levodopa – carbidopa
This is a combination product containing two medications in the form of a gel: levodopa and carbidopa. It is used to treat Parkinson’s disease in people who are responsive to levodopa treatment, have tried other types of Parkinson’s disease medication combinations but continue to have symptoms. Levodopa – carbidopa intestinal gel is given using a small portable pump and tube that connects directly into the gut. The medication is given throughout the day, which allows a constant amount of medication to be in the blood and decrease the Parkinson’s symptoms.
Levodopa helps to control the symptoms of Parkinson’s disease by correcting the chemical imbalance in the brain that produces symptoms. The addition of carbidopa lowers the amount of levodopa that is required and may reduce some of the side effects of levodopa, such as nausea and vomiting.
Although levodopa helps relieve symptoms of Parkinson’s disease, it does not slow down the progression of the disease.
100 mg/25 mg
Each dappled purple, oval-shaped, compressed tablet, engraved “601” on one side and plain on the other, contains levodopa 100 mg and carbidopa 25 mg. Nonmedicinal ingredients: hydroxypropylcellulose, hypromellose, magnesium stearate, FD&C Blue No. 2 Aluminum Lake, and FD&C Red No. 40 Aluminum Lake.
200 mg/50 mg
Each dappled purple, oval-shaped, compressed tablet, engraved “521” on one side and plain on the other, contains levodopa 200 mg and carbidopa 50 mg. Nonmedicinal ingredients: hydroxypropylcellulose, hypromellose, magnesium stearate, FD&C Blue No. 2 Aluminum Lake, and FD&C Red No. 40 Aluminum Lake.
Treatment with levodopa – carbidopa should be started slowly and increased gradually to reduce the risk of side effects while gaining maximum benefit from the medication.
The recommended starting dose for people not already taking levodopa is 1 tablet, containing levodopa 100 mg and carbidopa 25 mg, 3 times a day. Your doctor will usually increase the dosage by 1 tablet daily every 3 days until the best results occur with the least amount of side effects. When the daily dose rises above 3 tablets daily, the dose should be divided into 4 to 6 daily doses. The maximum daily dose of levodopa is 1500 mg.
If you have already been taking levodopa and are starting levodopa – carbidopa, the dose will be much lower than the dose of levodopa taken as a single medction.
Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
The controlled release (CR tablets) form of this medication should be swallowed whole with fluids. Do not crush or chew the medication as this will destroy the time-release property of the medication.
It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and continue on with your regular schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice. If you miss more than one dose, check with your doctor.
Do not use levodopa – carbidopa intestinal gel if you:
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
As this medication is delivered using a pump-tube delivery system, complications can occur from the surgical procedure required to create the small opening in the stomach wall for the intestinal tube and with long-term use of the intestinal tube. This risk should be discussed with your doctor to determine if this medication is a good choice for your treatment.
Although most of these side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
The following side effects may be caused from the tubing as you should check you with your doctor as soon as possible if any occurs:
Seek immediate medical attention if any of the following occur:
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Activities requiring alertness: There have been reports of sudden onset of sleep by individuals taking levodopa and carbidopa combination. The doctor should be informed immediately if any episodes of suddenly falling asleep occur.
Behavioural and mood changes: This medication has been known to cause mood swings, changes in behavior, and symptoms of depression. If you have depression or a history of depression, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. You may notice compulsive behaviour, such as gambling, increased sexual activity, or inappropriate spending. If you experience symptoms of depression such as poor concentration, changes in weight, changes in sleep, or decreased interest in activities, contact your doctor as soon as possible. If you notice compulsive behaviour or signs of depression in a family member, ensure that they see their doctor.
Blood pressure and heart: This medication can cause blood pressure changes, making symptoms of heart conditions worse. If you have an existing heart condition, you should discuss with your doctor about how your condition may affect your medication dosage, or how your dosage may affect your medical condition.
Device-related complications: A sudden decrease in treatment response with increased symptoms of Parkinson’s disease may be due to problems with the tubing or pump device, including tube blockages or dislocations. The doctor should be informed immediately if this occurs.
Diet: Protein-rich diets such as diets that contain a lot of meat, poultry, or fish may reduce the beneficial effects of levodopa. Discuss appropriate diet options with your doctor.
Glaucoma: This medication may make symptoms of glaucoma worse by increasing the pressure in the eye. If you have chronic wide-angle glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Medical conditions: People with epilepsy, peptic ulcer or previous surgery in the upper part of the abdomen, heart disease, lung disease (e.g. asthma), liver disease, kidney disease, or hormonal disturbances, should be frequently monitored by their doctor while taking this medication.
Neuroleptic malignant syndrome (NMS): Very rarely, levodopa – carbidopa can cause a potentially fatal syndrome known as neuroleptic malignant syndrome (NMS). If you notice the symptoms of NMS such as high fever, muscle stiffness, confusion or loss of consciousness, sweating, racing or irregular heartbeat, or fainting, get immediate medical attention.
Seizures: If you have seizures or a history of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Skin cancer: People with Parkinson’s have been shown to have 2 to 6 times the risk of developing skin cancer compared to the general population. It is unknown if this is caused by the medication or the Parkinson’s disease. You should discuss with your doctor regarding regular monitoring of your skin.
Sudden onset of sleep: There are reports of people who use levodopa – carbidopa falling asleep with no warning or drowsiness. If you have a sleep disorder, discuss this with your doctor. If you experience drowsiness while taking this medication, avoid driving or using machinery.
Surgeries: Except in emergencies, levodopa – carbidopa intestinal gel should be stopped 2 to 3 hours before any surgeries that require general anesthesia. Use of anesthesia and this medication together may cause changes in blood pressure or abnormal heart rhythms. Levodopa – carbidopa intestinal gel can be restarted after surgery as soon as the doctor allows you to drink fluids normally.
Pregnancy: The safety and effectiveness of using this medication have not been established for pregnant women. Levodopa – carbidopa intestinal gel should not be used during pregnancy unless the benefits outweigh the risks.
Breast-feeding: It is not known if levodopa – carbidopa passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of levodopa-carbidopa intestinal gel have not been established for use by people less than 18 years of age.
There may be an interaction between levodopa – carbidopa intestinal gel and any of the following:
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