Click to enlargeWhat is the Wearing-Off Effect?
Long term use of Levodopa
What is Sipping?

'Some patients take multiple small doses on an empty stomach, crushing the pills and mixing them with a lot of liquid.'

Before making any changes or modifications to your current Parkinson’s medication regimen, you should consult your physician or health care professional. The user maintains full responsibility to administer medications or perform medical tests at the appropriate times. Use of an e-pill Medication Reminder is only a supplement to any memory system that you currently use to remind yourself to take medications or perform medical tasks.

Parkinson's Disease & Levodopa

Within four to six years of treatment with levodopa, the effects of the drug in many patients begin to last for shorter periods of time (called the Wearing Off effect) and the following pattern may occur: | Inhaler for Levodopa?

  • Patients may first notice slowness (bradykinesia) or tremor in the morning before the next dose is due.
  • Less commonly, some experience painful dystonia, muscle spasms that can cause sustained contortions of various parts of the body, particularly the neck, jaw, trunk, and eyes and possibly the feet.
  • Patients must increase the frequency of levodopa doses. This puts them at risk for dyskinesia (the inability to control muscles), which usually occurs when the drug level peaks. Dyskinesia can take many forms, most often uncontrolled flailing of the arms and legs or chorea, rapid and repetitive motions that can affect the limbs, face, tongue, mouth, and neck. Dyskinesia is not painful, but it is very distressing.
  • In some people, eventually L-dopa is effective only for one to two hours and most patients start to experience motor fluctuations. In about 15% to 20% of patients such fluctuations become extreme, a phenomenon known as the on-off effect, which consists of unpredictable, alternating periods of dyskinesia and immobility. Sometimes the symptoms switch back in forth within minutes or even seconds. (The transition may follow such symptoms as intense anxiety, sweating, and rapid heartbeats.)

  • To reduce the effects of fluctuation and the wearing-off effect, it is important to maintain as consistent a level of dopamine as possible. Unfortunately, levodopa is poorly absorbed and may remain in the stomach a long time. Two strategies have been suggested to take care of these problems:

    What Is Sipping? Learn more: Sipping

  • Taking multiple small doses on an empty stomach by crushing the pills and mixing them with a lot of liquid.
  • A liquid form of Sinemet which may produce fewer fluctuations and a prolonged "on" time compared with the tablet.

  • Source: A.D.A.M Inc., Well-Connected series, Well-Connected reports are written and updated by experienced medical writers and reviewed and edited by the in-house editors and a board of physicians who have faculty positions at Harvard Medical School and Massachusetts General Hospital. Neither institution (HMS or MGH) nor e-pill, LLC reviews or endorses their content.

    American Parkinson's Disease Association
    1250 Hylan Blvd.
    Staten Island, NY 10305
    1-800-223-APDA (2732)

    National Institute of Neurological Disorders and Stroke
    P.O. Box 5801
    Bethesda, MD 20824

    National Parkinson Foundation Inc.
    1501 N.W. 9th Ave. (Bob Hope Road)
    Miami, FL 33136-1494
    in Florida: 1-800-433-7022

    Parkinson's Disease Foundation, Inc.
    650 W. 168th St.
    New York, NY 10032

    Parkinson's Institute
    1170 Morse Avenue
    Sunnyvale, CA 94089-1605
    (408) 734-2800

    Parkinson’s Resource Organization
    74-090 El Paseo, Suite 102
    Palm Desert, CA 92260-4135
    Telephone: (760) 773-5628
    Toll-Free: 1-877-775-4111
    Fax......: (760) 773-9803
    PRO Web site:

    Parkinson's Support Groups of America
    11376 Cherry Hill Road, No. 204
    Beltsville, MD 20705

    United Parkinson Foundation
    833 W. Washington Blvd.
    Chicago, IL 60607
    (312) 733-1893

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