Levodopa, carbidopa monohydrate and entacapone intestinal gel for severe motor fluctuations in advanced Parkinson’s Disease

Levodopa, carbidopa monohydrate and entacapone intestinal gel (LECIG, TRICEL, Lecigon) is in development to treat severe motor fluctuations in advanced Parkinson’s disease (PD). PD is a progressive neurological disease caused by a loss of nerve cells in a particular part of the brain that results in decreased levels of the chemical messenger dopamine. This results in the motor symptoms associated with PD: tremor, slow movement, and muscle stiffness. Initially symptoms are managed with oral levodopa therapy. However, levodopa causes side-effects such as nausea or vomiting, and excessive levodopa doses result in dyskinesias (involuntary twisting hyperkinetic movements) and as PD advances, symptoms may re-emerge between doses (“wearing off”).
LECIG is given through continuous infusion into the intestines and consists of levodopa, carbidopa monohydrate and entacapone. Levodopa can be converted to dopamine in the brain to supplement the low levels in PD patients and improve motor symptoms. Addition of carbidopa and entacapone prevent early breakdown of levodopa before it enters the brain, to make more available for conversion to dopamine. If licenced, LECIG would provide an additional treatment option for patients with advanced PD who are levodopa responsive and who have inadequately controlled motor fluctuations using existing medicinal products.