Carbidopa + levodopa + entacapone


Concise Prescribing Info
Indications/Uses
Parkinson's disease and "end of dose" motor fluctuations.
Dosage/Direction for Use
Adult: PO Each tab contains levodopa and carbidopa in a ratio of 4:1 and entacapone 200 mg: 1 tab each dose. Max: 8 tab/day. Doses are individualised based on therapeutic response. Patients previously treated w/ carbidopa/levodopa immediate-release tab (1:4 ratio): W/ current entacapone therapy: May switch directly to corresponding strength or slightly higher dose of combination tab. W/o entacapone therapy: May switch directly to corresponding strength or slightly lower dose of levodopa; patients taking levodopa doses >800 mg/day or w/ dyskinesia should start on a separate entacapone therapy before switching to the combination preparation, w/ 10-30% reduction in levodopa dose.
Administration
May be taken with or without food. Keep a consistent diet. A change in diet to foods high in protein may delay levodopa absorption & reduce amount taken up in circulation. Excessive acidity also delays stomach emptying & thus delays levodopa absorption. Fe salts (eg in multivit prep) may also reduce amount of levodopa available to the body.
Contraindications
Narrow-angle glaucoma, phaeochromocytoma, history of neuroleptic malignant syndrome (NMS) and/or non-traumatic rhabdomyolysis. Severe hepatic impairment. Concurrent use of or w/in 14 days of discontinuing non-selective MAOIs.
Special Precautions
Patient w/ ischaemic heart disease, severe CV or pulmonary disease, bronchial asthma, endocrine disease, chronic wide-angle glaucoma, biliary obstruction; history of peptic ulcer disease, convulsions, MI w/ residual atrial nodal or ventricular arrhythmias; past or current psychoses. Avoid abrupt withdrawal or dose reduction. Mild to moderate hepatic and severe renal impairment. Patient Counselling This drug may cause dark discolouration of urine, saliva or sweat. May cause dizziness and symptomatic orthostatism, if affected, do not drive or operate machinery. Monitoring Parameters Monitor hepatic, renal and cardiac functions; BP, mental status, serum Fe, wt loss, fibrotic complications, intraocular pressure; signs/symptoms of Parkinson's disease, neuroleptic malignant syndrome (during abrupt discontinuation), excessive drowsiness, depression. Perform regular dermatologic examination during therapy.
Adverse Reactions
Hypotension, orthostatic hypotension, syncope, dyskinesia, depression, hallucinations, impulse control/compulsive behaviour, diarrhoea, somnolence, urine discolouration, nausea, vomiting, abdominal pain, dry mouth.
Potentially Fatal: Hyperpyrexia and confusion resembling neuroleptic malignant syndrome (during dose reduction or withdrawal); severe rhabdomyolysis.
Drug Interactions
Increased heart rate and/or BP, arrhythmia w/ drugs metabolised by COMT. Risk of retroperitoneal fibrosis, pulmonary infiltrates, pleural effusion and thickening w/ ergot derived dopaminergic agents. Risk of symptomatic postural hypotension w/ antihypertensive agents. Dopamine D2 receptor antagonists (e.g. metoclopramide) and isoniazid may reduce the therapeutic effect of levodopa. Phenytoin and papaverine may reverse the effect of levodopa. Formation of chelates w/ Fe salts.
ATC Classification
N04BA01 - levodopa ; Belongs to the class of dopa and dopa derivative dopaminergic agents. Used in the management of Parkinson's disease.
N04BX02 - entacapone ; Belongs to the class of other dopaminergic agents used in the management of Parkinson's disease.
Disclaimer: This information is independently developed by CIMS based on carbidopa + levodopa + entacapone from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 CIMS. All rights reserved. Powered by CIMSAsia.com
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