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Levodopa in Dysphagia — RACP Adult Medicine MCQ

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HardGeriatric MedicineLevodopa in DysphagiaRACP Adult Medicine

A patient with advanced Parkinson disease is made nil by mouth after aspiration. Two precisely timed levodopa/carbidopa doses have already been missed, and nasogastric access is feasible. What is the best immediate medication plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Use an enteral levodopa conversion that preserves the established dose schedule

Explanation lettering: C = shown as A · D = shown as C · E = shown as D · A = shown as E

E is correct because abrupt interruption can cause severe akinesia and a malignant withdrawal syndrome; a verified enteral conversion using a suitable dispersible or immediate-release product preserves timing. A may be useful when enteral access is impossible, but requires careful equivalence and neuropsychiatric-risk review rather than being the first choice here. B can cause dose dumping or tube obstruction. C requires a supervised test dose and is not derived directly from the last tablet. D accepts preventable deterioration. Swallow assessment and aspiration management occur in parallel.

Reference: Parkinson’s Australia, Parkinson’s medications and hospital timing: https://www.parkinsons.org.au/information-hub/parkinsons-medications/