Levodopa

The Basics

What is Levodopa?

Used alone or in combination with carbidopa to treat Parkinson’s disease.

Brand names for Levodopa

Duopa

How Levodopa is classified

Antiparkinson Agents, Dopamine Agents

Levodopa During Pregnancy

Levodopa pregnancy category

Category CNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking Levodopa while pregnant

There are no adequate or well-controlled studies in pregnant women. It has been reported from individual cases that levodopa crosses the human placental barrier, enters the fetus, and is metabolized. In animal studies, carbidopa-levodopa has been shown to be developmentally toxic (including teratogenic effects) at clinically relevant doses. DUOPA should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. When administered to pregnant rabbits throughout organogenesis, carbidopa-levodopa caused both visceral and skeletal malformations in fetuses at all doses and ratios of carbidopa-levodopa tested. No teratogenic effects were observed when carbidopa-levodopa was administered to pregnant mice throughout organogenesis. There was a decrease in the number of live pups delivered by rats receiving carbidopa-levodopa during organogenesis.

Taking Levodopa While Breastfeeding

What are recommendations for lactation if you're taking Levodopa?

Limited data indicate that levodopa is poorly excreted into breastmilk and that the sustained-release product may result in a smaller amount of drug transferred to the breastfed infant than with the immediate-release product. Several studies indicate that levodopa can decrease serum prolactin during lactation. The prolactin level in a mother with established lactation may not affect her ability to breastfeed. The effect of long-term use of levodopa on breastfeeding has not been adequately evaluated, although some mothers were able to successfully breastfeed her infant without apparent harm while using relatively low doses of levodopa and carbidopa for Parkinson’s disease.

Maternal / infant drug levels

Limited data indicate that levodopa is poorly excreted into breastmilk and that the sustained-release product may result in a smaller amount of drug transferred to the breastfed infant than with the immediate-release product. Several studies indicate that levodopa can decrease serum prolactin during lactation. The prolactin level in a mother with established lactation may not affect her ability to breastfeed. The effect of long-term use of levodopa on breastfeeding has not been adequately evaluated, although some mothers were able to successfully breastfeed her infant without apparent harm while using relatively low doses of levodopa and carbidopa for Parkinson’s disease.

Possible effects of Levodopa on milk supply

Levodopa decreases serum prolactin in normal women and those with hyperolactinemia[3][4][5][6][7][8][9][10][11] and can suppress inappropriate lactation in galactorrhea,[3] although not consistently.[8] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

One mother with Parkinson’s disease took sustained-release levodopa 200 mg and carbidopa 50 mg 4 times daily. She successfully breastfed her infant.[1]

On postpartum day 3, 5 women were given a single oral dose of 500 mg of levodopa or bromocriptine 5 mg followed by a single oral dose of metoclopramide 10 mg 3 hours later. Bromocriptine suppressed basal serum prolactin to a greater extent than levodopa. Over the next 3 hours, serum prolactin increased after metoclopramide in the patients who received levodopa, but not in those who received bromocriptine.[12]

Six women who were 2 to 4 days postpartum, but were not nursing, were given 500 mg of levodopa orally on one day and 100 mg of levodopa plus 35 mg of carbidopa orally on the next day. Both regimens suppressed basal serum prolactin levels. However, levodopa alone caused an 78% decrease in prolactin while the lower dose combination produced only a 51% decrease. The maximal effect occurred about 2 hours after the dose with both regimens.[7]

Seven women in the first week postpartum who were breastfeeding about 7 times daily were given levodopa 500 mg orally and their serum prolactin responses was studied. The following day, they started carbidopa 50 mg orally every 6 hours for 2 days. On the third day, they received a single dose of carbidopa 50 mg plus levodopa 125 mg orally. Decreases in basal serum prolactin occurred by 30 minutes after the levodopa and afer 45 minutes with the combination. Decreases were maximum at 120 minutes after the dose and were 62% with levodopa alone and 48% with the combination, although the difference between the 2 regimens was not statistically significant.[13]

A 37-year-old Israeli woman with Parkinson’s disease became pregnant while taking a continuous infusion of levodopa 20 mg/mL and carbidopa 5 mg/mL gel. She breastfed her infant for 3 months while receiving the drug, although the extent of breastfeeding and the dosage of the gel is not clear from the paper.[2]

Possible alternatives to Levodopa

None listed