The concurrent use of levodopa and beta blockers normally appears to be favourable,but be aware that, as with all antihypertensives, additive hypotensive effects can occur.
Clinical evidence,mechanism, importance and management
Most of effects of combined use of levodopa and beta blockers seem to be favourable, although additive hypotension can be a problem. Dopamine derived from levodopa stimulates beta-receptors in heart, which can cause arrhythmias (See reference number 1). These receptors are blocked by propranolol and other beta blockers. An enhancement of effects of levodopa and a reduction in tremor has been described in 23 out of 25 patients taking propranolol,(See reference number 2) but not in 9 patients taking oxprenolol,(See reference number 3) or in another placebo-controlled study in 18 patients taking propranolol (See reference number 4). Early evidence showed that growth hormone levels were substantially raised by propranolol(See reference number 5,6) or practolol(See reference number 6) [now withdrawn due to fatal reactions] in conjunction with levodopa,but no clinical relevance for this has been demonstrated.
Goldberg LI,Whitsett TL. Cardiovascular effects of levodopa. Clin Pharmacol Ther (1971) 12, 376–82.
Kissel P,Tridon P, André JM. Levodopa-propranolol therapy in parkinsonian tremor. Lancet (1974) ii, 403–4.
Sandler M,Fellows LE, Calne DB, Findley LJ. Oxprenolol and levodopa in parkinsonian patients. Lancet (1975) i, 168.
Marsden CD,Parkes JD, Rees JE. Propranolol in Parkinson’s disease. Lancet (1974) ii, 410.
Camanni F,Massara F. Enhancement of levodopa-induced growth-hormone stimulation bypropranolol. Lancet (1974) i, 942.
Lotti G,Delitala G, Masala A. Enhancement of levodopa-induced growth-hormone stimulationby practolol. Lancet (1974) 2, 1329.