Why does the drug levodopa seem to work well for my father with Parkinson's only at certain times of the day?

A fellow caregiver asked...

My father is taking levodopa (Sinemet) for Parkinson's disease, but his shakiness seems to get worse after he eats a meal. Does his medication need to be adjusted?

Expert Answer

Kelly E. Lyons is a research associate professor of neurology at the University of Kansas Medical Center in Kansas City, and a member of the panel that authored the American Academy of Neurology's 2006 guidelines for treating advanced Parkinson's disease.

The first thing I'd check is that he's not taking the levodopa with a high-protein meal, because that in itself could be knocking out the medicine's effect. Levodopa should be taken either 30 minutes before or an hour after a high-protein meal. So if, say, your father eats a big steak for dinner and then takes his Sinemet right after that, he may get less benefit from that dose, or none at all. The dietary protein problem tends to be more of an issue as the disease advances. But depending on the patient, it can be a issue at any time.

Sinemet can cause nausea, so I'm not saying don't take it with food -- just not with high-protein food. Your father can take his pills with some bread or crackers or toast. If he makes these changes and is still having problems, I'd call his doctor, who might either adjust the dose or look at adding a new medication to improve control of your father's symptoms.