Modest increase in plasma homocysteine follows levodopa initiation in Parkinson's disease

Padraig E. O'Suilleabhain, Teodoro Bottiglieri, Richard B. Dewey, Shailja Sharma, Ramon Diaz-Arrastia

Research output: Contribution to journalArticle

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Abstract

Levodopa, typically ingested chronically at high daily doses, is predictably methylated by means of a series of reactions using B vitamins, which convert methionine to homocysteine. Elevated total plasma homocysteine (tHcy), a risk factor for dementia, has been found in PD patients using levodopa. We prospectively measured the effects on plasma tHcy and B vitamins of levodopa initiation, and measured the effects of dose changes and of treatment with dopamine agonists and entacapone. We collected paired plasma samples, at baseline and again after several months treatment, from patients initiating levodopa (n = 30), from patients whose levodopa dose was doubled (n = 15), halved or stopped (n = 14), from patients starting or stopping entacapone (n = 15) and from patients initiating or doubling dopamine agonist monotherapy (n = 16). Vitamin B12, folate, and tHcy concentrations were measured. Baseline tHcy concentration of 8.7 (2.8) μmol/L increased to 10.1 (3.1) μmol/L (P = 0.004) an average of 94 (range 36 to 200) days after initiation of 604 (240 to 1050) mg/day of L-dopa. Average concentration of vitamin B12 fell from 380 to 291 pmol/L (P = 0.01). Patients who doubled their daily levodopa dose experienced tHcy elevations from 9.5 to 11.1 μmol/L (P = 0.05). Levodopa reduction, agonist treatment, and entacapone treatment did not have significant effects. Levodopa elevates tHcy and lowers vitamin B12 concentration to modest degrees. The clinical implications, if any, have not yet been determined.

Original languageEnglish (US)
Pages (from-to)1403-1408
Number of pages6
JournalMovement Disorders
Volume19
Issue number12
DOIs
StatePublished - Dec 2004

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Levodopa
Homocysteine
Parkinson Disease
Vitamin B 12
Vitamin B Complex
Dopamine Agonists
Therapeutics
Folic Acid
Methionine
Dementia

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Modest increase in plasma homocysteine follows levodopa initiation in Parkinson's disease. / O'Suilleabhain, Padraig E.; Bottiglieri, Teodoro; Dewey, Richard B.; Sharma, Shailja; Diaz-Arrastia, Ramon.

In: Movement Disorders, Vol. 19, No. 12, 12.2004, p. 1403-1408.

Research output: Contribution to journalArticle

O'Suilleabhain, Padraig E. ; Bottiglieri, Teodoro ; Dewey, Richard B. ; Sharma, Shailja ; Diaz-Arrastia, Ramon. / Modest increase in plasma homocysteine follows levodopa initiation in Parkinson's disease. In: Movement Disorders. 2004 ; Vol. 19, No. 12. pp. 1403-1408.
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