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.
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 exactly as prescribed by your doctor. Do not take in larger or smaller 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. 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. Minor Through its central antimuscarinic actions, hyoscyamine can potentiate the dopaminergic effects of levodopa.
Clinicians should be ready to decrease doses of levodopa if hyoscyamine is added. Atropine; Hyoscyamine; Phenobarbital; Scopolamine: Major Antipsychotic agents may inhibit the clinical antiparkinsonian response to levodopa by blocking dopamine receptors in the brain.
In general, however, the 'atypical antipsychotics' are less likely to interfere with these therapies than traditional antipsychotic agents e.
Antipsychotics should be avoided during therapy for Parkinson's disease unless the benefit of the drug outweighs the risk of decreased therapeutic response to levodopa or other treatments. In general, experts consider quetiapine the atypical antipsychotic of choice in Parkinson's patients due to a lower incidence of extrapyramidal symptoms, although the choice of antipsychotic medication must always be made on a case-by-case decision. This action diminishes levodopa's therapeutic effects by decreasing the amount of levodopa that is available to cross into the CNS.
Patients receiving levodopa single-agent therapy should avoid vitamin B6 supplements. Belladonna Alkaloids; Ergotamine; Phenobarbital: Major Levodopa, due to its conversion to dopamine, may increase the risk of developing amphetamine-induced cardiac arrhythmias; dosage reductions or discontinuation of benzphetamine is recommended if the two agents are used concurrently. Minor Through its central antimuscarinic actions, antimuscarinics such as benztropine can potentiate the dopaminergic effects of levodopa.
While some patients may benefit from this interaction, clinicians should be ready to decrease doses of levodopa if benztropine is added. Moderate Concomitant use of beta-blockers with levodopa can result in additive hypotensive effects. Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: The manufacturer recommends an initial evaluation for signs and symptoms of peripheral neuropathy, and periodic monitoring for peripheral neuropathy during treatment with Duopa, particularly in patients receiving other medications that are associated with neuropathy.
Metronidazole has been associated with peripheral neuropathy, with the prevalence and severity of the neuropathy being directly related to the cumulative dose and duration of therapy. Peripheral neuropathy has also been reported in patients treated with other nitroimidazole drugs including tinidazole. Bismuth Subsalicylate; Metronidazole; Tetracycline: Peripheral neuropathy has been reported with the use of brentuximab vedotin. Brentuximab vedotin-induced peripheral neuropathy is cumulative.
Major Use bupropion cautiously in patients taking levodopa or combination drugs containing levodopa e. Both drugs are dopamine agonists; cumulative effects may result in central nervous system CNS toxicity. Adverse reactions reported with coadministration have included restlessness, agitation, tremor, ataxia, gait disturbance, vertigo, and dizziness.
If levodopa is used concurrently, low initial dosing and slow dosage titration of bupropion may be warranted. Minor Cabergoline and levodopa both increase dopaminergic function centrally. Although this combination appears safe and effective overall, additive neurologic effects are possible.
Hallucinations have been reported with the concurrent use of cabergoline and levodopa. Major Phenothiazines may inhibit the clinical antiparkinsonian response to levodopa by blocking dopamine receptors in the brain and levodopa may decrease the response to phenothiazines by increasing central dopamine levels. In general, phenothiazines should be avoided in patients requiring therapy for Parkinson's disease unless the benefit of the antipsychotic outweighs the risk of decreased therapeutic response to levodopa or phenothiazines.
Major Phenothiazines like promethazine may inhibit the clinical antiparkinsonian response to levodopa, pergolide, pramipexole, or ropinirole therapy by blocking dopamine receptors in the brain. Medications like entacapone, tolcapone, pramipexole or ropinirole may also cause additive drowsiness when combined with promethazine. In general, the use of a phenothiazine-type drug should be avoided in patients requiring therapy for Parkinson's disease unless the benefit of the drug outweighs the risk of decreased therapeutic response to levodopa or other treatments.
Patients taking these drugs should be carefully observed for loss of therapeutic response. If dacarbazine is used in a patient stabilized on levodopa therapy, practitioners may wish to be alert for needed adjustments in the levodopa regimen to maintain patient status. Minor Through central antimuscarinic actions, anticholinergics can potentiate the dopaminergic effects of levodopa. Antimuscarinics, by slowing GI transit, may also decrease levodopa bioavailability; however, this mechanism appears to be of modest clinical significance.
Antimuscarinic agents targeted specifically for urinary incontinence may be less likely to produce pronounced effects on levodopa response than those with more pronounced systemic action. Moderate Increased dopaminergic effects may occur during coadministration of dexmethylphenidate, an inhibitor of dopamine reuptake, and medications that increase dopaminergic activity such as levodopa. Dopaminergic side effects, such as nausea, loss of appetite, weight loss, insomnia, tremor, nervousness, or changes in mood or behavior, are possible.
Minor Anticholinergics can potentiate the dopaminergic effects of levodopa. Major Droperidol, a butyrophenone derivative, is a dopamine D2 receptor antagonist and thus, may reduce the therapeutic effects of levodopa, which is an agonist at dopamine D2 receptors. Avoidance of droperidol use in a patient with Parkinson's disease may be advisable unless the benefit of droperidol outweighs the risk of CNS depressive effects and decreased therapeutic response to dopamine agonists.
