Carbidopa, entacapone and levodopa (Oral)

Carbidopa, Entacapone and Levodopa are used in combination for the treatment of shaking palsy (Parkinson's Disease).

Overview:

Carbidopa, entacapone and levodopa is a drug combination that is used in the treatment of patients suffering from Parkinson's Disease.

Parkinson's disease, which is also known as shaking palsy, is a condition that affects the central nervous system of the body. Parkinson's is a progressive neurological disease, meaning that the condition will worsen as time passes. There is no cure for Parkinson's but this medication offers a treatment that can limit the side effects of the condition.

In patients suffering from Parkinson's Disease, there is a shortage of the naturally occurring substance dopamine. This chemical helps the brain to control both movement and speech. Levodopa is used to replace the dopamine that is missing from the brain. This similar substance can be used by the body to control speech and movement more easily. This increase of control helps the patient to carry out everyday activities such as dressing, moving around the home and handling utensils more easily.

Entacapone blocks the COMT enzyme in the body and in doing so allows levodopa to work more effectively. The COMT enzyme breaks down levodopa in the body, so preventing this can allow a better supply of dopamine replacement to the brain. This also allows the effects of the levodopa to be longer lasting.

Carbidopa has no effects on Parkinson's itself, but its use in this combination is to reduce the peripheral adverse effects of the use of levodopa. It inhibits DOPA decarboxylase, which usually converts levodopa in the body. By preventing this conversion a greater amount of levodopa is allowed to reach the central nervous system unchanged.

This medication will be prescribed for the treatment of Parkinson's disease in some patients and will be administered in the form of a tablet. The tablet must be swallowed whole and will start to release treatment 30 minutes after consumption.

Condition treated:

  • Parkinson's Disease (symptoms)

Type of medicine:

  • Levodopa 'Amino acid
  • Entacapone' Inhibitor
  • Carbidopa¬†' Inhibitor

Side effects

In addition to the desired effects of the use of this medication, some unwanted side effects can occur. Some of the side effects experienced may require you to seek medical attention. In other cases, however, it may not be necessary to take any action. The following side effects should all be considered before agreeing to take this medication.

If you experience any of the following side effects then you should contact your doctor immediately:

  • Occurring with the use of Entacapone
  • Twitching of the muscles
  • Involuntary twisting
  • Uncontrollable and repetitive movements of the tongue, lips, face, arms, or legs

Occurring with the use of Carbidopa and Levodopa
o Bloody gums
o Bloody or black stools with an appearance of tar
o Bloody or cloudy urine
o Change in appearance of an existing mole
o Changes in skin colour
o Chest pain or feelings of discomfort and tightness
o Constipation
o Constricted pupil
o Convulsions
o Cough
o Difficult or laboured breathing
o Difficulty with speaking
o Drooling
o Drooping eyelid (ptosis)
o Facial dryness
o Fast, irregular, or pounding heartbeat
o Fever with or without chills
o General feeling of illness
o Hallucinations or visions or lights or flashes
o Hoarseness
o Large, flat, blue, or purplish patches on the skin
o Large swellings appearing on the body. Can affect hands, feet, sexual organs and face.
o Loss of hunger
o Loss of bladder control
o Lower abdominal or stomach pain
o Lower back or side pain
o Mole that leaks fluid or bleeds
o Muscle cramps or spasms
o Muscle pain or stiffness
o Muscle trembling, jerking, or stiffness
o Nausea
o Pain
o Painful or difficult urination
o Pinpoint red spots on the skin
o Raised red swellings on the skin, the buttocks, legs, or ankles
o Restlessness
o Severe mental changes
o Shakiness and unsteady walk
o Shuffling walk
o Sore throat
o Sores, ulcers, or white spots on the lips or in the mouth
o Sweating
o Swollen glands
o Trembling, or other problems with muscle control or coordination
o Unusual bleeding or bruising
o Unusual tiredness or weakness
o Vomiting

Other side effects can also occur that will not necessarily require you to seek medical attention. The following side effects may abate over time as your body gets used to the medication and your healthcare professional may be able to help you to alleviate some of the side effects experienced. If the following side effects become bothersome or ongoing then inform your doctor.

