Levodopa

Aromatic amine that is metabolized to dopamine
First-line oral treatment option in combination with carbidopa for motor symptoms in Parkinson’s disease
Available for oral inhalation for “as needed” use for ‘off’ episodes in Parkinson’s patients receiving levodopa/carbidopa

Falling asleep while engaged in activities of daily living, including driving, reported; many patients report somnolence, while other had no warnings signs (sleep attack); some events reported >1 yr after initiating treatment

Rapid dose reduction, withdrawal of, or changes in dopaminergic therapy may result in a symptom complex that resembles neuroleptic malignant syndrome (eg, elevated temperature, muscular rigidity, altered consciousness, autonomic instability)

Hallucinations may occur, accompanied by confusion, insomnia, and excessive dreaming; abnormal thinking and behavior may also occur, including, paranoid ideation, delusion, confusion, psychotic-like behavior, disorientation, aggressive behavior, agitation, and delirium

Decreased impulse control and compulsive behaviors may emerge, including, gambling, sexual urges, spending money, binge eating, and/or other intense urges; patients may not recognize these as abnormal

May cause or exacerbate dyskinesias

Owing to bronchospasm risk, not recommended for patients with asthma, COPD, or other chronic lung disease

May increase intraocular pressure in patients with glaucoma