Levodopa onset of action

Case Study: Kelly came for a Dietitian assessment as she was concerned about a large amount of unintentional weight loss she had experienced. Kelly was aged in her sixties, was diagnosed with Parkinson’s in 2016 and was living with her husband.

During assessment, the following information was obtained:

Current weight: 64 kg (141 pounds)

Estimated healthy weight range: 56-69 kg (123-152 pounds)

Kelly reported the following:

  • 18 kg (39 pounds) weight loss in a 12-month period. Weight stable previous 2-months.
  • Decreased food intake, no hunger, full bloated feeling after eating small amounts.
  • Doesn’t always feel like her levodopa kicks in.
  • No chewing or swallowing issues.
  • Takes levodopa at 6am, 10am, 2pm, 6pm.
  • Mealtimes approximately: breakfast 6am, lunch 1pm, dinner 6pm.
  • No snacks consumed in-between meals.

Issues:

  • Significant loss of weight. Weight now stable. Loss of muscle mass and likely strength.
  • Inadequate food intake and not meeting nutritional requirements.
  • Possible gastroparesis or slow stomach emptying (based on reported symptoms).
  • Potential food and levodopa interactions.

Dietitian notes:

Protein can interfere with how well levodopa is absorbed.

With slow stomach emptying food can remain in the stomach for an abnormally long time and any levodopa taken while the stomach is full of food will be unable to exit into the small intestine. Instead, the levodopa must wait until the stomach clears.

Treatment goals:

  • Optimise nutritional intake
  • Prevent further loss of weight
  • Assist to increase muscle mass (ensure adequate protein intake)
  • Minimise potential food and levodopa interactions

Suggestions made following assessment:

  • Take levodopa on an empty stomach i.e. 30 minutes before a meal.
  • Change mealtimes to minimise potential food and levodopa interactions.

Current regimeSuggested regime
Levodopa: 6am, 10am, 2pm, 6pm
Levodopa: 6am, 10am, 2pm, 6pm
Breakfast: 6am
Lunch: 1pm
Dinner: 6pm
Breakfast: 6.30am
Lunch: 12pm
Dinner: 6.30pm
Introduce a small snack or nourishing drink at 10.30am & 2.30pm

  • Consume smaller and more frequent feedings – instead of trying to eat 3 meals per day I encouraged Kelly to eat at least 5 times per day.
  • Introduce a small snack or nourishing drink at 10.30am & 2.30pm such as:
    • Smoothie e.g. choc smoothie
    • Small handful of nuts
    • Boiled egg
    • Dark chocolate e.g. 85% cocoa
    • Hommus with cucumber/capsicum
  • Ongoing Dietitian review sessions.
  • Make an appointment with a Physiotherapist to guide appropriate exercises to help regain muscle mass.
  • Make an appointment with her doctor for investigation (and potential treatment) of gastroparesis.

 

Disclaimer: This case study contains information that is general in nature and should not be construed as personalised advice. It is not intended to replace information from your health care professional. Always ask your doctor or other health care professional if you have specific health or medical questions. Never make changes to your medication regime without consulting your doctor. Names and some details have been changed to protect privacy.