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Earl T, Jridi A, Thulin PC, Zorn M, McKee KE, Mitrovich K, Moretti P, Alshaikh J, Kassavetis P, Cortez MM, Lamotte G. Effect of levodopa on postural blood pressure changes in Parkinson disease: a randomized crossover study. Clin Auton Res 2024; 34:117-124. [PMID: 38429568 DOI: 10.1007/s10286-024-01024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE We investigated the effect of levodopa on postural blood pressure changes in individuals with Parkinson disease (PD) with (PD+OH) and without neurogenic OH (PD-OH). METHODS We performed a prospective randomized crossover study with autonomic testing performed ON and OFF levodopa. The primary outcome was the change in systolic blood pressure (SBP) from supine to 70° tilt at 3 min (ΔSBP-3'). Secondary outcomes included indices of baroreflex function and blood pressure and heart rate during tilt. RESULTS We enrolled 40 individuals with PD (21 PD+OH, 19 PD-OH), mean age (SD) 73.2 years (7.9), 13 women (32.5%)). There was no difference in age, sex, disease duration, and severity between PD+OH and PD-OH. Mean difference in ΔSBP-3' ON versus OFF levodopa in the whole study population was - 3.20 mmHg [- 7.36 to 0.96] (p = 0.14). Mean difference in ΔSBP-3' was - 2.14 mmHg [- 7.55 to 3.28] (p = 0.45) in PD+OH and - 5.14 mmHg [- 11.63 to 1.35] (p = 0.14) in PD-OH. Mean difference in ΔSBP ON versus OFF levodopa was greater at 7 and 10 min (- 7.52 mmHg [- 11.89 to - 3.15], p = 0.002, and - 7.82 mmHg [- 14.02 to - 1.67], p = 0.02 respectively). Levodopa was associated with lower absolute values of blood pressure in both PD+OH and PD-OH and cardiovascular noradrenergic baroreflex impairment. CONCLUSION Levodopa decreases blood pressure in both PD with and without autonomic failure, but it does not cause a greater fall in blood pressure from supine to standing at 3 min. Levodopa-induced baroreflex sympathetic noradrenergic impairment may contribute to lower blood pressure. Lower standing blood pressure with levodopa may increase the risks of fall and syncope.
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Affiliation(s)
- Timi Earl
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Amani Jridi
- Utah Clinical & Translational Science Institute, University of Utah, Salt Lake City, UT, USA
| | - Perla C Thulin
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Meghan Zorn
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Kathleen E McKee
- Neurosciences Clinical Program, Intermountain Health, Murray, UT, USA
| | - Kristin Mitrovich
- Neurosciences Clinical Program, Intermountain Health, Murray, UT, USA
| | - Paolo Moretti
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- George E. Wahlen VA Medical Center, Salt Lake City, UT, USA
| | - Jumana Alshaikh
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | | | - Melissa M Cortez
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Guillaume Lamotte
- Department of Neurology, University of Utah, Salt Lake City, UT, USA.
- George E. Wahlen VA Medical Center, Salt Lake City, UT, USA.
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Cani I, Guaraldi P, Giannini G, Sambati L, Barletta G, Cortelli P, Calandra‐Buonaura G. Levodopa-induced orthostatic hypotension in parkinsonism: A red flag of autonomic failure. Eur J Neurol 2024; 31:e16061. [PMID: 37724992 PMCID: PMC11235727 DOI: 10.1111/ene.16061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND AND PURPOSE Levodopa (LD) is the main treatment for parkinsonism, but its use may be limited by a potential hypotensive effect. METHODS We evaluated the cardiovascular effect of LD performing head-up tilt test (HUTT) before and 60 min after 100/25 mg LD/dopa-decarboxylase inhibitor (pre-LD vs. post-LD HUTT) in 164 patients with parkinsonism on chronic LD treatment. Features predictive of LD-induced orthostatic hypotension (OH) were assessed by logistic regression analysis. RESULTS Basal supine blood pressure (BP) and heart rate (HR) decreased after LD. During post-LD HUTT, BP drop and HR increase were significantly greater than at pre-LD HUTT. Thirty-eight percent of patients had OH at post-LD HUTT compared to 22% of patients presenting OH at pre-LD HUTT (p < 0.001). Risk factors for LD-induced/worsened OH were pre-LD OH (odds ratio [OR] = 36, 95% confidence interval [CI] = 10-131), absence of overshoot at Valsalva maneuver (OR = 9, 95% CI = 4-20), and pathological Valsalva ratio (OR = 6, 95% CI = 2-15). CONCLUSIONS LD administration caused/worsened hypotension in both supine and orthostatic conditions. Patients with cardiovascular autonomic failure had a higher risk of developing LD-induced OH. In clinical practice, LD-induced OH could represent a red flag for cardiovascular autonomic failure.
