42(5):627-632

IN THIS ARTICLE

Abstract and Introduction

Background: Dopaminergic agents are the mainstay therapy for the management of restless legs syndrome (RLS). There are no clear guidelines on RLS management, and no study has evaluated the appropriate use of dopaminergic agents in RLS.

Objective: To evaluate the appropriateness of use of dopaminergic agents in RLS management in an ambulatory care setting based on the most current scientific evidence.

Methods: A retrospective drug utilization evaluation was conducted in patients who received levodopa or dopamine agonist for RLS from July 1, 2006, to July 31, 2007. Patients' medical records were reviewed and data were collected on demographics; comorbidities; laboratory values; doses of levodopa or dopamine agonists; prescribing physician's specialty; and use of alcohol, tobacco, and caffeine.

Results: A total of 27 patients were included in the study for data collection and analysis. Twenty-two (81%) patients were on levodopa and 5 (19%) were on ropinirole. RLS severity was documented in only 2 (7%) patients. Serum ferritin levels and transferrin-iron saturation (Tsat) percentages were not obtained in 18 (67%) and 20 (74%) of the patients, respectively. Two (7%) patients had ferritin levels less than 50 ng/mL, and 7 (26%) patients had ferritin levels greater than 50 ng/mL. Fourteen (52%) patients were taking concurrent antidepressants and 6 (22%) were taking sedating antihistamines. Alcohol and tobacco use was documented in 2 (7%) and 8 (30%) patients, respectively. Twenty-six (96%) of the prescribing physicians were primary care providers.

Conclusions: The findings of this study confirm the need for provider education about the appropriate use of levodopa and dopamine agonists in patients with RLS. Appropriate use of these drugs may help decrease unnecessary adverse effects, complications, and costs.

All material on this website is protected by copyright, Copyright © 1994-2019 by WebMD LLC. This website also contains material copyrighted by 3rd parties.

[Hidden in reply to Tinabugsu]

Thanks Tinabugsu.

A couple of points -

This study concludes that providers need to be educated about the use of Levodopa and DAs for RLS. It doesn't comment on their effectiveness.

The original study was reported in 2008, which is a bit dated in research terms. Further studies may have been carried out since with the same or different conclusions.

It says "no study has evaluated the appropriate use of dopaminergic agents in RLS". That might have been true in 2008, but it might not be true now.

It also says "there are no clear guidelines on RLS management."

This is no longer true. European guidelines were published in 2012. No mention of Levodopa. Only DAs and A2d ligands.

ncbi.nlm.nih.gov/pubmed/229...

In the UK, NICE published guidelines in 2016, which are due for review in 2020. The guidelines make no mention of Levodopa only DAs and A2d ligands.

cks.nice.org.uk/restless-le...

My reasons for thinking that Levodopa is NOT a preferred option, admittedly was mistaken. However, overall, it seems that although Levodopa can have some effect on RLS, its use is limited because of the high risk of augmentation.

[Hidden in reply to Hidden]

Manerva that is the first time i have heard that we lack dopamine receptors, thought it was just the receptor's didnt work well so not enough dopamine gets through .

[Hidden in reply to Hidden]

I believe that's right, I read it somewhete, thete's less of them.

I'll check it again, I may be wrong.

i seem to have it wrong about Levodopa, i.e. it seems that it may be used for RLS, it's not mentioned in NICE guidelines. There is probably some reason for that.

Later - Not so simple, there are several types of dopamine receptor D1, 2, 3, 4 and 5

[Hidden in reply to Hidden]

You could be right about that we lack dopamine receptors, so would be good to see anything that states that. I have always believed its they just dont work well, which i what i always tell people., so if i am wrong then i need to give out the right info. Levodopa can be used for RLS, buts its not used like it used to be because of it augmenting much quicker than the other DA's. Its more known as Sinemet, Dr. B says on his website, it can be used for breakthough RLS, or when RLS is only intermittent. BUT i THINK he has changed his mind about using it for those reasons now. But of course his website needs updating on a few things. Everyday is a learning day, especially where RLS is concerned.

[Hidden in reply to Hidden]

I did find an article from John Hopkins University last night and added it to my post, perhaps I didn't click the button properly because it didn't get posted.

It was a bit ambiguous, I'm not 100% sure I've interpreted it correctly.

Direct quotes

"Imaging studies using special radioactive chemicals have found reduced receptor and transporter function in the brain of more severely affected RLS patients."

and

"Tissues from the Brain Bank have shown that the dopamine cells are normal in appearance and number, with no indication of damage. However, these studies also found that the dopamine receptors were decreased"

hopkinsmedicine.org/neurolo...

[Hidden in reply to Hidden]

Thanks Manerva, i have read all through what Dr Early says many times, but missed the bit on the receptors, altho it does say a malfunction of the receptors too. RLS is a complicated condition for sure. They need to do more research on those decreased receptors find out WHY they malfunction and not allow enough dopamine through.

[Sara_2611]

No never used it at all apologies