Levodopa/Carbidopa 250/25mg

Anti-Parkinson Agents; Decarboxylase Inhibitor; Dopamine Precursor

CSA NA – FDA Approved – REMS (N) – Can Ship

Levodopa is a dopamine precursor that crosses the blood brain barrier and gets converted to dopamine in the corpus striatum in the forebrain.  A lack of dopamine in the corpus striatum is the cause of most symptoms of Parkinson’s disease.  Carbidopa prevents the levodopa from being broken down in the blood by decarboxylation before it can pass the blood brain barrier.  

Levodopa+Carbidopa/Sinemet is officially indicated for Parkinson disease, but is also prescribed off-label to treat intermittent restless leg syndrome. (may be used for other conditions not listed)

Before starting Levodopa+Carbidopa/Sinemet make sure your physician is aware of any allergies, medications you currently take, if you have kidney disease, liver disease, cardiovascular disease, glaucoma, neuropathy, peptic ulcer disease, respiratory disease, psychotic disorders, or are pregnant or breastfeeding.

Levodopa+Carbidopa/Sinemet are in either a 1:4 or 1:10 ratio.  There is not a set maximum dosage but the minimum amount to treat the patient’s symptoms should be used and daily dosages should be divided into 2-4 daily dosages depending on dosage required and patient symptoms.  As the condition worsens and dosages increase a balance between Parkinson’s symptoms and levodopa induced dyskinesia will have to be accounted for.

How to Take: Follow instructions provided by physician/pharmacy label, swallow whole (controlled release), take consistently at same times each day unless otherwise directed, store at room temperature

You Need to Avoid: Do not stop this medication abruptly unless told to do so by medical professional, avoid a high protein diet (>2g/kg) as it may decrease absorption.  Daily protein should be evenly distributed between meals to keep absorption consistent.   

Orthostatic hypotension, dizziness, depression, headache, nausea, constipation, dyskinesia (movement disorder from extended use of levodopa)

Patients or their families should monitor for behavioral changes or abnormal thinking which may present as aggression, agitation, delirium, paranoia, disorientation, or a lack of impulse control which may result in hypersexualization, gambling, binge eating, spending money etc.  Another rare occurrence is neuroleptic malignant syndrome which may occur when starting the medication or if dosage is rapidly decreased or stopped.  This may present as altered consciousness, hyperthermia, muscle rigidity, involuntary movement, mental status change, etc.  If these occur or are suspected, seek medical attention immediately.

Note this is not a complete list of side effects, only common ones

1. This medication has a lot of scary side effects, is it safe?
   All medications have side effects, but dopamine does a lot of different things in the body therefore supplementing with a precursor has many effects all of which are dosage dependant.  Parkinson’s disease results in low dopamine in some areas of the brain but with an oral medication, the drug is distributed throughout the body resulting in higher than normal dopamine in some areas while bringing it to normal levels in the area of concern.  This is the main treatment for Parkinson’s disease as it replaces what the brain is missing directly and in most cases side effects are minimal especially when starting out at lower dosages.  If you experience side effects of concern, discuss it with your physician as steps can be made to manage them.
2. Why would my doctor treat my Parkinson’s disease with a drug that causes dyskinesia which is a different movement disorder?Parkinson’s is a progressive disease that worsens with time resulting in dosages getting higher and higher to manage symptoms.  Initially this medication will control the symptoms of it, but as the dosages get higher the risk of side effects increases and eventually with enough levodopa dyskinesias will occur.  At this point the condition is generally quite progressed and combination therapies using other medications can be used to lower the total daily dosage of levodopa.  As a dopamine is important for muscle control in many areas of the nervous system, it is unsurprising that both a deficiency and a surplus will have detrimental effects.