Indicated in the treatment of Parkinson's disease, post-encephalitic parkinsonism, and symptomatic parkinsonism that may follow carbon monoxide intoxication or manganese intoxication. Carbidopa allows patients treated for Parkinson's disease to use much lower doses of levodopa.
This is a combination of levodopa, carbidopa and entacapone for the treatment of Parkinson's disease. Levodopa is the metabolic precursor of dopamine, it crosses the bloodbrain barrier and is converted to dopamine in the brain. Carbidopa is a dopa decarboxylase (DDC) inhibitor which reduces the peripheral metabolism of levodopa to dopamine, and thus, more levodopa is available to the brain. Entacapone is a selective inhibitor of catecholo-methyltransferase. Given concurrently, entacapone results in greater and more sustained plasma levels of levodopa, leading to greater control of parkinsonism symptoms.
ORAL As monotherapy in Parkinson’s disease: Adult: Per tab contains L-dopa 100 mg & carbidopa 25 mg. Initially, 1 tab tid. Increase by 1 tab/day every 1-2 days up to a max. of 8 tabs of any strength! day. If the patient has been taking L-dopa alone, the combination should be started after a gap of at least 8 hr after stopping L-dopa.
Symptomatic postural hypotension may occur when levodopa is added to the treatment of patients already receiving antihypertensive. Dose adjustment of the antihypertensive agent may be required. Dopamine receptor antagonists (e.g. some antipsychotics and antiemetics), phenytoin and papaverine may reduce the therapeutic effect of levodopa. Patients taking these medicinal products with levodopa/ carbidopa/ entacapone combination should be carefully observed for loss of therapeutic response. Since levodopa competes with certain amino acids, the absorption of Levodopa, Carbidopa & Entacapone may be impaired in some patients on high protein diet.
Lactation, narrow angle glaucoma. melanoma, psychosis, severely decompensated endocrine. Heart disease, liver disease, dementia, psychosis, pregnancy, elderly, heart disease. Regular monitoring of renal & hepatic function is reccomended.
Nausea, vomiting, anorexia, increased risk of GI bleeding in peptic ulcer patients. Orthostatic hypotension, cardiac arrhythmias. Psychiatric symptoms (depression w/ or w/o suicidal tendency). Abnormal involuntary movements or dyskinesias, delirium, hallucinations (elderly). Slight elevation of liver enzymes, leucopenia & thrombocytopen ia. Severe postural hypotension in elderly.
There are no controlled data in human pregnancy. Two reports have described three patients who received levodopa or levodopa-carbidopa throughout pregnancy without evidence of fetal harm. Levodopa should only be given in human pregnancy when benefit outweighs risk. This drug in relatively low doses was used without apparent harmful effects in the nursing infant by 1 mother with Parkinson's disease; limited data indicate this drug is poorly excreted into breast milk.
The acute symptoms and signs of overdose include agitation, confusional state, coma, bradycardia, ventricular tachycardia, Cheyne Stokes respiration, discolorations of skin, tongue and conjunctiva, and chromaturia. Management of acute overdose with levodopa/ carbidopa/ entacapone combination is similar to acute overdose with levodopa. Pyridoxine, however, is not effective in reversing the actions of levodopa/ carbidopa/ entacapone combination. Hospitalization is advised and general supportive measures should be employed with immediate gastric lavage and repeated doses of charcoal over time.
Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.
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