Clinical evidence,mechanism, importance and management
A 66-year-old man with idiopathic Parkinson’s disease and AIDS was free of dyskinesias when taking levodopa with a dopa-decarboxylase inhibitor,although he had unpredictable fluctuations. After 1 month of starting indinavir 2400mg daily, lamivudine and zidovudine, he developed severe peak-dose dyskinesias, and on periods lasted all day, with no fluctuations. The antivirals were stopped and dyskinesias improved within 5 days. Each antiviral was then given separately for 2 weeks. Only indinavir induced dyskinesias,which started after 3 days of treatment.(See reference number 1)
The mechanism of this interaction is uncertain, but may be related to inhibition of cytochrome P450 by protease inhibitors such as indinavir (See reference number 1).
This appears to be only report of this possible interaction. Bear in mind possibility that levodopa dose may need to be decreased if a protease inhibitor such as indinavir is required
1. Caparros-Lefebvre D,Lannuzel A, Tiberghien F, Strobel M. Protease inhibitors enhance levodopa effects in Parkinson’s disease. Mov Disord (1999) 14, 535.