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Pharmacokinetics of Levodopa before and after Gastrointestinal Resection in Parkinson's Disease.

Nagayama H, Kajimoto Y, Kumagai T, Nishiyama Y, Mishina M, Kimura K - Case Rep Neurol (2015)

Bottom Line: Because LD is absorbed in the duodenum and jejunum, we checked his pharmacokinetics again after the operation.The results before the operation were almost similar; however, in comparison, the area under the curve and peak drug concentration was reduced, and the time-to-peak drug concentration and elimination halftime were elongated after the operation.Physicians must pay attention to the change of LD pharmacokinetics after gastrointestinal operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.

ABSTRACT

Introduction: Levodopa (LD) is important in the clinical treatment of Parkinson's disease (PD), and the changes of its pharmacokinetics may affect the clinical outcome. LD is mainly absorbed in the upper intestine; thus, the pharmacokinetics of LD may change after gastrointestinal operation. Here, we present the case of a patient who underwent resection of the intestine and compared his LD pharmacokinetics before and after resection.

Case presentation: A 72-year-old Japanese male PD patient developed jaundice and was diagnosed with cholangiocarcinoma. Pancreaticoduodenectomy was performed and part of the stomach, total duodenum, and part of the jejunum were resected. The patient had been treated with LD, and his pharmacokinetics was checked twice at the age of 68 years. Because LD is absorbed in the duodenum and jejunum, we checked his pharmacokinetics again after the operation. The results before the operation were almost similar; however, in comparison, the area under the curve and peak drug concentration was reduced, and the time-to-peak drug concentration and elimination halftime were elongated after the operation.

Conclusion: Physicians must pay attention to the change of LD pharmacokinetics after gastrointestinal operation.

No MeSH data available.


Related in: MedlinePlus

Gastrointestinal resection and reconstruction. a The resected portion (a part of the stomach, total duodenum, and a part of the jejunum) is denoted in dark gray. b Gastrointestinal tract after reconstruction.
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Figure 1: Gastrointestinal resection and reconstruction. a The resected portion (a part of the stomach, total duodenum, and a part of the jejunum) is denoted in dark gray. b Gastrointestinal tract after reconstruction.

Mentions: In the next month (at the age of 71 years 11 months), pancreaticoduodenectomy was performed. In this operation, subtotal removal of the stomach (3 cm from the pylorus side), total removal of the duodenum, and subtotal removal of the jejunum (20 cm from the ligament of Treitz on the distal side) was performed (fig. 1a). Reconstruction was made by end-to-end anastomosis of the pancreas to the bile duct to the jejunum (fig. 1b). There were no surgical complications in his post-operative course, and he recovered without any surgical problems. After 5 days, he could take the same oral antiparkinsonian agents as before the operation (500 mg/50 mg of LD/carbidopa, 0.5 mg of cabergoline, and 2.5 mg of selegiline); however, his Parkinsonian features were gradually remarkable within 2 weeks after the operation. The patient did not receive any agents as chemotherapy. He was then transferred to our ward for parkinsonian drug treatment.


Pharmacokinetics of Levodopa before and after Gastrointestinal Resection in Parkinson's Disease.

Nagayama H, Kajimoto Y, Kumagai T, Nishiyama Y, Mishina M, Kimura K - Case Rep Neurol (2015)

Gastrointestinal resection and reconstruction. a The resected portion (a part of the stomach, total duodenum, and a part of the jejunum) is denoted in dark gray. b Gastrointestinal tract after reconstruction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608656&req=5

Figure 1: Gastrointestinal resection and reconstruction. a The resected portion (a part of the stomach, total duodenum, and a part of the jejunum) is denoted in dark gray. b Gastrointestinal tract after reconstruction.
Mentions: In the next month (at the age of 71 years 11 months), pancreaticoduodenectomy was performed. In this operation, subtotal removal of the stomach (3 cm from the pylorus side), total removal of the duodenum, and subtotal removal of the jejunum (20 cm from the ligament of Treitz on the distal side) was performed (fig. 1a). Reconstruction was made by end-to-end anastomosis of the pancreas to the bile duct to the jejunum (fig. 1b). There were no surgical complications in his post-operative course, and he recovered without any surgical problems. After 5 days, he could take the same oral antiparkinsonian agents as before the operation (500 mg/50 mg of LD/carbidopa, 0.5 mg of cabergoline, and 2.5 mg of selegiline); however, his Parkinsonian features were gradually remarkable within 2 weeks after the operation. The patient did not receive any agents as chemotherapy. He was then transferred to our ward for parkinsonian drug treatment.

Bottom Line: Because LD is absorbed in the duodenum and jejunum, we checked his pharmacokinetics again after the operation.The results before the operation were almost similar; however, in comparison, the area under the curve and peak drug concentration was reduced, and the time-to-peak drug concentration and elimination halftime were elongated after the operation.Physicians must pay attention to the change of LD pharmacokinetics after gastrointestinal operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.

ABSTRACT

Introduction: Levodopa (LD) is important in the clinical treatment of Parkinson's disease (PD), and the changes of its pharmacokinetics may affect the clinical outcome. LD is mainly absorbed in the upper intestine; thus, the pharmacokinetics of LD may change after gastrointestinal operation. Here, we present the case of a patient who underwent resection of the intestine and compared his LD pharmacokinetics before and after resection.

Case presentation: A 72-year-old Japanese male PD patient developed jaundice and was diagnosed with cholangiocarcinoma. Pancreaticoduodenectomy was performed and part of the stomach, total duodenum, and part of the jejunum were resected. The patient had been treated with LD, and his pharmacokinetics was checked twice at the age of 68 years. Because LD is absorbed in the duodenum and jejunum, we checked his pharmacokinetics again after the operation. The results before the operation were almost similar; however, in comparison, the area under the curve and peak drug concentration was reduced, and the time-to-peak drug concentration and elimination halftime were elongated after the operation.

Conclusion: Physicians must pay attention to the change of LD pharmacokinetics after gastrointestinal operation.

No MeSH data available.


Related in: MedlinePlus