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May 29, 1972

Levodopa In Hepatic Failure

Author Affiliations

Saint Elizabeth Hospital Danville, Ill

JAMA. 1972;220(9):1247-1248. doi:10.1001/jama.1972.03200090069022

To the Editor.—  Parker, noting earlier observations in 1963 by Tsukijama, administered 5 gm of levodopa to five patients with acute hepatic failure in coma or stuporous state.1 The drug produced a striking, brief improvement in the level of consciousness, together with amelioration of a previously abnormal electroencephalogram (EEG) recording. Serum ammonia level was unchanged. More recently, Fischer and James administered levodopa with nasogastric tube to eight patients with alcoholic cirrhosis.2 One patient, moribund on arrival, failed to respond. Four patients in profound hepatic coma awakened within three to four hours, while the remaining four regained consciousness in 48 hours. The cardiac output decreased while peripheral vascular resistance, urinary sodium levels, and diuresis increased. Discontinuation of the drug was followed by further deterioration of the patients' conditions.We studied the effects of average oral doses of levodopa in a patient with severe, chronic, active hepatitis, who developed severe