Sublingual Crushed Levodopa for Parkinson’s Disease Management of a Lewy Body Dementia Patient With Dysphagia: A Case Report

Levodopa/carbidopa is the cornerstone treatment for Parkinson's disease (PD), but in patients with dysphagia, there are limited options for the routes of administration. Traditional methods of administering levodopa/carbidopa in these patients, such as rectal administration, have been shown to offer limited symptomatic relief and suboptimal pharmacokinetic outcomes. This case explores sublingual administration of levodopa/carbidopa as a novel solution for managing parkinsonian symptoms in dysphagic patients in the hospital setting, where non-oral options are often limited. We present an 85-year-old Caucasian male with Lewy body dementia and parkinsonian symptoms, who presented to the emergency department with dysphagia and altered level of consciousness in the context of a urinary tract infection. Due to a missed dose of levodopa/carbidopa, he exhibited worsening bradykinesia, rigidity, resting tremors, and dysphagia. Levodopa/carbidopa was crushed and administered sublingually. Symptom improvement and resolution were observed within two hours of the sublingual dose, and the patient was able to tolerate oral medications thereafter. This case demonstrates that sublingual administration of levodopa/carbidopa may be a practical and effective alternative approach for managing parkinsonian symptoms in patients with dysphagia.