Objective: To assess the influence of patient age on prescribed dosage and subsequent dose escalation regimes of levodopa therapy in a cohort of people with Parkinson’s (PwP).

Background: PD is typically diagnosed later in life with majority being elderly. Age poses challenges to therapy prescription and adherence, due to co-morbidities and polypharmacy. Levodopa is recommended as first-line therapy in the pharmacological management of motor symptoms of PD. However, there is a lack of consensus on whether dosage of Levodopa should be adapted for older adults.

Methods: A descriptive, cross-sectional study was undertaken on a cohort of PD patients in a University Hospital clinic in Cardiff, UK. Inclusion criteria were a diagnosis of Idiopathic PD between 2000-2016, and current Levodopa therapy. The study group (n = 54) was separated into subgroups by age: <75 (n = 27) and 75 (n = 27). Data on drug dosing were retrospectively collected from the electronic health record and the groups were compared for initial dosage of levodopa and whether their dose was subsequently escalated.

Results: The mean total daily dose at commencement of levodopa therapy was 287.7mg for patients <75 years and 345.6mg for patients 75 years. The data was not normally distributed; Mann-Whitney U test (p = 0.088) indicates that this difference in the mean starting doses was not statistically-significant. Of these patients, 63% (17) of the <75 group had their dose escalated during their treatment, compared to 37% (10) of the 75 group.

Conclusions: Although based on a small sample size, this study suggests that prescribers trend towards more caution in levodopa dose-escalation in older people. Possible reasons for this would include drug tolerability, the presence or risk of adverse effects, perceived frailty, and co-morbidities in the older group. Interestingly the higher mean starting dose in the older group (75) may account for the less frequent dose escalation in these patients, but any discrepancy in starting dose between the two age groups was not significant. The use of levodopa as monotherapy versus as an add-on agent may explain some of this difference but further research is needed to corroborate these results and assess the extent of levodopa dose escalation regimes.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-age-on-levodopa-dosage-regimes-in-idiopathic-parkinsons-disease/