This question has been debated for years because patients may develop motor fluctuations after several years of levodopa use. The assumption that Levodopa may be “toxic” led to the strategy of using dopamine agonists first and then adding Levodopa later as symptoms worsened, even though dopamine agonists are less effective and have frequent side effects.

Is Levodopa "toxic"?
Is Levodopa “toxic”?

By contrast, Levodopa is better tolerated and rapidly improves quality of life. A convincing study followed a large group of patients for fourteen years and showed that they develop dyskinesias because the disease progresses and not because they are taking Levodopa.

So, Levodopa is safe but is protective? Even though it is not, according to a new study that looked at 445 patients over 80 weeks, patients and physicians should have confidence in using it in early Parkinson’s.

See the articles by Verschuur and Bressman, both in Jan 24, 2019 issue of the NEJM.

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