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Carbidopa/Levodopa

    Brands

    DEA Class;  Rx

    Common Brand Names; Sinemet, Rytary, Duopa, Dhivy, Sinemet CR (DSC)

    • Decarboxylase Inhibitors; 
    • Antiparkinson Agents, Dopamine Precursors
    Combination product of dopamine precursor (levodopa) with a decarboxylase inhibitor (carbidopa)
    Used for idiopathic Parkinson’s disease, post-encephalitic parkinsonism, and symptomatic parkinsonism following injury to the nervous system; various formulations help with individualization of dosing
    An enteral suspension treats motor fluctuations in those with advanced Parkinson’s disease

    Indicated for the treatment of idiopathic Parkinson’s disease, post-encephalitic parkinsonism, and symptomatic parkinsonism that may follow injury to the nervous system by carbon monoxide intoxication and/or manganese intoxication.

    For the treatment of restless legs syndrome (RLS).
    For the treatment of amblyopia.

    Hypersensitivity

    Concurrent administration of nonselective monoamine oxidase inhibitors (MAOIs) or use within last 14 days

    Sinemet

    • Narrow-angle glaucoma (tablets)

    Duopa

    • Complication of device insertion (57%)
    • Nausea (30%)
    • Constipation (22%)
    • Incision site erythema (19%)
    • Dyskinesia (14%)
    • Depression (11%)
    • Post procedural discharge (11%)
    • Peripheral edema (8%)
    • Hypertension (8%)
    • Upper respiratory tract infection (8%)
    • Oropharyngeal pain (8%)
    • Atelectasis (8%)
    • Confusional state (8%)
    • Anxiety (8%)
    • Dizziness (8%)
    • Hiatal hernia (8%)
    • Postoperative ileus (5%)
    • Sleep disorder (5%)
    • Pyrexia (5%)
    • Excessive granulation tissue (5%)
    • Rash (5%)
    • Bacteriuria (5%)
    • White blood cells urine positive (5%)
    • Hallucination (5%)
    • Psychotic disorder (5%)
    • Diarrhea (5%)
    • Dyspepsia (5%)

    Avoid sudden discontinuation or rapid dose reduction; if discontinuing therapy, taper dose to reduce risk of hyperpyrexia and confusion

    Monitor patients with a history of myocardial infarction who have residual atrial, nodal, or ventricular arrhythmia, cardiac function in an intensive cardiac care facility during the initial dosage adjustment

    Hallucinations and psychotic-like behavior have been reported; do no treat patients with major psychotic disorder

    May experience an urge to gamble, increased sexual urges, intense urges to spend money, binge eating, and/or other intense urges, and inability to control these urges while taking 1 or more of the medications that increase central dopaminergic tone and that are generally used for the treatment of Parkinson disease; consider dosage reduction or stopping the medication if a patient develops such urges

    May exacerbate dyskinesia; reduce dose to control symptoms

    Treated patients with a history of peptic ulcer may increase the possibility of upper gastrointestinal hemorrhage

    Monitor intraocular pressure in patients with glaucoma

    Carefully observe patients for developing depression with concomitant suicidal tendencies

    Orthostatic hypotension may occur (more common with IR formulation)

    Peripheral neuropathy reported with use; evaluate patients for history of neuropathy and known risk factors prior to initiating therapy; assess for peripheral neuropathy periodically during therapy

    There are no adequate data on development risk associated with use in pregnant females

    Levodopa has been detected in human milk after administration of carbidopa-levodopa

    Adults

    NOTE: Experience with daily dosages of carbidopa greater than 200 mg/day PO is limited.
    Immediate-release carbidopa; levodopa (e.g., Sinemet): 80 mg/800 mg/day PO using 10 mg/100 mg tablet; 200 mg/800 mg/day PO using 25 mg/100 mg tablet; 200 mg/2,000 mg/day using 25 mg/250 mg tablet.
    Immediate-release carbidopa;levodopa functionally-scored tablets (e.g., Dhivy): 200 mg/800 mg/day PO using 25 mg/100 mg tablet.
    Extended-release tablets (e.g., Sinemet CR): Most patients are adequately controlled on doses that provide up to 1,600 mg/day PO of levodopa.
    Extended-release capsules (e.g., Rytary): 612.5 mg/2,450 mg/day PO.
    Enteral suspension (e.g., Duopa): 2,000 mg/day of the levodopa component administered enterally over 16 hours.

    Geriatric

    NOTE: Experience with daily dosages of carbidopa greater than 200 mg/day PO is limited.
    Immediate-release carbidopa; levodopa (e.g., Sinemet): 80 mg/800 mg/day PO using 10 mg/100 mg tablet; 200 mg/800 mg/day PO using 25 mg/100 mg tablet; 200 mg/2,000 mg/day using 25 mg/250 mg tablet.
    Immediate-release carbidopa;levodopa functionally-scored tablets (e.g., Dhivy): 200 mg/800 mg/day PO using 25 mg/100 mg tablet.
    Extended-release tablets (e.g., Sinemet CR): Most patients are adequately controlled on doses that provide up to 1,600 mg/day PO of levodopa.
    Extended-release capsules (e.g., Rytary): 612.5 mg/2,450 mg/day PO.
    Enteral suspension (e.g., Duopa): 2,000 mg/day of the levodopa component administered enterally over 16 hours.

    Adolescents

    Safety and efficacy have not been established.

    Children

    Safety and efficacy have not been established.

    Infants

    Not indicated.

    Neonates

    Not indicated.

    carbidopa/levodopa

    tablet (Sinemet, generic)

    • 10mg/100mg

    • 25mg/100mg

    • 25mg/250mg

    tablet (Dhivy)

    • 25mg/100mg (scored into 4 segments of 6.25mg/25mg each)

    capsule, extended-release (Rytary)

    • 23.75mg/95mg

    • 36.25mg/145mg

    • 48.75mg/195mg

    • 61.25mg/245mg

    enteral suspension, extended-release (Duopa)

    • (4.63mg/20mg)/mL in a single-use cassette

    • Each cassette contains ~100 mL