Levodopa and carbidopa are combined to treat Parkinson’s disease symptoms as well as Parkinson-like symptoms that can appear after encephalitis (brain swelling), damage to the neurological system from carbon monoxide or manganese poisoning, or encephalitis. Parkinson’s disease is characterised by tremors (shaking), stiffness, and slowness of movement. Dopamine, a naturally occurring chemical that is typically found in the brain, is lost when this happens. Levodopa belongs to a group of drugs known as central nervous system agents. It functions by turning into dopamine in the brain. Carbidopa belongs to the group of drugs known as decarboxylase inhibitors. It functions by inhibiting the breakdown of levodopa before it reaches the brain. Levodopa can now be administered at a lower dose, resulting in less nauseousness and vomiting.

Levodopa and carbidopa are available as a combination in the following oral dosage forms: normal tablets, orally disintegrating tablets, extended-release (long-acting) tablets, and extended-release (long-acting) capsules. Levodopa and carbidopa are also available as a liquid suspension that can be injected into the stomach via a PEG-J tube (a tube surgically placed through the skin and stomach wall) or, less frequently, a naso-jejunal tube (NJ; a tube inserted into the nose and down to the stomach). Typically, three to four doses of the standard and orally disintegrating pills per day are given. It is typical to take the extended-release tablet two to four times each day. Typically, three to five times a day are taken for the extended-release capsule. The suspension is often administered in the morning (by infusion over 10 to 30 minutes) and then continuously for 16 hours, with further doses administered no more frequently than once every two hours as necessary to regulate your symptoms. Take levodopa and carbidopa every day at roughly the same time. Ask your doctor or pharmacist to explain any instructions on your prescription label that you are unsure about following. Levodopa and carbidopa should be taken exactly as prescribed. Never take it in larger or less amounts or more frequently than directed by your doctor.

Do not chew or crush the extended-release pills; instead, swallow them whole.

Do not chew, split, or crush the extended-release capsules; instead, swallow them whole. One to two hours prior to eating, take the first dose of the extended-release capsule each day. If you have problems swallowing, you can gently open the extended-release capsule, open 1 to 2 teaspoons (15 to 30 mL) of apple sauce, and sprinkle the entire contents on top. Then, you can immediately eat the mixture. Never keep the combination on hand for later usage.

The orally disintegrating tablet should be taken by removing it from the bottle with dry hands and popping it right into your mouth. The tablet can be ingested with saliva and will immediately dissolve. To take dissolving tablets, no water is necessary.

Follow your doctor’s recommendations if you’re transitioning from levodopa (Dopar or Larodopa; no longer available in the US) to the combination of levodopa and carbidopa. Levodopa and carbidopa should not be used together until at least 12 hours have passed since your last dose, according to most medical professionals.

Levodopa and carbidopa dosages may be started at a low level by your doctor, and as needed, your dosage of the regular or orally disintegrating pill may be gradually increased daily or every other day. After three days, if necessary, your doctor may gradually raise your dose of the extended-release tablet or capsule.

Your doctor or pharmacist will demonstrate how to use the pump to administer your medication so that you can take the suspension. Read the written instructions that are included with the drug and the pump. Make sure you understand the descriptions of the keys and all the pump’s component parts by carefully studying the schematics. Whatever portion you do not understand, ask your physician or pharmacist to explain.

A single-use cassette containing levodopa and carbidopa suspension is provided to attach to the pump that will regulate the dosage you get during your infusion. Remove the cassette holding the medication from the fridge 20 minutes prior to use and let it come to room temperature. A cassette should not be reused or used for more than 16 hours. Even if the cassette still has medication in it, discard it when the infusion is finished.

Your doctor will modify your morning and continuous infusion doses as well as perhaps the doses of your other Parkinson’s disease drugs when you start using levodopa and carbidopa suspension in order to best control your symptoms. It typically takes 5 days to obtain a stable dose of the suspension, but as time goes on, your doses could need to be altered once more depending on how you continue to respond to the drug. Your doctor will configure your pump with the prescribed dose of the suspension. Unless your doctor instructs you to, never alter the dose or settings on your pump. The amount of medication you receive will be impacted if your PEG-J tube becomes kinked, knotted, or plugged, so take extra care to avoid this.

