A 60-year-old man with Parkinson's disease on levodopa-carbidopa 250/25 mg TDS develops involuntary writhing movements of his limbs and trunk occurring about 60 minutes after each dose, at peak plasma levodopa levels. What is this complication called and what is the most appropriate first management step?
- A Wearing-off; increase levodopa dose
- B Off-period dystonia; add a dopamine agonist
- C Peak-dose dyskinesia; reduce individual levodopa dose (may add amantadine or MAOB inhibitor) ✓
- D Drug-induced parkinsonism; stop levodopa
Correct answer: C. Peak-dose dyskinesia; reduce individual levodopa dose (may add amantadine or MAOB inhibitor)
Explanation
Peak-dose dyskinesia occurs at maximum plasma levodopa levels and manifests as choreiform/athetoid movements; it is distinct from wearing-off (return of parkinsonian features before next dose). Management includes reducing individual dose size while increasing dosing frequency, using extended-release formulations, or adding amantadine (which blocks NMDA receptors and reduces dyskinesia). Wearing-off requires shortening dose intervals or adding COMT/MAO-B inhibitors.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.