Occurring with the use of Entacapone
o Absence of or decrease in body movement
o Diarrhea
o Dizziness
o Urine discoloration
o Acid or sour stomach
o Anxiety
o Belching
o Bitter, sour, or unusual taste in the mouth
o Bloated
o Burning feeling in the chest or stomach
o Dry mouth
o Excess air or gas in the stomach or intestines
o Fear
o Full feeling
o Heartburn
o Hyperventilation
o Increased sweating
o Indigestion
o Irritability
o Lack or loss of strength
o Passing gas
o Restlessness
o Sleepiness or unusual drowsiness
o Stomach discomfort or upset
o Swollen mouth and tongue
o Tenderness in the stomach area
o Trouble sleeping
o Urge to have bowel movement

Occurring with the use of Carbidopa and Levodopa
o Being forgetful
o Bladder pain
o Blurred vision
o Body aches or pain
o Burning or tingling feelings extending over the skin
o Burning in the abdomen or stomach pain
o Burning on your tongue
o Clenching of teeth involuntarily
o Confusion about identity, place, and time or disorientation in familiar environments
o Darkening of the saliva
o Dark appearing sweat
o Decreased mental acuity
o Difficulty swallowing
o Discouragement
o Double vision
o Ear congestion
o Enlarged pupils
o Excessive watering of the mouth
o Fainting
o False or unusual sense of well-being
o Feeling like you will pass out
o Feeling of warmth
o Feeling sad or empty
o Flushing
o Hair loss
o Headache
o Hiccups
o Hives or welts
o Increased blinking
o Increased interest in sexual ability, desire, drive, or performance
o Increased interest in sexual intercourse
o Lack of appetite
o Large, hard skin blisters
o Leg pain
o Loss of voice
o Muscle spasm, especially of the neck and back
o Nasal congestion
o Nightmares
o Numbness
o Pain in the chest below the breastbone
o Painful or prolonged erection of the penis
o Pharyngeal pain
o Pounding in the ears
o Problems with memory or speech
o Redness of the face, neck, arms, and occasionally upper chest
o Runny nose
o Sense of stimulation
o Skin rash
o Sleeplessness
o Slow movement
o Slow or fast heartbeat
o Slow reflexes
o Sneezing
o Swelling
o Tremor, increased
o Trouble concentrating
o Trouble recognizing objects
o Trouble thinking and planning
o Urinary frequency
o Urinary retention
o Weight gain
o Weight loss

Other side effects that have not been listed herein can also occur from the use of these medications. If you experience any other side effects then inform your doctor and seek advice on what to do. If you are very worried about a side effect that you are experiencing then you should seek emergency medical care.

Dosage:

This medication needs to be used exactly as you are directed to take it using the schedule laid out by your doctor. You should not cease use without talking to your doctor first and you should not start taking any other treatments without talking to your doctor first.

The tablet should be taken as a whole tablet and swallowed. It should not be chewed, crushed, broken or dissolved. Do not take a broken tablet.

Tablets can be taken either with or without food.

Protein can interfere with the behaviour of levodopa in the body. You should avoid a diet with too high protein content and you should certainly avoid taking any protein supplements. You should take normal amounts of protein throughout the day as your doctor directs.

The medication will 'wear off' towards the end of your dosing period and you may experience the symptoms of Parkinson's more strongly again. If this is impacting on your life for long periods then your dose may need to be adjusted. Inform your doctor in this case and follow his instructions.

The medication will not begin to release into your body for 30 minutes after you take it.

Vitamin supplements that contain iron or iron salts can prevent the effective use of this medication. Inform your doctor of any and all vitamins that you are taking or plan to take when receiving this medication.

This medication is usually prescribed as a second stage in treatment for patients who have previously been receiving a carbidopa and levodopa combination treatment.

The dose of this medication will be different for each patient. The dose you receive will depend on a range of factors including the severity of your condition, your weight and the strength of the medication that you are being prescribed. The following is a guideline only and you should follow the instructions of your doctor closely at all times. Only take this medication at the doses and frequency as set out by your doctor.

Adults:The starting dose is usually the same as the patients carbidopa and levodopa combination treatment. Dosing should not exceed eight tablets per day.

Children:Use and dose to be determined by the doctor.

If you miss a dose then you should take it as soon as possible. If, however, it is close to the time of your next dose then you should skip the missed dose and return to your usual schedule. Never take a double dose of this medication.

