Important Note

The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug.

CARBIDOPA/LEVODOPA/ENTACAPONE - ORAL

(car-bee-DOE-pah/lee-vo-DOE-pah/en-TACK-up-own)

COMMON BRAND NAME(S): Stalevo

Uses

This combination medication is used to treat symptoms of Parkinson's disease. Parkinson's disease is believed to be due to a lack of an important chemical (dopamine) in the brain. Levodopa is converted into dopamine in the brain, leading to the relief of Parkinson's disease symptoms. Both carbidopa and entacapone are given with levodopa to increase the amount of levodopa that is converted into dopamine.

How To Use

Take this medication by mouth exactly as prescribed. Do not increase the dose or take more frequently without consulting your doctor. Do not split the tablets. It is best to avoid a high protein diet (decreases the amount of levodopa that your body takes in) during treatment, unless directed otherwise by your doctor. Consult your doctor or pharmacist for more details. The dosage is based on your medical condition, previous drug therapy, response to therapy, and side effects if they occur. Some patients may experience a "wearing-off" (worsening of symptoms) before the next dose is due. An "on-off" effect might also occur, in which sudden short periods of stiffness occur. If these effects occur, contact your doctor for possible dose adjustments that may help to lessen this effect. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased. The manufacturer advises a maximum of 8 tablets per day. Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time(s) each day. If symptoms worsen while using this medication, contact your doctor immediately.

Side Effects

Diarrhea, nausea, vomiting, headache, dizziness, drowsiness, stomach upset, loss of appetite, dry mouth, or difficulty sleeping may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Tell your doctor immediately if any of these serious side effects occur: involuntary movements (especially twitching of the eyelid), fainting or falling, confusion, difficulty swallowing, stomach/abdominal pain, vision changes (including blurred vision). Tell your doctor immediately if any of these unlikely but serious side effects occur: hallucinations, chest pain, black/tarry stools, muscle pain, change in the amount of urine. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: mental/mood changes or depression (sometimes severe, including rare thoughts of suicide), persistent sore throat, high fever, severe muscle stiffness, fast heartbeat, fast breathing, increased sweating. This medication may cause the saliva, urine, or sweat to turn a dark color. This is harmless; however, it may discolor clothing. An allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

Precautions

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: glaucoma (narrow-angle). Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, glaucoma (wide-angle), breathing problems, heart disease (especially history of heart attack), kidney disease, endocrine disease, ulcers, mental/mood disorders (e.g., depression, schizophrenia), blood disorders, history of skin cancer, any allergies. To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position. This drug may make you dizzy or drowsy; use caution engaging in activities requiring alertness such as driving or using machinery. Limit alcoholic beverages. Before you have surgery with a general anesthetic, including dental surgery, tell the doctor or dentist you are taking this medication. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. Levodopa passes into breast milk. It is unknown if carbidopa or entacapone pass into breast milk. Consult your doctor before breast-feeding.

Drug Interactions

This drug should not be used with the following medications because very serious interactions may occur: most MAO inhibitors (e.g., furazolidone, linezolid, moclobemide, phenelzine, procarbazine). If you are currently using any of these medications, tell your doctor or pharmacist before starting carbidopa/levodopa/entacapone. Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription products you may use, especially of: medications to treat high blood pressure (hypertension), other drugs to treat Parkinson's disease (including other drugs that contain levodopa, carbidopa, or entacapone), iron vitamins, tricyclic antidepressants (e.g., amitriptyline), phenytoin, papaverine, isoproterenol, adrenaline (epinephrine), norepinephrine, dopamine, dobutamine, alpha-methlydopa, apomorphine, isoetharine, bitolterol, probenecid, cholestyramine, metoclopramide, selegiline, certain antibiotics (e.g., erythromycin, ampicillin, rifampin, chloramphenicol). Also, report use of any medicine that can make you drowsy, such as: sedatives, tranquilizers, anti-anxiety medicine, anti-seizure drugs, narcotic pain relievers (e.g., codeine), psychiatric medicines, certain drowsiness-causing antihistamines (e.g., diphenhydramine). This medication can cause false results with urine glucose testing in diabetics. Blood glucose testing should be performed instead. Do not start or stop any medicine without doctor or pharmacist approval.

Overdose

If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include: severe dizziness, irregular or fast heartbeat, increased blinking/eyelid spasms (blepharospasms).

Notes

Do not share this medication with others. Laboratory and/or medical tests (e.g., liver function tests, eye exams) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

Missed Dose

If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

Storage

Store at room temperature at 77 degrees F (25 degrees C) away from light and moisture. Brief storage from 59 to 86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom. Keep all medicines away from children and pets.