Levodopa-Carbidopa-Related Rash in Parkinson’s Disease: A Case Series

• Published in: Canadian journal of neurological sciences Vol. 45; no. 5; pp. 588 - 589
• Main Author: Anang, Julius B. M.
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 01.09.2018
• Subjects: Adult; Aged, 80 and over; Antiparkinson Agents - adverse effects; Carbidopa - adverse effects; Case reports; Drug Combinations; Dyes; Exanthema - chemically induced; Female; Humans; Letter to the Editor; Levodopa - adverse effects; Middle Aged; Parkinson Disease - drug therapy; Parkinson's disease; Sinemet rash; Parkinson’s disease/Parkinsonism; Levodopa-carbidopa rash; Levocarb rash; Management of levodopa-related rash
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/cjn.2018.58

Skin rash related to levodopa-carbidopa 100/25 was first reported by Goetz in 1983.1 However, awareness of the occurrence of this skin reaction is low even among movement disorder neurologists,2 and the inappropriate classification of this rash as a levodopa allergy can result in significant limitations in the symptomatic management of patients with PD. We describe a case series of three patients who developed a diffuse maculopapular rash a few months after the initiation of levodopa-carbidopa 100/25 mg and discuss an approach to managing this skin reaction. The compounding ingredients in these drugs are D&C Yellow No. 10 Aluminum Lake and E104 that give the pill its yellow appearance.3,4 Given that these two dyes are contained in other drugs other than levodopa-carbidopa 100/25 mg, the use of any such drugs is best avoided in patients demonstrating such a skin rash. Skin rash has been reported with certain doses of warfarin containing one of the above compounding agents.5 The development of rash in all three cases was not immediate, and resolution was gradual over a period of 2-6 months.