Generic Name: carbidopa, entacapone, and levodopa (KAR bi DOE pa, en TAK a pone, LEE voe DOE pa)Brand Names: Stalevo 100, Stalevo 125, Stalevo 150, Stalevo 200, Stalevo 50, Stalevo 75
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.
When used with carbidopa, entacapone, and levodopa (Atamet, Parcopa, Sinemet), entacapone increases levels of levodopa in the body.
The combination of carbidopa, entacapone, and levodopa is used to treat Parkinson symptoms such as muscle stiffness, tremors, spasms, and poor muscle control.
Carbidopa, entacapone, 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, entacapone, and levodopa?Do not take this medication if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) within the past 14 days.
You should not take this medication if you are allergic to carbidopa (Lodosyn), entacapone (Comtan), or levodopa (Larodopa), or if you have narrow-angle glaucoma, unusual skin lesions, or a history of skin cancer.
Tell your doctor about all of your medical conditions, especially heart disease, high blood pressure, asthma or other breathing problems, liver or kidney disease, a hormonal disease, an ulcer, glaucoma, or mental illness. Also tell your doctor about all the medications you use.It may take up to several weeks of using carbidopa, entacapone, 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.
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, entacapone, and levodopa.Do not stop using carbidopa, entacapone, and levodopa without first talking to your doctor.What should I discuss with my healthcare provider before taking carbidopa, entacapone, and levodopa?Do not take this medication if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) within the past 14 days.
You should not take this medication if you are allergic to carbidopa (Lodosyn), entacapone (Comtan), 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 take carbidopa, entacapone, and levodopa:
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;
depression or other mental illness.
You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking carbidopa, entacapone, 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, entacapone, and levodopa.
Carbidopa, entacapone, and levodopa may cause hallucinations (the sensation of hearing or seeing something that is not there). Call your doctor if you experience hallucinations.
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, entacapone, 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, entacapone, 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.
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.
Take your medicine at regular intervals to keep a steady amount of the drug in your body at all times.It may take up to several weeks of using carbidopa, entacapone, 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 doctor will need to check your progress on a regular basis. Do not miss any scheduled appointments.Do not stop using carbidopa, entacapone, and levodopa without first talking to your doctor. You may need to use less and less before you stop the medication completely.
This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using carbidopa, entacapone, and levodopa.Store carbidopa, entacapone, and levodopa at room temperature away from moisture and heat.
See also: Carbidopa, entacapone, 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.
Overdose symptoms may include weakness, loss of coordination, trouble breathing, fainting, or seizure (convulsions).
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, entacapone, and levodopa. Talk with your doctor or nutrition counselor about the best foods to eat while you are taking this medication.Carbidopa, entacapone, 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.
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.
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:
nausea, sweating, feeling like you might pass out (especially when you first start taking this medication);
depression, confusion, hallucinations, unusual thoughts or behavior, thoughts about hurting yourself;
twitching or uncontrollable movements of your eyes, lips, tongue, face, neck, arms, or legs;
tremor (uncontrolled shaking);
muscle pain, tenderness, or weakness with fever or flu symptoms;
fast, pounding, or uneven heartbeats;
tight feeling in your chest, trouble breathing;
easy bruising or bleeding;
bloody or tarry stools, coughing up blood;
pain or burning when you urinate; or
chest pain or heavy feeling, pain spreading to the arm or shoulder, general ill feeling.
Less serious side effects may include:
stomach pain or upset, loss of appetite, constipation;
dry mouth, changes in your sense of taste;
unusual skin changes;
dizziness or drowsiness;
headache, blurred vision;
sleep problems (insomnia), strange dreams;
agitation or anxiety;
muscle cramps, back pain; or
mild 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:
Switching patients taking separate tablets of entacapone and carbidopa-levodopa: Give corresponding dosage of carbidopa/entacapone/levodopa.Switching patients not currently taking entacapone who are experiencing the "wearing-off" effect on carbidopa-levodopa therapy: Patients should be first titrated with the individual product of entacapone and the carbidopa-levodopa product (ratio 1:4), and then transferred to a corresponding dosage combination product after symptoms are under control.The maximum daily dosage of carbidopa/levodopa/entacapone is 8 tablets. Because there is limited experience with total daily doses of carbidopa greater than 300 mg, the maximum recommended daily dose of the carbidopa/entacapone/levodopa 200 tablets is six tablets.
Before taking carbidopa, entacapone, and levodopa, tell your doctor if you are taking any of the following medicines:
cholestyramine (Prevalite, Questran);
epinephrine (Epi-Pen, and others);
isoniazid (for treating tuberculosis);
isoproterenol (Isuprel, Medihaler-Iso);
papaverine (Pavabid, Papacon, Pavagen, Pavacot);
probenecid (Benemid); or
an antibiotic such as ampicillin, chloramphenicol, erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, and others), or rifampin (Rifadin, Rifater, Rifamate).
blood pressure medication;
an antidepressant such as amitriptyline (Elavil, Etrafon), doxepin (Sinequan), imipramine (Janimine, Tofranil), 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, entacapone, 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.