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左旋多巴:过去、现在与未来。

Levodopa: past, present, and future.

作者信息

Hauser Robert A

机构信息

Departments of Neurology, Molecular Pharmacology, and Physiology, University of South Florida, Tampa, FL 33606, USA.

出版信息

Eur Neurol. 2009;62(1):1-8. doi: 10.1159/000215875. Epub 2008 Sep 9.

Abstract

Levodopa has been the mainstay of treatment for Parkinson's disease (PD) for more than 40 years. During this time, researchers have strived to optimize levodopa formulations to minimize side effects, enhance central nervous system (CNS) bioavailability, and achieve stable therapeutic plasma levels. Current strategies include concomitant treatment with inhibitors of dopa decarboxylase (DDC) and catechol-O-methyltransferase (COMT) to prolong the peripheral levodopa half-life and increase CNS bioavailability. Levodopa combined with DDC inhibition is the current standard method of delivering levodopa for symptomatic treatment of PD. Recent research suggests that continuous dopaminergic stimulation that more closely approximates physiological stimulation may delay or prevent the development of motor fluctuations ('wearing off') and dyskinesias. Strategies currently being used to achieve more continuous dopaminergic stimulation include the combination of an oral levodopa/DDC inhibitor with a COMT inhibitor and the enteral infusion of a levodopa gel formulation. Attempts are underway to develop oral and transdermal very long-acting levodopa preparations.

摘要

四十多年来,左旋多巴一直是治疗帕金森病(PD)的主要药物。在此期间,研究人员致力于优化左旋多巴制剂,以尽量减少副作用、提高中枢神经系统(CNS)的生物利用度,并实现稳定的治疗性血浆水平。目前的策略包括与多巴脱羧酶(DDC)抑制剂和儿茶酚-O-甲基转移酶(COMT)抑制剂联合治疗,以延长外周左旋多巴半衰期并提高CNS生物利用度。左旋多巴与DDC抑制联合使用是目前用于PD症状性治疗的左旋多巴给药标准方法。最近的研究表明,更接近生理刺激的持续多巴胺能刺激可能会延迟或预防运动波动(“药效减退”)和异动症的发生。目前用于实现更持续多巴胺能刺激的策略包括口服左旋多巴/DDC抑制剂与COMT抑制剂联合使用以及肠内输注左旋多巴凝胶制剂。正在尝试开发口服和透皮的超长效左旋多巴制剂。

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