Dingemanse J
Jacor Research, Consultancy in Drug Development, Bottmingen, Switzerland.
Neurology. 2000;55(11 Suppl 4):S24-7; discussion S28-32.
Levodopa is the most efficacious drug in the symptomatic treatment of Parkinson's disease. However, exogenously administered levodopa is extensively metabolized in the periphery by aromatic amino acid decarboxylase (AAAD) and catechol-O-methyltransferase (COMT) so that only 1% of an administered dose gains access to the brain. Even when levodopa is co-administered with an inhibitor of AAAD such as benserazide or carbidopa, the bulk (90%) of levodopa is converted by COMT to the therapeutically inactive 3-O-methyldopa. Two COMT inhibitors, tolcapone and entacapone, have recently been introduced as adjuncts to levodopa to further inhibit peripheral levodopa metabolism and thereby enhance brain levodopa availability. This paper reviews the pharmacokinetics, dosing schedule, peripheral and central effects, and safety profile of these agents.
左旋多巴是帕金森病症状治疗中最有效的药物。然而,外源性给予的左旋多巴在周围组织中会被芳香族氨基酸脱羧酶(AAAD)和儿茶酚-O-甲基转移酶(COMT)广泛代谢,以至于给药剂量中只有1%能够进入大脑。即使左旋多巴与AAAD抑制剂如苄丝肼或卡比多巴联合使用,大部分(90%)的左旋多巴仍会被COMT转化为治疗无效的3-O-甲基多巴。两种COMT抑制剂,托卡朋和恩他卡朋,最近已被引入作为左旋多巴的辅助药物,以进一步抑制外周左旋多巴代谢,从而提高大脑中左旋多巴的可用性。本文综述了这些药物的药代动力学、给药方案、外周和中枢作用以及安全性。