Carbidopa Levodopa

Carbidopa Levodopa Brand Names

Atamet | Duopa | Parcopa | Rytary | SINEMET | SINEMET CR

What is Carbidopa Levodopa

The combination of levodopa and carbidopa is used in the treatment of Parkinson’s disease and parkinsonism due to other causes.

Carbidopa is added to levodopa to inhibit the peripheral destruction of levodopa; thus, more levodopa is available for transport to the brain.

Carbidopa levodopa products are marketed in several strengths containing carbidopa and levodopa in ratios of either 1:10 or 1:4, respectively.

Advantages of combination therapy over levodopa alone include less dopaminergic side effects such as nausea; lower doses of levodopa are required for reduction in symptoms.

The dosage of carbidopa-levodopa is highly individualized in attempt to balance the relief of symptoms and occurrence of side effects.

Many times the dosage does not always correlate with the severity or duration of Parkinson’s disease. In clinical trials, patients with moderate to severe symptom fluctuations who received the extended-release preparation did not experience quantitatively significant reductions in ‘off ‘ time as compared to the regular-release; however, global symptom ratings improved.

In patients without major fluctuations, the extended-release tablets provided the same therapeutic benefit as the immediate-release tablets but with less frequent dosing.

The FDA first approved commercial products of levodopa-carbidopa prior to 1982; various dosage forms are now available to meet the needs of individual patients including extended-release tablets and capsules, orally disintegrating tablets (ODT), and, a tablet intended for oral suspension prior to administration.

An enteral suspension is available also that is used for the treatment of motor fluctuations in patients with advanced Parkinson’s disease.

Indications

1. amblyopia
2. Parkinson’s disease
3. parkinsonism
4. restless legs syndrome (RLS)

For the treatment of idiopathic Parkinson’s disease, post-encephalitic parkinsonism, and symptomatic parkinsonism that may follow injury to the nervous system by carbon monoxide intoxication and/or manganese intoxication

Side Effects

1. abdominal pain
2. agitation
3. agranulocytosis
4. akinesia
5. alopecia
6. angioedema
7. anorexia
8. anxiety
9. asthenia
10. ataxia
11. back pain
12. bezoar
13. blepharospasm
14. blurred vision
15. bullous rash
16. chest pain (unspecified)
17. confusion
18. constipation
19. cough
20. depression
21. diarrhea
22. diplopia
23. dizziness
24. drowsiness
25. dysgeusia
26. dyskinesia
27. dyspepsia
28. dysphagia
29. dyspnea
30. dystonic reaction
31. edema
32. elevated hepatic enzymes
33. erythema
34. euphoria
35. fatigue
36. fever
37. flatulence
38. flushing
39. GI bleeding
40. GI obstruction
41. GI perforation
42. hallucinations
43. headache
44. hemolytic anemia
45. hiccups
46. hoarseness
47. hot flashes
48. hyperbilirubinemia
49. hyperhidrosis
50. hypersalivation
51. hypertension
52. hypotension
53. impulse control symptoms
54. increased urinary frequency
55. infection
56. insomnia
57. intussusception
58. involuntary movements
59. leukopenia
60. libido increase
61. malaise
62. memory impairment
63. muscle cramps
64. mydriasis
65. myocardial infarction
66. nausea
67. neuroleptic malignant syndrome-like symptoms
68. nightmares
69. orthostatic hypotension
70. palpitations
71. paranoia
72. paresthesias
73. peptic ulcer
74. peripheral edema
75. peripheral neuropathy
76. phlebitis
77. priapism
78. pruritus
79. psychosis
80. purpura
81. pyrosis (heartburn)
82. pyuria
83. rash
84. seizures
85. skin cancer
86. sudden sleep onset
87. suicidal ideation
88. syncope
89. teeth grinding (bruxism)
90. thrombocytopenia
91. tremor
92. trismus
93. urinary incontinence
94. urinary retention
95. urine discoloration
96. urticaria
97. vitamin B6 deficiency
98. vomiting
99. weight gain
100. weight loss
101. xerostomia