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Affiliation(s)
- Ilaria Cani
- Department of Biomedical and NeuroMotor SciencesAlma Mater Studiorum ‐ University of BolognaBolognaItaly
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Pietro Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Giulia Giannini
- Department of Biomedical and NeuroMotor SciencesAlma Mater Studiorum ‐ University of BolognaBolognaItaly
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Luisa Sambati
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Giorgio Barletta
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Pietro Cortelli
- Department of Biomedical and NeuroMotor SciencesAlma Mater Studiorum ‐ University of BolognaBolognaItaly
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Giovanna Calandra‐Buonaura
- Department of Biomedical and NeuroMotor SciencesAlma Mater Studiorum ‐ University of BolognaBolognaItaly
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
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Duan SC, Kwon SJ, Eom SH. Effect of Thermal Processing on Color, Phenolic Compounds, and Antioxidant Activity of Faba Bean ( Vicia faba L.) Leaves and Seeds. Antioxidants (Basel) 2021; 10:antiox10081207. [PMID: 34439455 PMCID: PMC8388975 DOI: 10.3390/antiox10081207] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 12/21/2022] Open
Abstract
The leaves and seeds of the faba bean are good sources of L-3,4-dihydroxyphenylalanin (L-dopa), and are usually eaten with thermal cooking methods. However, little information is available on the effect of thermal treatments on their nutritional value. We compared the changes in color, contents of L-dopa, vitamin C (Vc), total phenolics (TP), total flavonoids (TF) and antioxidant activity after dry heating or steaming faba bean leaves and seeds. The young leaves provided higher values of all the estimate factors, regardless of the thermal treatment. Steaming significantly degraded nutritional values of the leaves, but less changed in seeds, whereas dry heat maintained these attributes. The contents of L-dopa, Vc, TP and TF were shown to have strongly positive correlations with antioxidant activity in the leaves, whereas only L-dopa content was positively correlated with antioxidant activity of the seeds. Faba leaves contained relatively high L-dopa which possessed strong antioxidant activity compared to the Vc. As L-dopa is an important contributor to the antioxidant activity of faba leaves and seeds, consuming L-dopa from leaves may provide beneficial effects not only regarding Parkinson's Disease.
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Affiliation(s)
- Shu-Cheng Duan
- Department of Horticultural Biotechnology, College of Life Sciences, Kyung Hee University, Yongin 17104, Korea;
| | - Soon-Jae Kwon
- Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup 56212, Korea;
| | - Seok-Hyun Eom
- Department of Horticultural Biotechnology, College of Life Sciences, Kyung Hee University, Yongin 17104, Korea;
- Correspondence:
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Siddiqi SH, Abraham NK, Geiger CL, Karimi M, Perlmutter JS, Black KJ. The Human Experience with Intravenous Levodopa. Front Pharmacol 2016; 6:307. [PMID: 26779024 PMCID: PMC4701937 DOI: 10.3389/fphar.2015.00307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/11/2015] [Indexed: 11/24/2022] Open
Abstract
Objective: To compile a comprehensive summary of published human experience with levodopa given intravenously, with a focus on information required by regulatory agencies. Background: While safe intravenous (IV) use of levodopa has been documented for over 50 years, regulatory supervision for pharmaceuticals given by a route other than that approved by the U.S. Food and Drug Administration (FDA) has become increasingly cautious. If delivering a drug by an alternate route raises the risk of adverse events, an investigational new drug (IND) application is required, including a comprehensive review of toxicity data. Methods: Over 200 articles referring to IV levodopa were examined for details of administration, pharmacokinetics, benefit, and side effects. Results: We identified 142 original reports describing IVLD use in humans, beginning with psychiatric research in 1959–1960 before the development of peripheral decarboxylase inhibitors. At least 2760 subjects have received IV levodopa, and reported outcomes include parkinsonian signs, sleep variables, hormone levels, hemodynamics, CSF amino acid composition, regional cerebral blood flow, cognition, perception and complex behavior. Mean pharmacokinetic variables were summarized for 49 healthy subjects and 190 with Parkinson's disease. Side effects were those expected from clinical experience with oral levodopa and dopamine agonists. No articles reported deaths or induction of psychosis. Conclusion: At least 2760 patients have received IV levodopa with a safety profile comparable to that seen with oral administration.
