Carbidopa, Entacapone, and Levodopa (Oral Route)
Original Article: http://www.mayoclinic.com/health/drug-information/DR600055
US Brand Names
Carbidopa, entacapone, and levodopa combination is used to treat Parkinson's disease, sometimes called shaking palsy. Parkinson's disease is a disorder of the central nervous system (brain and spinal cord).
Dopamine is a naturally occurring substance in the brain that helps provide control of movement and activities such as walking and talking. In patients with Parkinson's disease, there is not enough dopamine in some parts of the brain. Levodopa (a component of this medicine) enters the brain and helps replace the missing dopamine, which allows people to function better. By increasing the amount of dopamine in the brain, levodopa helps control symptoms and helps you to perform daily activities such as dressing, walking, and handling utensils.
This medicine is a combination of three different medicines. This medicine is known as a levodopa therapy. The difference between this medicine and other levodopa treatments is that this medicine contains entacapone. Entacapone helps levodopa last longer by blocking a substance called COMT enzyme. This enzyme breaks down levodopa before it reaches the brain. When less levodopa is broken down, more is available to the brain. Increased availability of levodopa may lead to smoother and steadier levels of dopamine in the brain, which may provide better symptom control for longer periods each day. This may lead to improvement in daily activities.
This medicine is available only with your doctor's prescription.
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of carbidopa, entacapone, and levodopa combination in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date in elderly patients up to age 75 years have not demonstrated geriatrics-specific problems that would limit the usefulness of carbidopa, entacapone, and levodopa combination in the elderly. However, elderly patients are more likely to have age-related kidney, liver, and cardiovascular insufficiency, which may require extra caution.
|All Trimesters||C||Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.|
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Ferric Ammonium Citrate
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
- High Protein Food
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Asthma or
- Biliary obstruction or blockage or
- Colitis (inflammation of the colon) or
- Depression, history of or
- Dyskinesia (abnormal muscle movements) or
- Endocrine or metabolic disease or
- Heart attack, history of or
- Heart or blood vessel disease, severe or
- Heart rhythm problems (e.g., ventricular tachycardia) or
- Hypotension (low blood pressure) or
- Kidney disease or
- Liver disease or
- Lung disease, severe or
- Psychosis (mental disorder), or history of or
- Wide-angle glaucoma (eye pressure problem)—Use with caution. May make these conditions worse.
- Melanoma (skin tumor), history of or
- Narrow–angle glaucoma (eye pressure problem) or
- Skin lesions, undiagnosed (rashes that involve changes in color or texture of the skin)—Should not be used in patients with these conditions.
- Peptic ulcer, history of—May increase risk of stomach or bowel hemorrhage.
Take this medicine exactly as directed, and every time that you are supposed to take it. It is important that you do not stop taking your medicine unless ordered by your doctor. It is also important to not start taking other medicines for your Parkinson's disease without first talking with your doctor.
Since protein may interfere with the body's response to levodopa, high protein diets should be avoided. Intake of normal amounts of protein should be spaced equally throughout the day, or taken as directed by your doctor.
You may experience a “wearing-off” effect towards the end of the dosing interval. You should tell your doctor if you have problems with this that affect your every day life. Your doctor may want to adjust your dose.
This medicine begins to release its ingredients 30 minutes after you take it.
If you are taking multivitamin tablets or plan to start taking them, discuss this first with your doctor. Iron salts (in vitamins) may keep this medicine from working properly.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage forms (capsules or tablets):
- For Parkinson's disease:
- Adults—The starting dose is usually the same as the current dose you are taking. If you are starting this medicine for the first time, your doctor may want to start you on a carbidopa and levodopa combination with entacapone and gradually switch you over to this combination.
- Children—Use and dose must be determined by your doctor.
- For Parkinson's disease:
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
It is very important that your doctor check your progress at regular visits to allow changes in your dose and to check for any unwanted effects.
Do not take this medicine if you have taken a monoamine oxidase (MAO) inhibitor (e.g. phenelzine [Nardil®] or tranylcypromine [Parnate®]) in the past 2 weeks.
Do not stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping completely.
Check with your doctor right away if you are having convulsions (seizures); difficulty with breathing; a fast heartbeat; a high fever; high or low blood pressure; increased sweating; loss of bladder control; severe muscle stiffness; unusually pale skin; or tiredness. These could be symptoms of a serious condition called neuroleptic malignant syndrome (NMS).
This medicine may cause dizziness, trouble in controlling movements, or trouble in concentrating or seeing clearly. Make sure you know how you react to this medicine before you drive, use machines, or do other jobs that require you to be alert, well-coordinated, or able to think or see well.
Dizziness, lightheadedness, or fainting may occur with this medicine, especially when you get up from a lying or sitting position suddenly. These symptoms are more likely to occur when you begin taking this medicine, or when the dose is increased. Getting up slowly may also help. If this problem continues or gets worse, check with your doctor.
