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
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