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Levodopa doesn’t seem to work as it used to
Due to their proven efficacy, levodopa therapies are prescribed eventually to most people with Parkinson’s. However, long-term use of this medicine may give rise to certain complications where symptom control fades out and the effect of the drug wears off.
Figure 3. Typical pattern of wearing-off during the day
‘Wearing-off’, ‘fading effect’ and ’end-of-dose effect’ all describe the same inconvenient situation where levodopa no longer seems to work as effectively as it used to. This can also happen with other medications.
In the early days of treatment with levodopa, people with Parkinson’s disease experience a period where the symptoms are well controlled for the entire day5. This is a time when people often feel contented with their treatment and is commonly referred to as the ‘honeymoon period’. However, over the years, the effect of levodopa seems to fade and symptom control may become more irregular (Figure 3). During this period of wearing-off, the medicine seems to suddenly stop working, allowing symptoms of Parkinson’s disease to re-emerge and worsen before the next dose of levodopa is due (Figure 3). Because this fading effect is usually seen towards the end of the dose period, wearing-off is also referred to as the ‘end-of-dose effect’.
The symptoms that tend to return during wearing-off may include tremor, stiffness, slowness, muscle cramping, reduced dexterity and agility, mood changes, slowness of thinking, anxiety or even pain at the end-of-dose period.
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