LEVODOPA + CARBIDOPA + Entacapone

Indications & Dose:

Parkinson’s disease, restless legs syndrome;* phenylketonuria,* psoriasis,* shingles,* sleep behavior disorder,* swallowing disorders,* tardive dyskinesia,* vitiligo*

•  BY MOUTH

Adult: •2-6 tablets daily

Children: Not recommended 

Contraindications:

Narrowangle glaucoma, undiagnosed skin lesions. 

Side Effects:

Cautions:

Precautions:

Renal disease, cardiac disease, hepatic disease, respiratory disease, MI with dysrhythmias, convulsions, peptic ulcer 

Interaction:

Drugs

Benzodiazepines: May exacerbate Parkinsonism in patients receiving levodopa; inhibits antiparkinsonian effects of levodopa

Food: High protein diets inhibit the efficacy of levodopa

Iron (oral): Reduces levodopa bioBrands Available with Cost by 50%

MAOIs: May result in hypertensive response

Methionine: Inhibits the clinical response to levodopa

Neuroleptics: Phenothiazines block dopamine receptors, can produce extrapyramidal symptoms, and inhibit the antiparkinsonian effect of levodopa

Phenytoin: May inhibit the antiparkinsonian effect of levodopa 

Pyridoxine: Inhibits the antiparkinsonian effect of levodopa; concurrent carbidopa negates the interaction

Spiramycin: Reduces the plasma concentration of levodopa, with reduction of antiparkinson efficacy

Tacrine:May inhibit the effect of levodopa in Parkinsons patients; dosage adjustments may be required.

Warnings:

Adverse Effects:

Lactations:

Should not be given to nursing mothers 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Agitation, anxiety, confusion dizziness, fatigue, hallucination, hand tremors, headache, hypomania, insomnia, involuntary choreiform movements, nightmares, numbness, psychosis, severe depression, twitching, weakness

CV: Hypertension, orthostatic hypotension, palpitation, tachycardia

EENT: Blurred vision, dilated pupils, diplopia

GI: Abdominal distress, anorexia, bitter taste, constipation, diarrhea, dry mouth, dysphagia, flatulence, nausea, vomiting

GU: Dark urine, incontinence, urinary retention

HEME: Agranulocytosis, hemolytic anemia, leukopenia

METAB: Weight change

SKIN: Alopecia, rash, sweating 

Patient And Carer Advice: