Title:How to Optimize the Effectiveness and Safety of Parkinson’s Disease
Therapy? – A Systematic Review of Drugs Interactions with Food and Dietary
Supplements
Volume: 20
Issue: 7
Author(s): Wiesner Agnieszka, Paśko Paweł and Kujawska Małgorzata*
Affiliation:
- Department of Toxicology, Poznan University of Medical Sciences, 30 Dojazd
Str., 60-631 Poznań, Poland
Keywords:
Parkinson, interaction, food, meal, levodopa, protein, fiber.
Abstract:
Background: Despite increasing worldwide incidence of Parkinson’s disease, the therapy
is still suboptimal due to the diversified clinical manifestations, lack of sufficient treatment, the poor
adherence in advanced patients, and varied response. Proper intake of medications regarding food
and managing drug-food interactions may optimize Parkinson’s disease treatment.
Objectives: We investigated potential effects that food, beverages, and dietary supplements may
have on the pharmacokinetics and pharmacodynamics of drugs used by parkinsonian patients; identified
the most probable interactions; and shaped recommendations for the optimal intake of drugs
regarding food.
Methods: We performed a systematic review in adherence to PRISMA guidelines, and included a
total of 81 studies in the qualitative synthesis.
Results and Conclusion: We found evidence for levodopa positive interaction with coffee, fiber and
vitamin C, as well as for the potential beneficial impact of low-fat and protein redistribution diet.
Contrastingly, high-protein diet and ferrous sulfate supplements can negatively affect levodopa
pharmacokinetics and effectiveness. For other drugs, the data of food impact are scarce. Based on
the available limited evidence, all dopamine agonists (bromocriptine, cabergoline, ropinirole), tolcapone,
rasagiline, selegiline in tablets, safinamide, amantadine and pimavanserin can be taken with
or without a meal. Opicapone and orally disintegrating selegiline tablets should be administered on
an empty stomach. Of monoamine oxidase B inhibitors, safinamide is the least susceptible for interaction
with the tyramine-rich food, whereas selegiline and rasagiline may lose selectivity to monoamine
oxidase B when administered in supratherapeutic doses. The level of presented evidence is
low due to the poor studies design, their insufficient actuality, and missing data.
