Generic
Levodopa+Carbidopa+Entacapone
4 brands available in the market
At a glance
Levodopa + Carbidopa + Entacapone is used for Parkinson's disease in patients with end-of-dose motor fluctuations who are not stabilized on levodopa/dopa decarboxylase (DDC) inhibitor treatment.
Description
Levodopa is the metabolic precursor of dopamine, crosses the blood-brain barrier and is converted to dopamine in the brain. Carbidopa is a DDC inhibitor that reduces peripheral metabolism of levodopa, allowing more levodopa to reach the brain. Entacapone is a selective COMT inhibitor that results in greater and more sustained plasma levels of levodopa, leading to greater control of parkinsonism symptoms.
Indications
- Parkinson's disease - patients with end-of-dose motor fluctuations not stabilized on levodopa/DDC inhibitor treatment
Therapeutic class
Antiparkinson Drugs
Pharmacological class
Dopamine Precursor + DDC Inhibitor + COMT Inhibitor
Pharmacology
Levodopa is converted to dopamine; Carbidopa inhibits peripheral decarboxylation; Entacapone inhibits COMT to prolong levodopa plasma levels.
Mechanism of action
Increases brain dopamine levels and prolongs levodopa plasma levels to control Parkinson's symptoms.
Dosage
Adult Dose:
- Optimal dose must be titrated for each patient
- Only 1 tablet per dose administration
- Maximum daily entacapone dose: 2,000 mg
- Available strengths: Stalevo 50, 75, 100, 125, 150, 200 (carbidopa/levodopa/entacapone mg)
Select appropriate Stalevo strength based on patient's current levodopa/DDC inhibitor dose.
Administration
- Swallow tablet whole; do not chew, crush or break
- May be taken with or without food
- Only 1 tablet per dose administration
Missed dose
Not generally applicable (regular dosing required); consult doctor if needed.
Side effects
Common Side Effects:
- Dyskinesia (abnormal movements)
- Nausea
- Hyperkinesia
- Urine color change (red/brown/black)
- Diarrhea (sometimes severe)
- Abdominal pain
- Hallucinations
- Orthostatic hypotension
Precautions & warnings
- Reduce levodopa dose by 10-30% if dyskinesia occurs
- Diarrhea may be severe and can lead to colitis
- Caution with orthostatic hypotension
- Caution if symptoms resembling NMS occur
- Caution when driving or using machines
Contraindications
- Severe hepatic impairment
- Narrow-angle glaucoma
- Pheochromocytoma
- Coadministration with non-selective MAO inhibitors
- History of NMS or non-traumatic rhabdomyolysis
- Hypersensitivity to ingredients
Drug interactions
- Postural hypotension with antihypertensives; dose adjustment may be needed
- Dopamine receptor antagonists (antipsychotics, antiemetics) reduce therapeutic effect
- High protein diet may impair absorption
Food interactions
Safety with alcohol is not known; consult your doctor.
Use in pregnancy
Use in Pregnancy: Should not be used during pregnancy (Category C) unless potential benefit justifies risk to the fetus.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Women should not breastfeed during treatment with this combination.
Pediatric use
Safety and effectiveness not established in pediatric patients.
Geriatric use
No dose adjustment required for elderly patients.
Renal / hepatic impairment
Hepatic Impairment: Caution in mild-moderate hepatic impairment; dose reduction may be needed.
Renal Impairment: Caution in severe renal impairment (including dialysis).
Overdose effects
Overdose symptoms: agitation, confusion, coma, bradycardia, ventricular tachycardia, Cheyne-Stokes respiration, discoloration of skin/tongue/conjunctiva. Pyridoxine is not effective; gastric lavage and activated charcoal.
Storage conditions
Store below 30°C, away from light and moisture; keep out of reach of children.
Chemical structure
Levodopa + Carbidopa + Entacapone