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To the Editor.—
Urinary retention is an occasional troublesome side effect of levodopa therapy. For example, it developed in a 49-year-old man with moderate bilateral parkinsonism who was taking levodopa. Substitution of a mixture of carbidopa and levodopa (Sinemet) did not alleviate this symptom. Cystoscopy did not disclose significant prostatic obstruction, but a cystometric examination did disclose a hypotonic bladder. The addition of phenoxybenzamine hydrochloride (Dibenzyline), 10 mg three times a day, completely reversed the urinary retention without exacerbating the parkinsonism.These observations suggest that the levodopa effect on the bladder is, at least in part, central (ie, inside the blood-brain barrier), since carbidopa (100 mg/day) did not block this effect. Furthermore, phenoxybenzamine may be useful clinically in reversing levodopa-induced urinary retention, without exacerbating the parkinsonism.From pharmacological considerations, one might have anticipated an increase in postural hypotension and compensatory tachycardia with this combination. Fortunately, this did not occur to
Jotkowitz S. Urinary Retention as a Complication of Levodopa Therapy. JAMA. 1976;235(24):2586. doi:10.1001/jama.1976.03260500014014
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