From Dr R. J. Needle, MRPharmS
SIR,-A 70-year-old man was recently treated as an inpatient in this hospital for gastric carcinoma. The gastric outflow obstruction caused by his tumour rendered oral medication ineffective. Tremor due to pre-existing cerebellar atrophy had been controlled with Sinemet Plus, but because of his inability to absorb oral medication, the severity of the tremor was drastically increased, curtailing his ability to undertake activities of daily living.
As an experiment, his Sinemet Plus was administered rectally, which resulted in a marked reduction in his tremor and greatly improved his quality of life. This apparent therapeutic effect is contrary to the only published study on rectal administration of Sinemet or levodopa.1 However, since this unlicensed method of administration appeared effective in this instance, it may be worth contemplating in other patients in a similar predicament.
If anyone else has had experience of using Sinemet or Madopar effectively by this route, I would be interested to hear from them.
Richard Needle
Chief Pharmacist Colchester General Hospital, Turner Road, Colchester, Essex CO4 5JL
| 1. Eisler T, Eng N, Plotkin C, Calne DB. Absorption of levodopa after rectal administration. Neurology 1981; 31:215-7. |