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Reduction in dosage reverses most of the adverse effects of levodopa. Nausea and vomiting may be diminished by increasing the dose of levodopa gradually, and/or by taking with or after meals, although taking levodopa on a full stomach may lead to lower plasma concentrations. Gastrointestinal effects may also be reduced by giving an antiemetic such as cyclizine or domperidone but not a phenothiazine. Use with a peripheral dopa-decarboxylase inhibitor reduces peripheral but not central adverse effects. Orthostatic hypotension may respond to the use of elastic stockings.
The benefits of gastric decontamination are uncertain. However, activated charcoal should be considered in adults who have ingested more than 2 g (or more than the total daily dose, whichever is greater), and in children who have taken more than 200 mg, if they present within 1 hour of ingestion. Supportive measures should also be instituted. Pyridoxine may increase the metabolism of levodopa but its value in overdosage has not been established; it does not reduce the effects of levodopa given with a peripheral dopa-decarboxylase inhibitor.
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