Paper I
2025 March (Supplementary (SAY)) (2019 Scheme) · 100 marks · 180 min

Question

Explain the rationale of Levodopa and Carbidopa fixed drug combination in Parkinson’s disease

Q104 marksShort Answers

Answer

Carbidopa (a peripheral dopa-decarboxylase inhibitor that does not cross the blood-brain barrier) is combined with levodopa to prevent peripheral conversion of levodopa to dopamine before it reaches the CNS. Since dopamine itself cannot cross the blood-brain barrier, levodopa (its precursor) must be given — but without carbidopa, most of an oral dose would be decarboxylated peripherally, producing dopamine-mediated peripheral adverse effects (nausea, vomiting, postural hypotension, cardiac arrhythmias) while only a small fraction reached the brain. Co-administration increases the CNS-available fraction of levodopa (allowing the dose to be reduced by up to 75%) and substantially reduces the peripheral adverse-effect burden for the same central antiparkinsonian effect — though it does not reduce central dyskinesias, which can still occur or even be more prominent given more levodopa now reaches the brain.

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