Parkinson’s disease is controlled by levodopa and carbidopa, but it is not cured. Before you experience the full benefits of levodopa with carbidopa, it may take several months. Even if you feel good, keep taking levodopa and carbidopa. Without consulting your doctor, do not discontinue taking levodopa and carbidopa. If you abruptly stop taking levodopa with carbidopa, you run the risk of developing a severe condition that results in confusion, tight muscles, fever, and other symptoms. Your dose will likely be gradually reduced by your doctor. Your PEG-J tube will be removed by a medical professional if your doctor instructs you to stop taking levodopa and carbidopa suspension; do not attempt to remove the tube yourself.

Get a copy of the levodopa and carbidopa patient information sheet from the manufacturer as well as the levodopa and carbidopa suspension medication guide from your pharmacist or doctor.

Ask your doctor or pharmacist for more details if you believe this drug should be used for something else.

Before taking levodopa and carbidopa,

• If you have an allergy to levodopa, carbidopa, any other medications, or any of the substances in levodopa, carbidopa tablets, capsules, or suspension, let your doctor and pharmacist know right once. Get a list of the components from your pharmacist.
• Inform your doctor if you are currently taking or have just discontinued taking phenelzine (Nardil) or tranylcypromine (Parnate). Most likely, your doctor will advise against using levodopa and carbidopa.
• Inform your physician and pharmacist about all prescription and over-the-counter drugs, vitamins, dietary supplements, and herbal products you are currently taking or intend to use. Make certain to bring up any of the following: mood elevators) such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); antihistamines; metoclopramide (Reglan), other Parkinson’s disease treatments, papaverine (Pavabid), isocarboxazid (Marplan), isoniazid (INH, Nydrazid), medications for high blood pressure, irritable bowel syndrome, mental illness, motion sickness, nausea, ulcers, or urinary difficulties; sedatives, selegiline (Emsam, Eldepryl, Zelapar), sleeping pills, tetrabenazine (Xenazine), and tranquillizers. They include phenytoin (Dilantin), rasagiline (Azilect), risperidone (Risperdal), and selegiline. Your physician might need to adjust the dosage of your drugs or keep a close eye on you for side effects.
• If you have glaucoma, melanoma (skin cancer), or a skin growth that has not been identified, let your doctor know. Your physician might advise against taking levodopa plus carbidopa.
• Asthma, emphysema, mental illness, diabetes, stomach ulcers, heart attacks, an irregular heartbeat, blood vessel, heart, kidney, liver, or lung disease are all things you should mention to your doctor if you have them or have ever had them. Tell your doctor if you have or have ever had stomach surgery, nerve issues, low blood pressure, or fainting if you are taking levodopa with carbidopa suspension.
• Inform your physician if you are nursing a baby, intend to get pregnant, or are already pregnant. Call your doctor if you become pregnant while taking levodopa and carbidopa.
• Inform the surgeon or dentist that you are taking levodopa and carbidopa if you are having surgery, including dental surgery.
• You should be aware that taking levodopa or carbidopa during normal daily activities may make you feel sleepy or cause you to wake up quickly. It’s possible that you don’t experience any drowsiness or other early warning symptoms before you unexpectedly nod off. At the beginning of your therapy, refrain from engaging in potentially risky activities until you have a better understanding of how the medication affects you. Call your doctor if you find yourself dozing off mid-task while engaging in activities like talking on the phone, eating, or driving, or if you start to feel extremely sleepy, especially during the day. Until you speak with your doctor, avoid operating machinery, working at heights, or driving.
• As you take levodopa and carbidopa, consult your doctor about whether drinking alcohol is safe. Levodopa and carbidopa side effects may become severe if alcohol is used.
• You should be aware that some persons who used drugs like levodopa and carbidopa experienced gambling issues or other strong obsessive or odd impulses or behaviours, like increased sexual drives or behaviours. There isn’t enough data to determine if the individuals’ troubles were brought on by their pharmaceutical use or something else. If you have a hard time resisting the impulse to gamble, have strong urges, or find it difficult to manage your conduct, call your doctor. Informing your family about this risk can enable them to seek medical attention even if you are unaware that your gambling or any other strong cravings or strange actions have become a problem.
• You should be aware that taking levodopa plus carbidopa may cause your saliva, urine, or perspiration to turn dark (red, brown, or black). Although this is risk-free, your clothes might get dirty.
• You should be aware that when you get up too rapidly from a supine posture, levodopa and carbidopa may produce dizziness, lightheadedness, and fainting. When you initially start taking levodopa and carbidopa, this is more typical. Get out of bed gradually, resting your feet on the floor for a few minutes before standing up, to avoid this issue.
• You should be aware that the orally disintegrating pills contain aspartame, a substance that converts to phenylalanine if you have phenylketonuria (PKU), a genetic disorder that requires adherence to a particular diet to prevent brain damage that can result in severe intellectual incapacity.

