carbidopa and levodopa

What is the most important information I should know about carbidopa and levodopa?

If you are already taking levodopa (Larodopa, Dopar), you must stop taking it at least 12 hours before you start taking carbidopa and levodopa.

It may take up to several weeks of using carbidopa and levodopa before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after a few weeks of treatment. Also tell your doctor if the effects of this medication seem to wear off quickly in between doses.

Do not crush, chew, or break an extended-release tablet (Sinemet CR). Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

Carbidopa and levodopa can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

This medication may cause you to fall asleep during normal daytime activities such as working, talking, eating, or driving. You may fall asleep suddenly, even after feeling alert. Tell your doctor if you have any problems with daytime sleepiness or drowsiness. If you are unsure of how this medicine will affect you, be careful if you drive or do anything that requires you to be awake and alert.

You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medication. Talk with your doctor if you believe you have any intense or unusual urges while taking carbidopa and levodopa.

What is carbidopa and levodopa?

Levodopa is converted to a chemical called dopamine (DOE pa meen) in the brain. Symptoms of Parkinson's disease may be caused by low levels dopamine in the brain. Levodopa is turned into dopamine in the body.

Carbidopa helps prevent the breakdown of levodopa before it can reach the brain and take effect.

The combination of carbidopa and levodopa is used to treat Parkinson symptoms such as muscle stiffness, tremors, spasms, and poor muscle control.

Carbidopa and levodopa is also used to treat Parkinson symptoms caused by carbon monoxide poisoning or manganese intoxication.

Carbidopa and levodopa may also be used for other purposes not listed in this medication guide.

What should I discuss with my healthcare provider before taking carbidopa and levodopa?

Do not use carbidopa and levodopa if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take carbidopa and levodopa before the MAO inhibitor has cleared from your body.

You should not take this medication if you are allergic to carbidopa (Lodosyn) or levodopa (Larodopa), or if you have:

• narrow-angle glaucoma;
• unusual skin lesions that have not been checked by a doctor; or
• a history of malignant melanoma (skin cancer).

If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication. Before you take carbidopa and levodopa, tell your doctor if you have:

• heart disease, high blood pressure, coronary artery disease, a heart rhythm disorder, or a prior heart attack;
• asthma, chronic obstructive pulmonary disease (COPD), or other breathing disorder;
• liver disease;
• kidney disease;
• an endocrine (hormonal) disease;
• a stomach or intestinal ulcer;
• wide-angle glaucoma; or
• depression or other mental illness.

Carbidopa and levodopa may cause you to fall asleep during normal daytime activities such as working, talking, eating, or driving. You may fall asleep suddenly, even after feeling alert. Tell your doctor if you have any problems with daytime sleepiness or drowsiness. If you are unsure of how this medicine will affect you, be careful if you drive or do anything that requires you to be awake and alert.

You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking carbidopa and levodopa. It is not known whether the medicine actually causes this effect. Talk with your doctor if you believe you have any intense or unusual urges while taking carbidopa and levodopa.

Some people taking medicines for Parkinson's disease have developed skin cancer (melanoma). However, people with Parkinson's disease may have a higher risk than most people for developing melanoma. Talk to your doctor about your specific risk and what skin symptoms to watch for. You may need to have regular skin exams.

FDA pregnancy category C. It is not known whether carbidopa and levodopa is harmful to an unborn baby. Before taking this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment.

Carbidopa and levodopa may pass into breast milk and could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

The disintegrating tablet (such as Parcopa) may contain phenylalanine. Talk to your doctor before using this form of carbidopa and levodopa if you have phenylketonuria (PKU).

How should I take carbidopa and levodopa?

If you are already taking levodopa (Larodopa, Dopar), you must stop taking it at least 12 hours before you start taking carbidopa and levodopa.

Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Carbidopa and levodopa can be taken with or without food. Take your doses at regular intervals to keep a steady amount of the drug in your body at all times.

If you are switched from regular tablets to extended-release tablets, you may notice it takes a little longer for your medicine to start working. Talk with your doctor if this concerns you.

Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

The regular tablet can be broken or crushed if needed to make it easier to swallow.

To take the orally disintegrating tablet (Parcopa):

• Keep the tablet in its blister pack until you are ready to take the medicine. Open the package and peel back the foil from the tablet blister. Do not push a tablet through the foil or you may damage the tablet.
• Using dry hands, remove the tablet and place it in your mouth. It will begin to dissolve right away.
• Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. Swallow several times as the tablet dissolves.

It may take up to several weeks of using carbidopa and levodopa before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after a few weeks of treatment. Also tell your doctor if the effects of this medication seem to wear off quickly in between doses.

To be sure this medication is helping your condition and not causing harmful side effects, your blood will need to be tested on a regular basis. Your kidney, heart, and liver function may also need to be tested. Do not miss any scheduled appointments.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using carbidopa and levodopa.

Parkinson's disease is sometimes treated with a combination of different drugs. To best treat your condition, use all of your medications as directed by your doctor. Be sure to read the medication guide or patient instructions provided with each of your medications. Do not change your doses or medication schedule without advice from your doctor.

Store carbidopa and levodopa at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose can cause uneven heart rate.

What should I avoid while taking carbidopa and levodopa?

Avoid taking iron supplements or eating a diet that is high in protein (protein sources include meat, eggs, and cheese). These things can make it harder for your body to digest and absorb carbidopa and levodopa. Talk with your doctor or nutrition counselor about the best foods to eat while you are taking this medication.

Carbidopa and levodopa can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What are the possible side effects of carbidopa and levodopa?

You may notice that your sweat, urine, or saliva appears dark in color, such as red, brown, or black. This is not a harmful side effect, but it may cause staining of your clothes or bed sheets.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• restless muscle movements in your eyes, tongue, jaw, or neck;
• worsening of tremors (uncontrolled shaking);
• high fever, stiff muscles, sweating, fast or uneven heartbeats, rapid breathing, feeling like you might pass out;
• seizure (convulsions);
• painful or difficult urination;
• severe nausea, vomiting, or diarrhea;
• uneven heart rate or fluttering in your chest;
• confusion, hallucinations, anxiety, agitation, unusual thoughts or behavior;
• depressed mood, thoughts of suicide or hurting yourself; or
• chest pain or heavy feeling, pain spreading to the arm or shoulder.

Less serious side effects may include:

• mild nausea, dry mouth, loss of appetite, heartburn;
• diarrhea, constipation;
• headache, dizziness, drowsiness, blurred vision;
• sneezing, stuffy nose, cough, or other cold symptoms;
• sleep problems (insomnia), strange dreams;
• numbness or tingly feeling;
• muscle pain; or
• skin rash or itching.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect carbidopa and levodopa?

Before taking carbidopa and levodopa, tell your doctor if you are taking any of the following medicines:

• other Parkinson's medications;
• metoclopramide (Reglan);
• isoniazid (Nydrazid);
• phenytoin (Dilantin);
• papaverine (Pavabid, Papacon, Pavagen, Pavacot);
• blood pressure medication;
• an antidepressant such as amitriptyline (Elavil, Etrafon), amoxapine (Ascendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil); or
• medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), haloperidol (Haldol), prochlorperazine (Compazine), risperidone (Risperdal), and others;

This list is not complete and there may be other drugs that can interact with carbidopa and levodopa. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about carbidopa and levodopa.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2003 Cerner Multum, Inc. Version: 7.02. Revision date: 4/12/2009.

Your use of the content provided in this service indicates that you have read, understood and agree to the End-User License Agreement, which can be accessed by clicking on this link.