Abstract Details

Title Acute Effects of Oral Levodopa on Seated Mean Arterial Blood Pressure in Parkinson’s Disease

Topic Movement Disorders

Presentation(s) P7 - Poster Session 7 (5:00 PM-6:00 PM)

Poster/Presentation
Number 5-021

Objective Determine the acute effects of levodopa on blood pressure (BP) in persons with Parkinson’s disease (PwP).

Background

Levodopa decreases BP in PwP [1-5]. This is thought to be due to a negative inotropic effect, either due to central sympathetic inhibition or peripheral cardiac effects [6]. Intravenous levodopa is associated with hypotension that correlates with better motor performance and higher levodopa levels [7], but no pharmacodynamic studies have determined oral levodopa’s effects on BP. Understanding this relationship is relevant to guide therapeutic decision-making, e.g., how aggressively to treat hypotension before initiating or increasing levodopa.

Design/Methods Using novel technology to measure levodopa from finger-pricked blood [8], we recruited PwP [9] taking oral carbidopa/levodopa with baseline BP ≥ 90/60 mmHg. Participants arrived after holding antiparkinsonian medications overnight. At time 0 they took carbidopa/levodopa instant-release tablets. Capillary blood levodopa levels, BP measurements (seated), and motor assessments using a modified Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III [11] were performed at baseline and repeated every 10 minutes for 100 minutes. Non-compartmental pharmacokinetic parameters of levodopa were determined including AUC0→last, Cmax, Tmax (Phoenix WinNonLin v 8.4).

Results We enrolled 14 PwP (6 females, mean age 69.5 years, ± 7.6). Two had orthostatic hypotension, and six took antihypertensive medications. The mean arterial pressure (MAP = DBP + (SBP-DBP)/3) dropped over the course of the study visit for all participants, with an average of 105 mmHg ± 13.1 at baseline to a nadir of 74 mmHg ± 32.5. The average maximum drop in MAP occurred at 100 minutes post-dose and as mean AUC increases over time, mean MAP decreases.

Conclusions

Oral levodopa is associated with acute hypotension in PwP, and levodopa exposure and MAP are inversely correlated. These effects should be considered when adjusting levodopa doses, especially in people with hypotension, to improve safety outcomes.

Authors/Disclosures
Katherine Longardner, MD (UCSD MEDICAL CENTER) PRESENTER	Dr. Longardner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Scientific. Dr. Longardner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. An immediate family member of Dr. Longardner has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Boston Scientific. An immediate family member of Dr. Longardner has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Trisalus. An immediate family member of Dr. Longardner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AstraZenica. An immediate family member of Dr. Longardner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sirtex. An immediate family member of Dr. Longardner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Society of Interventional Oncology. An immediate family member of Dr. Longardner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for France Foundation. An immediate family member of Dr. Longardner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Varian. Dr. Longardner has received research support from NIH.
Catherine W. Liu, PharmD	Dr. Liu has received personal compensation in the range of $10,000-$49,999 for serving as a Fellow with UCSD.
Jeremiah Momper (University of California San Diego)	No disclosure on file
Kuldeep Mahato (University of California- San Diego)	Kuldeep Mahato has nothing to disclose.
Chochanon Moonla (University of California San Diego (UCSD))	Chochanon Moonla has nothing to disclose.
Hamidreza Ghodsi, MD	Dr. Ghodsi has nothing to disclose.
Joseph Wang (UCSD)	Joseph Wang has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for VitalTrace.
Irene Litvan, MD, FAAN (UC San Diego Parkinson and Other Movement Disorder Center)	Dr. Litvan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Aprinoia. Dr. Litvan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. Litvan has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers in Neurology. Dr. Litvan has received personal compensation in the range of $50,000-$99,999 for serving as a Chief Editor with Frontiers in Neurology.

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