Carbidopa-Levodopa-Entacapone

Carbidopa-Levodopa-Entacapone is available in various strengths, with the amount of each component clearly indicated on the label. Some common strengths include:

• 12.5 mg/50 mg/200 mg (carbidopa/levodopa/entacapone)
• 25 mg/100 mg/200 mg
• 37.5 mg/150 mg/200 mg

The dosage is individualized based on the patient's response and symptoms, and the dosing frequency is typically several times per day.

Carbidopa-Levodopa-Entacapone is contraindicated in patients with:

• Known hypersensitivity to carbidopa, levodopa, entacapone, or any excipients.
• Narrow-angle glaucoma.
• History of neuroleptic malignant syndrome (NMS) or non-traumatic rhabdomyolysis.
• Use of non-selective MAO inhibitors (e.g., phenelzine, tranylcypromine) within the past 14 days, due to the risk of hypertensive crisis.

Patients using Carbidopa-Levodopa-Entacapone should be advised to:

• Take the medication at regular intervals, as prescribed, to maintain stable dopamine levels.
• Be aware that it may take a few weeks to achieve full symptom control.
• Avoid high-protein meals around dosing, as protein can reduce the absorption of levodopa and entacapone, decreasing effectiveness.
• Monitor for and report any unusual movements (dyskinesia), mental changes (such as hallucinations or confusion), or compulsive behaviors like gambling or shopping.
• Avoid abrupt discontinuation of the medication without consulting their healthcare provider, as sudden withdrawal can lead to severe side effects like neuroleptic malignant syndrome (NMS).

• Nausea or vomiting
• Diarrhea
• Dry mouth
• Dizziness or lightheadedness
• Dyskinesia (involuntary movements)

• Hallucinations or Psychosis: Patients may experience confusion, vivid dreams, or hallucinations, particularly older adults.
• Orthostatic Hypotension: Sudden drops in blood pressure when standing, leading to dizziness or fainting.
• Impulse Control Disorders: Some patients may develop compulsive behaviors like gambling, binge eating, or excessive shopping.

Neuroleptic Malignant Syndrome (NMS): Abrupt discontinuation or rapid dose reduction of Carbidopa-Levodopa-Entacapone can lead to NMS, a life-threatening condition characterized by fever, muscle rigidity, and altered mental status.

Dyskinesia: Long-term use may lead to involuntary movements, which may require dosage adjustments.

Hepatotoxicity: Entacapone has been associated with liver toxicity, and liver function tests should be monitored regularly during treatment.

Carbidopa-Levodopa-Entacapone may interact with:

• Non-selective MAO inhibitors: Combining these with this medication can cause a hypertensive crisis. MAO inhibitors should be discontinued 14 days before starting this medication.
• Antihypertensives: May increase the risk of orthostatic hypotension.
• Antipsychotic Medications: These can reduce the effectiveness of Carbidopa-Levodopa by blocking dopamine receptors.
• Iron Supplements: May reduce the absorption of levodopa and entacapone.

Patients should inform their healthcare provider of all medications and supplements they are taking to avoid potential interactions.

Alternative treatments for Parkinson’s disease include:

• Other COMT Inhibitors: Such as tolcapone, which can be used in place of entacapone, though tolcapone has a higher risk of liver toxicity.
• Dopamine Agonists: Such as pramipexole or ropinirole, mimic the effects of dopamine.
• MAO-B Inhibitors: Such as rasagiline or selegiline, which slow the breakdown of dopamine in the brain.
• Deep Brain Stimulation (DBS): A surgical option for patients with advanced Parkinson’s disease who do not respond well to medication.