Skip to main content
Log in

Parenteral application of NADH in Parkinson's disease: Clinical improvement partially due to stimulation of endogenous levodopa biosynthesis

  • Published:
Journal of Neural Transmission Aims and scope Submit manuscript


Exogenous application of levodopa is conventionally used to equalize the striatal dopamine deficit in idiopathic Parkinson's disease (PD). The stimulation of endogenous biosynthesis of levodopa via activation of tyrosine hydroxylase (TH) has been proposed as new therapeutic concept in PD. This may be achieved by exogenous supply with the reduced coenzyme nicotinamide adenine dinucleotide (NADH). Aim of this open prospective study was to investigate (1) the efficacy of a new developed, parenteral application form of NADH on Parkinsonian symptoms and (2) the influence of bioavailability of levodopa. 15 patients, suffering from idiopathic PD (11 male, 4 female, age: 61.40[mean] ± 10.27[SD] range: 44–74 years, Hoehn and Yahr stage: 3.03 ± 0.69, range 2–4) received intravenous infusions of NADH (10 mg a' 30 min) over a period of 7 days in addition to conventional Parkinsonian pharmacotherapy. Parkinsonian symptoms were scored before (day 1) and after NADH treatment (day 8). Levodopa plasma levels were estimated over a period of four hours on the day before and on the first day of NADH application by HPLC. Parkinsonian patients showed a significant response, evaluated by the Unified Parkinson's Disease Rating Scale Version 3.0 (p=0.025; Wilcoxon test). Moreover application of NADH significantly increased bioavailability of plasma levodopa (AUC, p=0.035; Cmax, p=0.025). In conclusion NADH in the used galenic form may be a potent stimulator of endogenous levodopa biosynthesis with clinical benefit for Parkinsonian patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  • Birkmayer GJ, Birkmayer W (1989) Stimulation of endogenous L-dopa biosynthesis — a new principle for the therapy of Parkinson's disease. The clinical effect of nicotinamide adenine dinucleotide (NADH) and nicotinamide adenine dinucleotidephosphate (NADPH). Acta Neurol Scand [Suppl 126]: 183–187

    Google Scholar 

  • Birkmayer JG, Vrecko C, Volc D, Birkmayer W (1993) Nicotinamide adenine dinucleotide (NADH) — a new therapeutic approach to Parkinson's disease. Comparison of oral and parenteral application. Acta Neurol Scand [Suppl 146]: 32–35

    Google Scholar 

  • Birkmayer W, Birkmayer GJ, Vrecko K, Mlekusch W, Paletta B, Ott E (1989) The coenzyme nicotinamide adenine dinucleotide (NADH) improves the disability of parkinsonian patients. J Neural Transm [PD Sect] 1: 297–302

    Google Scholar 

  • Birkmayer W, Birkmayer JG, Vrecko K, Paletta B (1990) The clinical benefit of NADH as stimulator of endogenous L-dopa biosynthesis in parkinsonian patients. Adv Neurol 53: 545–549

    Google Scholar 

  • Dizdar N, Kagedal B, Lindvall B (1994) Treatment of Parkinson's disease with NADH. Acta Neurol Scand 90: 345–347

    Google Scholar 

  • Gerlach M, Klaunzer N, Przuntek H (1986) Determination of L-Dopa and 3-O-methyl-dopa in human plasma by extraction using C18-cartridges followed by high-performance liquid chromatographie analysis with electochemical detection. J Chromatogr 380: 379–385

    Google Scholar 

  • Iuvone PM, Reinhard JF, Jr, Abou Donia MM, Viveros OH, Nichol CA (1985) Stimulation of retinal dopamine biosynthesis in vivo by exogenous tetrahydrobiopterin: relationship to tyrosine hydroxylase activation. Brain Res 359: 392–396

    Google Scholar 

  • Leeming RJ, Blair JA, Melikian V (1983) Intestinal absorption of tetrahydrobiopterin and biopterin in man. Biochem Med 30: 328–332

    Google Scholar 

  • Mattern C (1995) Zur Entwicklung von stabilen Arzneiformen des Coenzyms NADH für die perorale und parenterale Applikation. Humboldt-Universität, Berlin

    Google Scholar 

  • Nichol CA, Smith GK, Duch DS (1985) Biosynthesis and metabolism of tetrahydro-biopterin and molybdopterin. Annu Rev Biochem 54: 729–764

    Google Scholar 

  • Rausch WD, Hirata Y, Nagatsu T, Riederer P, Jellinger K (1988) Tyrosine hydroxylase activity in caudate nucleus from Parkinson's disease: effects of iron and phosphorylating agents. J Neurochem 50: 202–208

    Google Scholar 

  • Uitti RJ, Calne DB (1993) Pathogenesis of idiopathic parkinsonism. Eur Neurol 33 [Suppl 1]: 6–23

    Google Scholar 

  • Vrecko K, Birkmayer JG, Krainz J (1993) Stimulation of dopamine biosynthesis in cultured PC 12 phaeochromocytoma cells by the coenzyme nicotinamide adeninedinucleotide (NADH). J Neural Transm [PD Sect] 5: 147–156

    Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

Reprints and permissions

About this article

Cite this article

Kuhn, W., Müller, T., Winkel, R. et al. Parenteral application of NADH in Parkinson's disease: Clinical improvement partially due to stimulation of endogenous levodopa biosynthesis. J. Neural Transmission 103, 1187–1193 (1996).

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: