Die fixe Kombination von Levodopa/Carbidopa mit Entacapon in der Parkinson-Therapie

Zusammenfassung

Der Catechol-O-Methyltransferase-Hemmer Entacapon ist eine in der medikamentösen Parkinsontherapie etablierte Substanz. Sie erweitert das therapeutische Spektrum durch Hemmung des Abbaus von Levodopa (LD) in der Peripherie, womit die Wirkung von LD verstärkt wird. Entacapon ist nur in Kombination mit LD und besonders bei Patienten mit vorhersagbaren Fluktuationen der Beweglichkeit wirksam. Nebenwirkungen können eine Verstärkung von Dyskinesien, Diarrhoe, Blutdruckabfall und Urinverfärbung sein. Da Entacapon meist gleichzeitig mit jeder LD/Decarboxylasehemmer (DCH)-Dosis verabreicht wird, erhöht dies deutlich die Anzahl der einzunehmenden Tabletten, was klinisch oft die Medikamentencompliance beeinträchtigt. Die Zulassung von Stalevo®, der fixen Kombination von LD/Carbidopa (CD) in drei verschiedenen Dosierungen (50 LD/12,5 CD, 100 LD/25 CD, 150 LD/37.5 CD [mg]) und Enta-capon (200 mg) in einer Tablette, umgeht dieses Problem. Wir schildern zusammenfassend das optimierte therapeutische Vorgehen der LD/DCI-Gabe mit Entacapon in der Behandlung des Morbus Parkinson und versuchen erste praktische, therapeutische Richtlinien für den Einsatz dieses neuen Kombinationspräparates zu geben. Basierend auf den positiven Ergebnissen der Multizenterstudien mit Entacapon schlagen wir den Einsatz dieser fixen Kombination von LD/CD/Entacapon insbesondere bei Parkinsonpatienten mit End-off-doseFluktuationen vor.

Summary

The catechol-O-methyltransferase inhibitor entacapone is an established drug, which expands the therapeutic options for the treatment of Parkinson’s disease (PD) by extending the action of levodopa (LD) due to inhibition of its peripheral metabolism. Entacapone is solely used in conjunction with LD and particularly provides symptomatic benefit to PD patients who suffer from predictable motor fluctuations. Possible side effects may include worsening of dyskinesias, hypotension, constipation and urine discoloration. The postulated therapeutic concept of simultaneous administration of entacapone with each levodopa/decarboxylase inhibitor (DCI) dose often markedly increased intake of tablets, which may cause compliance problems. The launch of Stalevo®, the fix combination of LD/carbidopa (CD) in the three different dosages (50 LD/12.5 CD, 100 LD/25 CD, 150 LD/ 37.5 CD [mg]) and entacapone (200 mg) in one tablet, may circumvent this issue. We review this optimized therapeutic approach of LD/DCI administration with entacapone in the drug therapy of idiopathic PD and try to provide initial therapeutic guidelines for the use of this novel LD/CD/entacapone formulation. We suggest the preponderant application of this LD/CD/entacapone preparation in PD patients with end-off dose fluctuations according to the positive outcomes of previous multicenter trials with entacapone.

Schlüsselwörter

Levodopa - Entacapon - Stalevo

Keywords

Levodopa - entacapone - Stalevo

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