Levodopa

in SINEMET

Open Levodopa in the interactive console ↗

Pronunciation: lee-voe-DOE-pa

Levodopa ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Levodopa ballicule

Levodopa mascot mnemonic cartoon — Visual mnemonic: Levodopa mascot
**“Levi Dopey”**

What it isDopamine precursor, given with carbidopa to block peripheral decarboxylation; Parkinson disease.

Why this oneBy far the most effective symptomatic treatment in Parkinson disease.

What limits itMotor fluctuations and dyskinesia accumulate with duration of therapy. Protein competes for absorption; never stop abruptly.

Pearls

Impulse-control disorders less frequent than with dopamine agonists
Abrupt withdrawal can trigger an NMS-like syndrome
Hallucinations and confusion rise with age and dementia
Inhaled form rescues off episodes; avoid in asthma or COPD

Levodopa molecular structure (skeletal formula) — Molecular structure: Levodopa

Levodopa prescription history

Animated chart of estimated U.S. prescriptions per year, Parkinson medicines (1948–2026). Levodopa enters in 1970 (estimated).

FDA-approved for

Parkinson disease (1970)

Principal riskDyskinesia and motor fluctuation with cumulative exposure

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability1 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryUnknown / historical label unavailable

Defining liabilityOrthostasis, hallucinations, dyskinesia and impulse-control symptoms; abrupt withdrawal can be hazardous.

FDA label

Read the full label on DailyMed ↗

NO BOXED WARNINGS

FDA dosing	Population	Start	Target	Max
Parkinson's disease — intermittent OFF episodes (adjunct to carbidopa/levodopa)	Adults	84 mg (two 42 mg capsules) PRN per OFF period	84 mg PRN per OFF period, up to 5x/day	84 mg per OFF period; 420 mg/day

Renal Undefined

Hepatic Undefined

Max 84 mg per OFF period; max 420 mg/day (up to 5 uses/day).

Instructions

Oral inhalation only using the INBRIJA inhaler; do NOT swallow capsules.
Use only in combination with oral carbidopa/levodopa.
Avoid sudden discontinuation or rapid dose reduction (withdrawal-emergent hyperpyrexia/confusion).
Store capsules in blister until immediately before use.

Available strengths

inhaler 42 mg/inh (Inbrija)

Contraindications

MAOIs (concurrently or within 14 days)
Current or recent (within 2 weeks) use of a nonselective MAO inhibitor (e.g., phenelzine, tranylcypromine) — risk of hypertension

Cautions

Falling asleep during activities of daily living / somnolence
Withdrawal-emergent hyperpyrexia and confusion with rapid dose reduction
Hallucinations/psychosis — avoid in major psychotic disorder
Impulse control/compulsive behaviors
May cause or exacerbate dyskinesia
Bronchospasm — not recommended in asthma/COPD/chronic lung disease
May increase intraocular pressure in glaucoma

Adverse reactions

Cough, discolored sputum
Nausea, vomiting
Upper respiratory tract infection

Pregnancy No adequate human data; carbidopa/levodopa developmentally toxic/teratogenic in animals.

Lactation Levodopa detected in human milk; may interfere with lactation (prolactin-lowering).

Cost

Levodopa (IN SINEMET)

Strength		#/mo	generic $/unit	CostPlus
42 mg/inh	inhaler	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Levodopa is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Available combined with: Carbidopa/ levodopa (SINEMET) · Carbidopa/ levodopa ER (RYTARY) · Carbidopa/ levodopa enteral (DUOPA)

Generic entry2032 est.