Background: Carbidopa/levodopa (CD/LD) remains the primary treatment for Parkinson's disease (PD) motor control symptoms. With progressing disease, for better symptom management, patients often split immediate-release CD/LD tablets-research on this practice is limited.
Objective: Survey patients with PD/caregivers, and neurologists on CD/LD pill-splitting practices and motor complications' impact on quality of life (QoL).
Methods: We surveyed 101 patients/caregivers and 120 neurologists.
Results: All agreed that motor control symptoms substantially affect QoL, particularly as PD progresses. 47% of patients surveyed halved immediate-release CD/LD tablets, and 27% fragmenting them further, with 27% and 18% finding it easy and accurate, respectively. Pill splitters reported longer disease duration, more advanced PD, worse motor fluctuations/dyskinesia control, and QoL. Neurologists reported dissatisfaction with CD/LD treatments for advanced disease, noting 44.9% of patients split tablets with, and 21.9% without, physician recommendation.
Conclusions: Pill splitting is common but burdensome and imprecise. Further research is needed to evaluate clinical impact.
Keywords: Parkinson’s disease; carbidopa/levodopa; patient/caregiver survey; pill-splitting practices; symptom management.
A large number of patients with Parkinson’s disease (PD) still rely on carbidopa/levodopa (CD/LD) to manage their movement-related symptoms. As the disease worsens over time, many patients on the immediate-release form of CD/LD need to take small amounts more frequently, which often means cutting tablets into halves or smaller pieces. However, little is known about how common this is or how patients and doctors feel about it. To learn more, 101 patients and caregivers, as well as 120 neurologists who treat PD, were surveyed. All parties agreed that movement-related symptoms seriously affect patients’ quality of life, especially as the disease advances. Nearly half of the patients said they cut their pills in half, and over a quarter broke them into even smaller pieces, but most did not find this process easy or accurate. Patients who split their pills had PD for a longer time and were in more advanced stages of the disease. Compared to the overall group of patients, these patients, in particular, had more difficulty controlling their movements and experienced more involuntary movements (dyskinesia), which had a greater effect on their quality of life. Doctors said that many patients split their pills—some because the doctor told them to, and others on their own. In conclusion, splitting pills is common but often difficult and imprecise for patients with PD. More research is needed to better understand this practice and its benefits and challenges.