Enteric coated levo-dopa in clinical practice.

The results of a clinical trial of enteric coated Levo-dopa are described for nineteen patients with Parkinsonism. Twelve cases comprise the nuclear group and all were intolerant to therapeutic doses of standard Levo-dopa. Seven cases were receiving Levo-dopa for the first time. Treatment periods ranged from three to twelve months. Of the whole group, 84% have improved. Of the poor responders to standard Levo-dopa 58% have improved markedly and the remaining 42% have improved to a moderate degree using clinical criteria. The mean stabilization dose was 1.5 grams daily and using the Mann-Whitney U test the difference is highly significant when comparison is made with the stabilization dose of 3.0 grams for standard Levo-dopa (P less than .001). The method of stabilization is described; the commonest initial stabilization period is three weeks. Side-effects are dose-related. No side-effects have appeared in 60% of the patients and only mild or transient side-effects have appeared in 20%. A characteristic toxic reaction is described. This enteric-coated preparation of the drug appears to control the "on-off" phenomenon in at least 50% of cases with this problem. The preparation is suitable for routine use in outpatients but added care is required to ensure that vitamin tonics are rigorously avoided. Two deaths are recorded during the trial, but analysis shows them to be unrelated causally to the therapy. Enteric coated Levo-dopa is recommended as the primary treatment in all new cases where Levo-dopa therapy is indicated. No adverse interactions have occurred with other commonly used anti-Parkinsonian drugs.