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Carbidopa-Levodopa ER
Carbidopa-Levodopa ER is the extended-release formulation of the combination drug used to treat Parkinson’s disease and Parkinson-like symptoms. This medication allows for a slower, sustained release of the active ingredients, providing more stable control of symptoms over a longer period. It is primarily used to manage motor symptoms such as tremors, rigidity, and slowness of movement by replenishing dopamine levels in the brain.
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Frequently Asked Questions
How long does it take for Carbidopa-Levodopa ER to start working?
Carbidopa-Levodopa ER typically begins working within 30-60 minutes after ingestion, with its effects lasting for about 4-6 hours. However, it may take several weeks to achieve optimal symptom control.
Can I take Carbidopa-Levodopa ER with food?
Yes, it can be taken with or without food. However, high-protein foods may reduce the absorption of levodopa, so it is best to avoid these close to dosing times.
What should I do if I miss a dose?
If you miss a dose, take it as soon as you remember. If it’s close to the time of the next dose, skip the missed dose and take the next one at the regular time. Do not double the dose to make up for the missed one.
Can Carbidopa-Levodopa ER cause weight gain?
Weight gain is not a common side effect of Carbidopa-Levodopa ER. However, some patients may experience changes in appetite or engage in impulse control behaviors that could lead to weight changes.
Is Carbidopa-Levodopa ER safe during pregnancy?
There is limited data on the use of Carbidopa-Levodopa ER during pregnancy. Women who are pregnant or planning to become pregnant should consult their healthcare provider to weigh the potential risks and benefits.
Comprehensive Drug Guide
How Does Carbidopa-Levodopa ER Work?
Levodopa: Crosses the blood-brain barrier and is converted into dopamine, replenishing deficient dopamine levels in the brain. This helps improve motor function and reduces symptoms like rigidity, tremors, and bradykinesia (slowness of movement).
Carbidopa: Prevents the early conversion of levodopa into dopamine outside the brain, allowing more levodopa to reach the brain and reducing peripheral side effects like nausea.
What is Carbidopa-Levodopa ER Used For?
Parkinson’s Disease: To reduce symptoms of motor impairment such as tremors, stiffness, and slow movement.
Parkinsonism: Secondary to other neurological conditions such as encephalitis or exposure to carbon monoxide or manganese.
Common Dosages
Carbidopa-Levodopa ER is available by prescription only and is not classified as a controlled substance. It is provided in extended-release tablet form to allow for less frequent dosing compared to the immediate-release version.
- Administration: Carbidopa-Levodopa ER is typically taken 2-4 times a day depending on symptom control. The extended-release formulation provides a longer-lasting effect compared to immediate-release versions, allowing for less frequent dosing.
- Swallowing Instructions: The tablets should not be crushed or chewed, as this would disrupt the extended-release mechanism. They should be swallowed whole with water.
- With or Without Food: It can be taken with or without food, but high-protein meals should be avoided near dosing, as protein can interfere with levodopa absorption.
Typical Dosing
FDA Approved Indications
Carbidopa-Levodopa ER is available in several strengths:
- 50 mg/200 mg: 50 mg of carbidopa and 200 mg of levodopa.
- 25 mg/100 mg: 25 mg of carbidopa and 100 mg of levodopa.
The appropriate dosage is individualized based on patient needs, symptom severity, and response to treatment.
Who Shouldn't Take Carbidopa-Levodopa ER?
Carbidopa-Levodopa ER is contraindicated in patients with:
- Known hypersensitivity to carbidopa, levodopa, or any components of the formulation.
- Narrow-angle glaucoma.
Concurrent use of non-selective MAO inhibitors (such as phenelzine or tranylcypromine) within the last 14 days due to the risk of hypertensive crisis.
Advice From The Pharmacist
Patients taking Carbidopa-Levodopa ER should be advised to:
- Take the medication consistently at the same times each day to maintain stable dopamine levels.
- Be aware that it may take several weeks to see the full benefits of the medication.
- Avoid high-protein meals around dosing times, as this can interfere with the absorption of levodopa.
- Monitor for potential side effects such as dizziness, hallucinations, or involuntary movements (dyskinesia).
- Do not abruptly stop taking Carbidopa-Levodopa ER without consulting a healthcare provider, as sudden discontinuation can lead to severe withdrawal symptoms and worsening of Parkinson’s symptoms.
Side Effects of Carbidopa-Levodopa ER
Common Side Effects
- Dizziness or lightheadedness
- Nausea or vomiting
- Dry mouth
- Drowsiness
- Involuntary movements (dyskinesia)
Uncommon/Severe Side Effects
- Hallucinations or Psychosis: Patients may experience vivid dreams, confusion, or hallucinations, particularly in older adults.
- Orthostatic Hypotension: A drop in blood pressure when standing up, which can cause dizziness or fainting.
- Impulse Control Disorders: Patients may engage in compulsive behaviors such as gambling, shopping, or overeating.
Risks and Warnings of Carbidopa-Levodopa ER
Neuroleptic Malignant Syndrome (NMS): Abrupt withdrawal or rapid reduction of Carbidopa-Levodopa ER 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, and dosage adjustments may be necessary to manage this side effect.
Impulse Control Issues: Some patients may develop compulsive behaviors like gambling, shopping, or hypersexuality.
Interactions with Carbidopa-Levodopa ER
Common Drug Interactions
Carbidopa-Levodopa ER may interact with:
- MAO Inhibitors: Non-selective MAO inhibitors can cause hypertensive crises if taken with Carbidopa-Levodopa. MAO inhibitors should be discontinued at least 14 days before starting this medication.
- Antipsychotic Medications: May reduce the effectiveness of Carbidopa-Levodopa as they block dopamine receptors.
- Iron Supplements: Can reduce the absorption of levodopa.
- Antihypertensive Drugs: May increase the risk of low blood pressure (orthostatic hypotension).
Alternatives to Carbidopa-Levodopa ER
Alternative treatments for Parkinson’s disease include:
- Dopamine Agonists: Such as pramipexole or ropinirole, which mimic the effects of dopamine in the brain.
- COMT Inhibitors: Such as entacapone, which prolong the effect of levodopa.
- MAO-B Inhibitors: Such as selegiline, which slow the breakdown of dopamine in the brain.
- Deep Brain Stimulation (DBS): A surgical option for advanced Parkinson’s disease.