Interactions:

Medications can interact with one another and with other substances present in the body. It is very important that you tell your doctor about all medications that you take before beginning this treatment. This includes protein supplements, vitamin supplements, herbal remedies, over the counter prescriptions and other prescribed medication.

It is especially important that you inform your healthcare professional if you are taking any of the medications listed herein. However, this list has been selected for severity and may not be all-inclusive.

Use of the following medication alongside the carbidopa, entacapone and levodopa combination is not recommended. If you are taking one of these medications currently then your doctor may wish to change one or more of your medications.

  • Amisulpride
  • Bromopride
  • Clorgyline
  • Furazolidone
  • Iproniazid
  • Isocarboxazid
  • Linezolid
  • Methylene Blue
  • Moclobemide
  • Nialamide
  • Pargyline
  • Phenelzine
  • Procarbazine
  • Sulpiride
  • Toloxatone
  • Tranylcypromine

The use of the carbidopa, entacapone and levodopa combination is not usually recommended alongside the following medications. In some cases, your doctor may decide to prescribe both, but in doing so may wish to adjust the dose of one or more of the medications.

  • Apomorphine
  • Bitolterol
  • Bupropion
  • Desipramine
  • Dobutamine
  • Dopamine
  • Epinephrine
  • Fluvastatin
  • Glimepiride
  • Glipizide
  • Glyburide
  • Irbesartan
  • Isoetharine
  • Isoniazid
  • Isoproterenol
  • Losartan
  • Methyldopa
  • Nateglinide
  • Norepinephrine
  • Rosiglitazone
  • Tolbutamide
  • Venlafaxine
  • Voriconazole
  • Warfarin

Using the carbidopa, entacapone and levodopa combination alongside the following medications can increase the risk of the patient experiencing certain side effects and should be avoided when possible. Treatment with both medications may still be the best option for some patients and both may be prescribed by the doctor.

  • Droxidopa
  • Fosphenytoin
  • Indinavir
  • Iron
  • Kava
  • Metoclopramide
  • Phenylalanine
  • Phenytoin
  • Spiramycin
  • Tyrosine

This medication can also interact with proteins in the body. As such it is important for the patient to avoid eating a high protein diet. Your doctor will be able to advise on dietary matters when prescribing this medication.

Other medical problems experienced by the patient can also affect the use of this medication. You should inform your doctor of all medical problems that you have or have had in the past before beginning this treatment. This is especially important for the following medical conditions:

These conditions may be worsened by the use of the carbidopa, entacapone and levodopa combination:

  • Asthma
  • Biliary obstruction or blockage
  • Colitis
  • History of depression
  • Dyskinesia
  • Endocrine or metabolic disease
  • History of heart attack
  • Severe heart or blood vessel disease
  • Heart rhythm problems
  • Hypotension
  • Kidney disease
  • Liver disease
  • Severe lung disease
  • History of psychosis
  • Wide-angle glaucoma
  • Intraocular hypertension

The carbidopa, entacapone and levodopa combination should not be used in patients suffering from the following:

  • History of or active melanoma
  • Narrow-angle glaucoma
  • Skin lesions
  • Undiagnosed skin conditions

The use of carbidopa, entacapone and levodopa with the following condition can increase the risk of suffering stomach or bowel haemorrhage:

History of peptic ulcer

Warnings:

This medication has serious side effects on the body and should not be taken without due consideration for the risks. These should be weighed against the benefits of using the treatment with your doctor. To ensure you and your doctor can consider all of the relevant factors you should ensure that you discuss the following:

Allergies:It is vital that your doctor knows of any and all allergies that you have suffered from. This is particularly important if you have ever suffered from an allergic or unusual reaction to any medication that you have received in the past. You should also inform your doctor of allergies to dyes, foods, preservatives, animals or other substances that you are aware of.

Pediatric:Appropriate studies have not been carried out on the use of carbidopa, entacapone and levodopa. Discuss use with your doctor.

Geriatric:No limitations for the use of the carbidopa, entacapone and levodopa combination have been determined in patients aged up to 75. Elderly patients are, however, more likely to be suffering from conditions that would require extra caution. Be alert for kidney, liver and cardiovascular conditions in elderly patients.

