رجل عمره ٧٠ سنة عنده باركنسون منذ ٨ سنوات، يأخذ كاربيدوبا-ليفودوبا ٤ مرات يومياً. يشتكي أن مفعول الجرعة يخف قبل موعد الجرعة التالية ويتيبس، خاصة بعد الظهر، لأنه يأخذ جرعة الظهر مع غداء كبير فيه لحم كثير. ما النصيحة المناسبة؟

A 70-year-old man with Parkinson’s for 8 years takes carbidopa-levodopa four times a day. He reports the dose wearing off and stiffness before the next dose, especially in the afternoon, as he takes the midday dose with a large meat-rich lunch. What advice is appropriate?

1. Double the midday dose to cover the wearing-off before the next one
2. Take it with a glass of full-fat milk to reduce nausea
3. Stop it abruptly for 2 days, then restart to restore its effect
4. Take it 30 minutes before meals and spread protein across meals

Answer: D) Take it 30 minutes before meals and spread protein across meals. Protein competes with levodopa for absorption and entry into the brain, so a high-protein meal weakens its effect. Doubling the dose himself increases dyskinesia, and abrupt withdrawal can cause a dangerous neuroleptic malignant-like syndrome.