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Affiliation(s)
- Shan H Siddiqi
- Department of Psychiatry, Washington University School of Medicine St. Louis, MO, USA
| | - Natalia K Abraham
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Ottawa, ON, Canada
| | | | - Morvarid Karimi
- Department of Neurology, Washington University School of Medicine St. Louis, MO, USA
| | - Joel S Perlmutter
- Programs in Occupational Therapy and Physical Therapy, Division of Biology and Biomedical Sciences, Departments of Neurology, Radiology, and Anatomy and Neurobiology, Washington University School of Medicine St. Louis, MO, USA
| | - Kevin J Black
- Division of Biology and Biomedical Sciences, Departments of Psychiatry, Neurology, Radiology, and Anatomy and Neurobiology, Washington University School of Medicine St. Louis, MO, USA
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Garland EM, Cesar TS, Lonce S, Ferguson MC, Robertson D. An increase in renal dopamine does not stimulate natriuresis after fava bean ingestion. Am J Clin Nutr 2013; 97:1144-50. [PMID: 23553159 PMCID: PMC3628380 DOI: 10.3945/ajcn.112.048470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Fava beans (Vicia faba) contain dihydroxyphenylalanine (dopa), and their ingestion may increase dopamine stores. Renal dopamine regulates blood pressure and blood volume via a natriuretic effect. OBJECTIVE The objective was to determine the relation between dietary fava beans, plasma and urinary catechols, and urinary sodium excretion in 13 healthy volunteers. DESIGN Catechol and sodium data were compared by using a longitudinal design in which all participants consumed a fixed-sodium study diet on day 1 and the fixed-sodium diet plus fava beans on day 2. Blood was sampled at 1, 2, 4, and 6 h after a meal, and 3 consecutive 4-h urine samples were collected. RESULTS Mean (±SD) plasma dopa was significantly greater 1 h after fava bean consumption (11,670 ± 5440 compared with 1705 ± 530 pg/mL; P = 0.001) and remained elevated at 6 h. Plasma dopamine increased nearly 15-fold during this period. Fava bean consumption also increased urinary dopamine excretion to 306 ± 116, 360 ± 235, and 159 ± 111 μg/4-h urine sample compared with 45 ± 21, 54 ± 29, and 44 ± 17 μg in the 3 consecutive 4-h samples after the control diet (P ≤ 0.005). These substantial increases in plasma and urinary dopa and dopamine were unexpectedly associated with decreased urinary sodium. CONCLUSION The failure of fava bean consumption to provoke natriuresis may indicate that dopa concentrations in commercially available beans do not raise renal dopamine sufficiently to stimulate sodium excretion, at least when beans are added to a moderate-sodium diet in healthy volunteers. This trial was registered at clinicaltrials.gov as NCT01064739.
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Affiliation(s)
- Emily M Garland
- Autonomic Dysfunction Center and Pharmacology, Vanderbilt University School of Medicine, Nashville, TN 37232-2195, USA.
