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Comparative effectiveness of two extracerebral DOPA decarboxylase inhibitors in Parkinson disease

In four patients with Parkinson disease, we compared carbidopa combined with levodopa (Sinemet®) and benserazide combined with levodopa (Madopar®). All of these patients had responded to treatment, first with levodopa and then with Sinemet; after 6 years two continued to show a good response, while two developed marked “on-off” phenomena. Clinically, Sinemet and Madopar were similar; however, DOPA levels were higher, but with a shorter half-life, on Madopar. The higher DOPA levels may have been offset by the shorter half-life, resulting in no clinical change. DOPA levels were lower and half-life was shorter in patients with on-off phenomena. These differences may be responsible in part for the on-off phenomena.