This medicine may cause diarrhea, and in some cases it can be severe. It can occur months after starting this medicine. Do not take any medicine to treat diarrhea without first checking with your doctor. Diarrhea medicines may make the diarrhea worse or make it last longer. If you have any questions about this or if mild diarrhea continues or gets worse, check with your doctor.
If you develop any unusual or strange thoughts and behavior while receiving this medicine, be sure to discuss it with your doctor. Other changes might be confusion, worsening of depression, visual hallucinations (seeing things that are not there), suicidal thoughts, and unusual excitement, nervousness, or irritability.
Check with your doctor right away if you have dark-colored urine, fever, muscle cramps or spasms, muscle pain or stiffness, or unusual tiredness or weakness. These may be symptoms of a condition called rhabdomyolysis.
Stop using this medicine and check with your doctor right away if you are having shortness of breath, chest tightness, or any type of breathing problem while being treated with this medicine.
It is important that your doctor check your skin regularly for signs of a skin cancer called melanoma. If you notice any unusual red, brown, or black spots on your skin, talk to your doctor right away.
It is possible that a dark color (red, brown, or black) may appear in saliva, urine, or sweat after taking this medicine. The color may cause some of your garments to become discolored. This is normal and nothing to worry about.
It is possible that you may become nauseous, especially when you are first starting your medicine.
Some people who have used this medicine had unusual changes in their behavior. Talk with your doctor right away if you start having problems with gambling or an increased interest in sex while using this medicine.
Before you have any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of some tests may be affected by this medicine.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:More common-Entacapone
- Twitching, twisting, or uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
- Bleeding gums
- Bloody or black, tarry stools
- Bloody or cloudy urine
- Change in size, shape, or color of an existing mole
- Changes in skin color
- Chest pain, discomfort, or tightness
- Constricted pupil
- Difficult or labored breathing
- Difficulty with speaking
- Drooping eyelid (ptosis)
- Facial dryness
- Fast, irregular, or pounding heartbeat
- Fever with or without chills
- General feeling of illness
- Hallucinations (seeing, hearing, or feeling things that are not there)
- High or low blood pressure
- Large, flat, blue, or purplish patches in the skin
- Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
- Loss of appetite
- Loss of bladder control
- Lower abdominal or stomach pain
- Lower back or side pain
- Mole that leaks fluid or bleeds
- Muscle cramps or spasms
- Muscle pain or stiffness
- Muscle trembling, jerking, or stiffness
- Painful or difficult urination
- Pinpoint red spots on the skin
- Raised red swellings on the skin, the buttocks, legs, or ankles
- Severe mental changes
- Shakiness and unsteady walk
- Shuffling walk
- Sore throat
- Sores, ulcers, or white spots on the lips or in the mouth
- Swollen glands
- Trembling, or other problems with muscle control or coordination
- Unusual bleeding or bruising
- Unusual tiredness or weakness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More common-Entacapone
- Absence of or decrease in body movement
- Urine discoloration
- Acid or sour stomach
- Bitter, sour, or unusual taste in the mouth
- Burning feeling in the chest or stomach
- Dry mouth
- Excess air or gas in the stomach or intestines
- Full feeling
- Increased sweating
- Lack or loss of strength
- Passing gas
- Sleepiness or unusual drowsiness
- Stomach discomfort or upset
- Swollen mouth and tongue
- Tenderness in the stomach area
- Trouble sleeping
- Urge to have bowel movement
- Being forgetful
- Bladder pain
- Blurred vision
- Body aches or pain
- Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
- Burning and upper abdominal or stomach pain
- Burning sensation of the tongue
- Clenching, gnashing, or grinding teeth
- Confusion about identity, place, and time
- Dark saliva
- Dark sweat
- Decreased mental acuity
- Difficulty swallowing
- Double vision
- Ear congestion
- Enlarged pupils
- Excessive watering of the mouth
- False or unusual sense of well-being
- Feeling like you will pass out
- Feeling of warmth
- Feeling sad or empty
- Hair loss
- Hives or welts
- Increased blinking
- Increased interest in sexual ability, desire, drive, or performance
- Increased interest in sexual intercourse
- Lack of appetite
- Large, hard skin blisters
- Leg pain
- Loss of voice
- Muscle spasm, especially of the neck and back
- Nasal congestion
- Pain in the chest below the breastbone
- Painful or prolonged erection of the penis
- Pharyngeal pain
- Pounding in the ears
- Problems with memory or speech
- Redness of the face, neck, arms, and occasionally upper chest
- Runny nose
- Sense of stimulation
- Skin rash
- Slow movement
- Slow or fast heartbeat
- Slow reflexes
- Tremor, increased
- Trouble concentrating
- Trouble recognizing objects
- Trouble thinking and planning
- Urinary frequency
- Urinary retention
- Weight gain
- Weight loss
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.