If you intend to switch to a diet high in protein-rich foods like meat, poultry, and dairy products, see your doctor beforehand.

When you remember to take it, immediately take the missing dose of the standard tablet, orally disintegrating tablet, extended-release (long-acting) tablet, or extended-release (long-acting) capsule. If the next dose is soon due, skip the missed one and carry on with your regular dosing plan. To make up for a missing dose, do not take a second one.

Ask your doctor if you should take an extra dose before disconnecting the infusion pump if you are using levodopa and carbidopa enteral infusion and will be doing so for a brief period of time (less than 2 hours), as opposed to the typical nighttime disconnection. Call your doctor if the infusion pump will be off for more than two hours; you’ll probably be told to take levodopa and carbidopa orally while you’re not using the suspension.

Levodopa and carbidopa may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• Dizziness
• Reduced appetite
• Diarrhoea
• Mouth ache
• Throat and mouth ache
• Constipation
• Alterations in taste
• Forgetfulness or uncertainty
• Nervousness
• Nightmares
• Having trouble falling or staying asleep
• Headache
• Weakness

Some side effects can be serious. If you experience any of the following symptoms or those listed in the SPECIAL PRECAUTIONS section, call your doctor immediately or get emergency medical treatment:

• Strange or uncontrollable facial, mouth, tongue, head, neck, arm, and leg motions
• Hammering, rapid, or erratic heartbeat
• Increased perspiration
• Chest ache
• Depression
• Ideas of suicide or self-immolation
• Hallucinating (seeing things or hearing voices that do not exist)
• Edoema of the hands, feet, ankles, lower legs, cheeks, neck, tongue, lips, and eyes
• Hoarseness
• Breathing or swallowing challenges
• Hives
• Lack of strength, numbness, or sensation in the fingers or feet
• Around your PEG-J tube, look for any signs of discharge, redness, swelling, soreness, or warmth (if you are taking levodopa and carbidopa suspension)
• Stool that is dark and tarry
• Bench with a reddish tint
• Fever
• Abdomen ache
• Nausea
• Vomiting
• Tainted vomit
• Vomit that looks like coffee grounds

Keep this medication tightly closed in the original container and out of the reach of children. Keep it away from excessive heat and moisture at room temperature (not in the bathroom).

Levodopa and carbidopa enteral suspension cassettes should be kept in the refrigerator in their original cartons, away from light. Don’t let the suspension freeze.

Unused prescriptions must be disposed of carefully to prevent pets, kids, and other people from ingesting them. You should not, however, dispose of this medication in the toilet. Instead, utilising a medicine take-back programme is the easiest approach to get rid of your medication. To find out about take-back programmes in your area, speak with your pharmacist or the garbage/recycling department in your city. If you do not have access to a take-back programme, see the FDA’s Safe Disposal of Medications website at http://goo.gl/c4Rm4p for additional information.

Although many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and are simple for young children to open, it is crucial to keep all medications out of sight and out of reach of children. Always lock safety caps and promptly stash medication up and away from young children where it is out of their sight and reach to prevent poisoning. http://www.upandaway.org

Call the poison control hotline at 1-800-222-1222 in the event of an overdose. Moreover, information can be found online at https://www.poisonhelp.org/help. Call 911 right once if the person has collapsed, experienced a seizure, is having difficulty breathing, or cannot be roused.

Keep all of your appointments with your physician and the lab. In order to determine how you react to levodopa and carbidopa, your doctor will request a number of lab tests.

Inform your doctor and the lab staff that you are taking levodopa and carbidopa before to any laboratory test.

Carbidopa and levodopa may only be effective at particular times of the day or fully wear off over time. If your Parkinson’s disease symptoms shaking, stiffness, and slowness of movement get worse or change in intensity, call your doctor.

Avoid overdoing physical activity when your health improves and you find it easier to move around. To prevent falls and injuries, gradually increase your exercise level.

Levodopa and carbidopa can provide false-positive urine test results for ketones and sugar (Clinistix, Clinitest, and Tes-Tape) (Acetest, Ketostix, and Labstix).

No one else should take your medication. Any queries you may have regarding medication refills should be directed to your pharmacist.

You should keep a written record of every medication you take, including any over-the-counter (OTC) items, prescription drugs, and dietary supplements like vitamins and minerals. This list should be brought with you whenever you see a doctor or are admitted to the hospital. You should always have this information with you in case of emergencies.