Classes
DEA Class; Rx
Common Brand Names; Sinemet, Rytary, Duopa, Dhivy, Sinemet CR (DSC)
- Decarboxylase Inhibitors;
- Antiparkinson Agents, Dopamine Precursors
Description
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
Indications
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.
Contraindications
Hypersensitivity
Concurrent administration of nonselective monoamine oxidase inhibitors (MAOIs) or use within last 14 days
Sinemet
- Narrow-angle glaucoma (tablets)
Adverse Effects
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%)
Warnings
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
Pregnancy and Lactation
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
Maximum Dosage
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.
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.
Safety and efficacy have not been established.
Safety and efficacy have not been established.
Not indicated.
Not indicated.
How supplied
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