Monitoring Parameters

• LFTs
• neurologic function
• skin cancer screening exam

Contraindications

• abrupt discontinuation
• asthma
• behavioral changes
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• children
• closed-angle glaucoma
• coadministration with other CNS depressants
• depression
• diabetes mellitus
• driving or operating machinery
• dyskinesia
• ethanol ingestion
• geriatric
• GI bleeding
• GI obstruction
• GI perforation
• hepatic disease
• hyperthermia
• hypotension
• impulse control symptoms
• infants
• intussusception
• laboratory test interference
• MAOI therapy
• melanoma
• mental status changes
• myocardial infarction
• orthostatic hypotension
• peptic ulcer disease
• peripheral neuropathy
• phenylketonuria
• pheochromocytoma
• pregnancy
• psychosis
• pulmonary disease
• pulmonary fibrosis
• renal disease
• retroperitoneal fibrosis
• suicidal ideation
• surgery
• syncope

Interactions

• Alfentanil
• Amantadine
• Amoxapine
• Amphetamine; Dextroamphetamine Salts
• Angiotensin II receptor antagonists
• Angiotensin-converting enzyme inhibitors
• Asenapine
• Atropine
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Edrophonium
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• atypical antipsychotic
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Benzphetamine
• Benztropine
• Beta-blockers
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Brentuximab vedotin
• Bupropion
• Bupropion; Naltrexone
• Calcium-channel blockers
• Cenobamate
• Central-acting adrenergic agents
• Cetirizine
• Cetirizine; Pseudoephedrine
• Chlorpromazine
• Chlorthalidone; Clonidine
• Clonidine
• Cocaine
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Dacarbazine, DTIC
• Darifenacin
• Dexmethylphenidate
• Dextromethorphan; Promethazine
• Dicyclomine
• Doxazosin
• Droperidol
• Droxidopa
• Enflurane
• Eplerenone
• Epoprostenol
• Esketamine
• Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
• Ethinyl Estradiol; Norethindrone; Ferrous fumarate
• Fluphenazine
• food
• Fosphenytoin
• Furazolidone
• Gabapentin
• Glycopyrrolate
• Glycopyrrolate; Formoterol
• Guanabenz
• Guanfacine
• Haloperidol
• Halothane
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hyoscyamine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Iloperidone
• Iloprost
• Indacaterol; Glycopyrrolate
• Iron
• Iron Salts
• Isocarboxazid
• Isoflurane
• Isoniazid, INH
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Isoproterenol
• Lasmiditan
• Lemborexant
• Levocetirizine
• Linezolid
• Lisdexamfetamine
• Loop diuretics
• Loxapine
• Lurasidone
• Macimorelin
• Maprotiline
• Mecamylamine
• Meperidine; Promethazine
• Mesoridazine
• Methamphetamine
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methscopolamine
• Methyldopa
• Methylphenidate
• Metoclopramide
• Metronidazole
• Metyrosine
• Molindone
• Nabilone
• Oxybutynin
• Papaverine
• Perphenazine
• Perphenazine; Amitriptyline
• Phenelzine
• Phenothiazines
• Phenoxybenzamine
• Phenylephrine; Promethazine
• Phenytoin
• Pimozide
• Polysaccharide-Iron Complex
• Potassium-sparing diuretics
• Pramipexole
• Prazosin
• Pregabalin
• Procarbazine
• Prochlorperazine
• Promethazine
• Propantheline
• Propofol
• Pyridoxine, Vitamin B6
• Rasagiline
• Reserpine
• Rotigotine
• Safinamide
• Sapropterin
• Scopolamine
• Selegiline
• Sevoflurane
• Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate
• Solifenacin
• Solriamfetol
• Tedizolid
• Tetrabenazine
• Thiazide diuretics
• Thiethylperazine
• Thioridazine
• Thiothixene
• Tranylcypromine
• Treprostinil
• Tricyclic antidepressants
• Trifluoperazine
• Trihexyphenidyl
• Vasodilators