Major Droxidopa is directly metabolized to norepinephrine by dopa-decarboxylase; therefore, coadministration with dopa-decarboxylase inhibitors e. Patients in the clinical trials with droxidopa received concomitant medications used to treat Parkinson's disease. However, in clinical trials, it was found that the decreased clearance was not associated with a significant need for a different treatment dose or increases in associated adverse events.
No dose adjustments are expected to be required. However, the manufacturer states that in some patients, it is possible that dose adjustments for droxidopa will be required. Major If administered before halogenated anesthetics, levodopa without concomitant use of a decarboxylase inhibitor has been associated with cardiac arrhythmias. This interaction is presumably due to the levodopa-induced increases in plasma dopamine. Levodopa single-agent therapy should be discontinued 6 to 8 hours before administering halogenated anesthetics.
Otherwise, when general anesthesia is required, levodopa may be continued as long as the patient is permitted to take oral medication. Patients should be observed for signs of neuroleptic malignant syndrome while therapy is interrupted, and the usual levodopa regimen should be administered as soon as the patient is able to take oral medication. Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate: Major Iron salts may reduce the bioavailability of levodopa and carbidopa; levodopa.
Administration of iron salts, including polysaccharide-iron complex, should be separated from levodopa by at least 2 hours. Ethinyl Estradiol; Norethindrone; Ferrous fumarate: Major Foods with a high protein content may interfere with the absorption of levodopa.
It has been recommended to take levodopa at least 30 minutes before eating or one hour after meals. Major Patients with Parkinson's disease should avoid foods high in fat around the time of taking carbidopa; levodopa. These foods may delay gastric emptying, which can decrease and delay the absorption of levodopa. Major Patients with Parkinson's disease should avoid foods high in fiber around the time of taking carbidopa; levodopa. Moderate Phenytoin or fosphenytoin can possibly interfere with the effects of levodopa; the mechanism of the interaction has not been established.
The beneficial effects of levodopa in Parkinson's disease have been reported to be reversed by phenytoin. Monitor carefully for loss of therapeutic response. Major Concomitant use of levodopa and drugs with monoamine oxidase inhibitor activity, such as furazolidone, can result in hypertensive crisis.
Simultaneous use of these agents should be avoided if possible. Moderate Coadministration of glycopyrrolate with levodopa may decrease levodopa serum concentrations. If coadministration is necessary, monitor clinical response to levodopa and increase levodopa dose accordingly. Haloperidol should be avoided during therapy for Parkinson's disease unless the benefit of the drug outweighs the risk of decreased therapeutic response to levodopa or other treatments.
Major The use of levodopa with halothane may enhance cardiac adverse effects of halothane. Otherwise, when general anesthetics are required, levodopa may be continued as long as the patient is permitted to take oral medication.
Falling Asleep During Activities of Daily Living and Somnolence Patients taking SINEMET alone or with other dopaminergic drugs have reported suddenly falling asleep without prior warning of sleepiness while engaged in activities of daily living includes operation of motor vehicles.
Road traffic accidents attributed to sudden sleep onset have been reported. Although many patients reported somnolence while on dopaminergic medications, there have been reports of road traffic accidents attributed to sudden onset of sleep in which the patient did not perceive any warning signs, such as excessive drowsiness, and believed that they were alert immediately prior to the event.
Sudden onset of sleep has been reported to occur as long as one year after the initiation of treatment. Falling asleep while engaged in activities of daily living usually occurs in patients experiencing preexisting somnolence, although some patients may not give such a history. For this reason, prescribers should reassess patients for drowsiness or sleepiness especially since some of the events occur well after the start of treatment. Prescribers should be aware that patients may not acknowledge drowsiness or sleepiness until directly questioned about drowsiness or sleepiness during specific activities.
Patients who have already experienced somnolence or an episode of sudden sleep onset should not participate in these activities during treatment with SINEMET. Before initiating treatment with SINEMET, advise patients about the potential to develop drowsiness and ask specifically about factors that may increase the risk for somnolence with SINEMET such as the use of concomitant sedating medications and the presence of sleep disorders.
Consider discontinuing SINEMET in patients who report significant daytime sleepiness or episodes of falling asleep during activities that require active participation e. If treatment with SINEMET continues, patients should be advised not to drive and to avoid other potentially dangerous activities that might result in harm if the patients become somnolent. There is insufficient information to establish that dose reduction will eliminate episodes of falling asleep while engaged in activities of daily living.
Hyperpyrexia And Confusion Sporadic cases of a symptom complex resembling neuroleptic malignant syndrome NMS have been reported in association with dose reductions or withdrawal of certain antiparkinsonian agents such as levodopa, carbidopa levodopa, or carbidopa levodopa extended release. Therefore, patients should be observed carefully when the dosage of levodopa is reduced abruptly or discontinued, especially if the patient is receiving neuroleptics.
NMS is an uncommon but life-threatening syndrome characterized by fever or hyperthermia. Neurological findings, including muscle rigidity, involuntary movements, altered consciousness, mental status changes; other disturbances, such as autonomic dysfunction, tachycardia , tachypnea , sweating, hyper- or hypotension ; laboratory findings, such as creatine phosphokinase elevation, leukocytosis , myoglobinuria, and increased serum myoglobin have been reported.
The early diagnosis of this condition is important for the appropriate management of these patients. Considering NMS as a possible diagnosis and ruling out other acute illnesses e. This may be especially complex if the clinical presentation includes both serious medical illness and untreated or inadequately treated extrapyramidal signs and symptoms EPS.
Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke , drug fever, and primary central nervous system CNS pathology.
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