Generic Name: carbidopa and levodopa (KAR bi DOE pa and LEE voe DOE pa)Brand Names: Atamet, Parcopa, Sinemet, Sinemet CR
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.
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. This medication 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 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. 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. 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.
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 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:
unusual skin lesions that have not been checked by a doctor; or
a history of malignant melanoma (skin cancer).
If you have any of these other conditions, you may need a dose adjustment or special tests to safely use this medication:
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;
an endocrine (hormonal) disease;
a stomach or intestinal ulcer;
wide-angle glaucoma; or
depression or other mental illness.
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).
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.
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.Store carbidopa and levodopa at room temperature away from moisture, heat, and light.
See also: Carbidopa and levodopa dosage in more detail
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.
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.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 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;
painful or difficult urination;
severe nausea, vomiting, or diarrhea;
uneven heart rate or fluttering in your chest;
confusion, hallucinations, anxiety, agitation, depressed mood, thoughts of suicide or hurting yourself;
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;
muscle pain, numbness or tingly feeling; 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.
Usual Adult Dose for Parkinson's Disease:
Initial: 1 tablet of carbidopa 25 mg/levodopa 100 mg orally 3 times a day, or 1 tablet of 10 mg carbidopa/100 mg levodopa 3 to 4 times a day. May increase dose by 1/2 to 1 tablet every 1 to 2 days to a dose of 8 tablets/day.Switch from Immediate to Extended Release:Dosage with extended release should be substituted at an amount that provides approximately 10% more levodopa per day, although this may need to be increased to a dosage that provides up to 30% more levodopa per day depending on clinical response. Allow at least a 3 day interval between dosage adjustments. The interval between doses of extended release should be 4 to 8 hours during the waking day. Maintenance: May be increased or decreased depending upon therapeutic response. Most patients have been adequately treated with 400 to 1600 mg of levodopa/day, administered as divided doses at intervals ranging from 4 to 8 hours during the waking day. Higher doses (2400 mg or more of levodopa/day) and shorter intervals (less than 4 hours) have been used, but are not usually recommended. The maximum daily dosage of carbidopa should not exceed 200 mg.Extended Release - No Prior Levodopa: Initial: 1 tablet of extended release 50 to 200 twice a day. Initial dosage should not be given at intervals less than 6 hours.
Usual Adult Dose for Neuroleptic Malignant Syndrome:
Case Report:Carbidopa 25 mg/levodopa 250 mg three times daily via nasogastric tube for 2 days.
Usual Pediatric Dose for GTP-CH Deficiency:
Case Reports:>1 year: Initial: 5 mg/kg/day of carbidopa/levodopa, then titrated slowly downward with the aim of maintaining control of extrapyramidal syndrome.
Before taking carbidopa and levodopa, tell your doctor if you are taking any of the following medicines:
other Parkinson's medications;
papaverine (Pavabid, Papacon, Pavagen, Pavacot);
blood pressure medication;
an antidepressant such as amitriptyline (Elavil, Vanatrip), doxepin (Sinequan), nortriptyline (Pamelor), and others; 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.