Pregnancy:There is a risk to the use of the carbidopa, entacapone and levodopa combination when pregnant. Animal studies have shown an increase in skeletal malformations and an increase in fetus death. Discuss the risk with your doctor. This treatment in pregnant women should only be used where the benefits outweigh the risks.

Breastfeeding: Caution should be used when administering the carbidopa, entacapone and levodopa combination to nursing women. It is unknown whether the medication has an effect on human milk, but animal testing has shown contamination. Discuss breastfeeding with your doctor and weigh the benefits against the risk. Infants may need to be monitored when breastfeeding from a patient.

Your doctor will need to check up on you when you are using this treatment. This will allow them to check for any unwanted effects that may occur and to ensure that the treatment is working effectively. The progression of your condition will also need to be examined and treatment may need to be amended as it develops.

Do not take this medication if you have used a monoamine oxidase inhibitor (MAO) treatment within the previous two weeks.

Do not cease use without discussing with your doctor. Your use will need to be gradually reduced to prevent dramatic changes in your condition.

Treatment with this medication can trigger neuroleptic malignant syndrome (NMS) in patients. Inform your doctor immediately if you experience the following symptoms:

  • Seizures or convulsions
  • Difficulty breathing
  • Increased heart rate
  • High fever
  • Changed blood pressure
  • Increased sweating
  • Loss of control of bladder
  • Severe muscle stiffening
  • Unusual paleness
  • Unusual tiredness

This medication can make you dizzy and drowsy. It can even cause you to fall asleep without warning. Ensure that you understand the effects it has on your body before you drive or operate any kind of machinery. Only do so if you are in safe control.

You may get dizzy or drowsy when you stand up from a sitting or lying position with this medication. Get up slowly to alleviate this side effect.

This medication will affect the use of antihistamines, relaxants, sleeping medications and pain medications. You should inform your doctor of all medication that you are taking or have been prescribed.

This medication can cause diarrhea and in some cases, this won't occur until several months after you start taking the medication. Diarrhea medication can make this side effect worse. Contact your doctor immediately for advice.

If your urine appears dark while taking this combination then you should contact your doctor immediately. If combined with a fever then there is a high chance this is a symptom of a serious condition called rhabdomyolysis.

Look for unusual red, brown or black spots that appear on your skin. These can be signs of a melanoma developing on your skin and you should talk to your doctor immediately.

You may experience a change in behaviour when taking this medication. You should discuss this with your doctor if you have an increased interest in gambling or an increased interest in sex while taking this medication.

Do not take any other medications or substances without first discussing them with your doctor.

Storage:

This medication should be stored in a sealed container well out of the reach of children. Keep the container at room temperature in a cool, dark place. Prevent this treatment from freezing. Do not keep outdated medication and ensure that it is properly and safely disposed of. Your healthcare professional will be able to advise you on how best to dispose of unwanted medication.

Summary:

The combination medication carbidopa, entacapone and levodopa are used in the treatment of Parkinson's disease. Parkinson's, which is also known as shaking palsy, is a condition that affects the central nervous system because of a shortage of dopamine.

The combination medication carbidopa, entacapone and levodopa work to provide a replacement chemical to the central nervous system so that the patient can regain better control of basic functions including movement and sleep.

The replacement chemical is provided by levodopa, which acts in the same way as the missing dopamine would usually. The carbidopa and entacapone have no direct effect on the condition, but they enable the more effective delivery of levodopa to the central nervous system by inhibiting enzymes that break down the levodopa before it reaches the central nervous system.

The combination medication of carbidopa, entacapone and levodopa is not a cure for Parkinson's, it is a treatment to alleviate the symptoms of the condition and allow the patient to carry out a normal lifestyle that is not dramatically impaired by the symptoms of the condition.

This treatment interacts with a wide range of medications and medical conditions, so it is very important that your doctor is informed of your medical history and current medications before you begin this treatment. The medication can also be affected by protein, vitamin supplements and iron, so it is important that you discuss your diet and habits with the doctor too. The doctor will provide a meal plan in addition to this medication to ensure that you can get the nourishment that you need at appropriate stages throughout the day.

This medication is administered in a tablet form. The tablets begin release 30 minutes after consumption and are in a casing that should not be broken. The tablets must be swallowed whole and you should not take a tablet that is broken or has been crushed.

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