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Pursiainen V, Lyytinen J, Pekkonen E. Effect of duodenal levodopa infusion on blood pressure and sweating. Acta Neurol Scand 2012; 126:e20-4. [PMID: 22329867 DOI: 10.1111/j.1600-0404.2012.01648.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Non-motor symptoms are a major contributor to quality of life in patients with advanced Parkinson's disease (PD). Duodenal levodopa infusion (DLI) has been shown to alleviate motor fluctuations, but data on its possible effect on non-motor symptoms are scarce. The aim of the study was to assess the effect of DLI on blood pressure (BP), sweating, and non-motor symptoms. METHODS We evaluated prospectively and open-label nine male patients with advanced PD (age 68.5 ± 6.2 years) treated with DLI because of daily motor fluctuations. Patients were evaluated using orthostatic test, sweating and skin temperature measurements, Unified Parkinson's Disease Rating Scale (UPDRS), Non-motor Symptom Scale (NMSS), and PDQ-39 before and after 2 months of treatment. RESULTS Orthostatic BP drop worsened after 1 week of DLI compared with oral medication (24.1 vs 11.9 mmHg, P = 0.011) and remained significant after 2 months of treatment. UPDRS motor scores improved significantly in 2 months compared with baseline (25 vs 19, P < 0.01). Sweating or skin temperatures did not change. Several domains in NMSS (sleep/fatigue, gastrointestinal symptoms, sweating) and PDQ-39 (mobility, bodily discomfort, communication) improved significantly. CONCLUSIONS BP should be monitored during initiation of DLI because of the risk of orthostatic hypotension. Our results indicate that DLI improves both motor and non-motor symptoms in patients with advanced PD.
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Affiliation(s)
| | - J. Lyytinen
- Department of Neurology; Helsinki University Central Hospital; Helsinki; Finland
| | - E. Pekkonen
- Department of Neurology; Helsinki University Central Hospital; Helsinki; Finland
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Autonomic nervous system and risk factors for vascular disease. Effects of autonomic unbalance in schizophrenia and Parkinson’s disease. Neurol Sci 2008; 29:15-21. [DOI: 10.1007/s10072-008-0853-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 01/31/2008] [Indexed: 11/27/2022]
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Männistö PT, Ulmanen I, Lundström K, Taskinen J, Tenhunen J, Tilgmann C, Kaakkola S. Characteristics of catechol O-methyl-transferase (COMT) and properties of selective COMT inhibitors. PROGRESS IN DRUG RESEARCH. FORTSCHRITTE DER ARZNEIMITTELFORSCHUNG. PROGRES DES RECHERCHES PHARMACEUTIQUES 1992; 39:291-350. [PMID: 1475365 DOI: 10.1007/978-3-0348-7144-0_9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- P T Männistö
- Department of Pharmacology and Toxicology, University of Helsinki, Finland
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Lee MR. Five years' experience with gamma-L-glutamyl-L-dopa: a relatively renally specific dopaminergic prodrug in man. JOURNAL OF AUTONOMIC PHARMACOLOGY 1990; 10 Suppl 1:s103-8. [PMID: 2129121 DOI: 10.1111/j.1474-8673.1990.tb00235.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
1. Over the last 5 years we have given intravenous gludopa in man and established its effects on the kidney. 2. At doses of 12.5 to 100 micrograms kg-1 min-1 it is natriuretic and also tends to increase renal blood flow and glomerular filtration. Despite the natriuresis, plasma renin activity is depressed and this effect is blocked by domperidone. The receptors for the tubular natriuretic effect are blocked by d-sulpiride. 3. Four-hour infusions in man do not lower blood pressure; 10-h infusions lower blood pressure and increase pulse rate. 4. The oral bioavailability of gludopa is only 1 to 2% and this rules out the dipeptide as an effective dopaminergic prodrug.
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Affiliation(s)
- M R Lee
- Clinical Pharmacology Unit, Royal Infirmary, Edinburgh, Scotland
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Abstract
Some amino acids have bioregulatory functions, which far exceed those of precursors for proteins or of substrates for specific enzymes. Two of these amino acids, L-tyrosine and L-dopa, are precursors to melanin and catecholamines. In vertebrates, they can act as inducers and regulators of the melanogenic apparatus and of MSH receptors--two quite complex functions that could hardly be performed by mere substrates. Focussing on the pigmentary system as a study model, we therefore explore the hypothesis that L-tyrosine and L-dopa act as hormone-like bioregulators in mammals, with melanocytes regulating tyrosine and dopa activity via their metabolic consumption.
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Affiliation(s)
- A Slominski
- Toolan Institute for Medical Research, Bennington, VT 05201
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