Dr. C P Ravi Kumar
Dr. C. P. Ravi Kumar Lead & Senior Consultant – Paediatric Neurology, The Krishna Institute of Medical Sciences (KIMS), Mahadevapura, Bangalore
What is levodopa and carbidopa?
Levodopa: Converts into dopamine in the brain, helping to improve movement and control symptoms like stiffness and tremor.
Carbidopa: Prevents levodopa from breaking down in the bloodstream before it reaches the brain, improving its effectiveness and reducing side effects such as nausea and vomiting.
What are the indications of levodopa and carbidopa combination?
- Dystonia (Dystonic CP)
- Parkinson disease
- Restless leg syndrome (off-label)
What are the uses of levodopa and carbidopa?
- Dopa responsive dystonia (under doctor guidance)
What are the various forms available?
- Oral tablets
- Extended-release tablets
- Extended-release capsules
What are important things I share with my doctor before taking this medicine?
- If you are taking any other medications, especially antidepressants, antipsychotics, MAO inhibitors, or other Parkinson’s drugs
- If you have any allergies
- If you have taken MAO inhibitors (like selegiline, phenelzine, tranylcypromine) in the past 14 days
- If you have a history of:
- a) Asthma, chronic obstructive pulmonary disease (COPD), or emphysema
- b) Glaucoma (especially narrow-angle glaucoma)
- c) Mental health conditions such as depression, psychosis, or schizophrenia
- d) Skin cancer or suspicious skin growths
When is the best time to take this combination?
Take this medication with or without food, and at the same time every day. Avoid taking with a high-protein meal, as it can reduce absorption
If you experience stomach upset, always take it with food.
Guide to follow while consuming this medicine.
Swallow complete tablet; do not crush, chew, or break them.
Do not forget to swallow extended-release tablets as a whole; do not chew, break, or crush them.
Who should avoid taking levodopa and carbidopa?
- Do not give this medicine to children prior physician consent
- Patients allergic to levodopa/carbidopa or any other component of the formulation
- Asthma, emphysema or mental illness
- If you have high intra ocular (eye) pressure - Glaucoma
- Unconfirmed melanoma (skin cancer), or a skin growth
What happens if I stop taking this medicine suddenly?
- Don’t stop taking levodopa and carbidopa suddenly. It can cause withdrawal symptoms like shaking, anxiety, restlessness, and stiff muscles.
- In RARE cases, stopping suddenly can lead to a serious condition called neuroleptic malignant syndrome (NMS) — with symptoms like fever, stiff muscles, and confusion.
- Always talk to your doctor before stopping this medicine. It should always be reduced slowly.
Is there any harm to my body if I take alcohol with levodopa and carbidopa?
Avoid drinking alcohol before you begin this medicine, as it can make dizziness, sleepiness, and difficulty concentrating worse, and impact your ability to think clearly and make decisions.
What happens if I omit a dose?
- Unless if it's almost time for your next dose, take this medicine while you remember.
- You can avoid having the missed one and take your medicine at the usual time.
- Make sure that you do not take two doses together.
What special care do I need to care of?
- Avoid High fat, High protein meal before or after taking this medicine, as it can make teh medicine less effective.
- This medicine may cause sleepiness or dizziness. Don’t drive or use machines.
- Your urine, sweat, or saliva may become darker in colour — this is harmless. Some people may experience impulse-control disorders (e.g., gambling, hyper sexuality, compulsive spending). Report such behaviours to your doctor.
Are there any side effects to levodopa and carbidopa?
- Common: Dizziness, drowsiness, nausea, headache, dry mouth, loss of appetite, or insomnia.
- Rare but serious: Irregular heartbeat, severe allergic reaction, difficulty breathing or swallowing, hallucinations, or confusion.
What medicines are unsafe to use with combination?
You should avoid taking these medications together with levodopa and carbidopa:
- Some antibiotics (like Linezolid)
- Metoclopramide
- Medications for anxiety, depression or psychotic disorders
- Medications for sleep
- Iron supplements or multivitamins with iron
- Medicines for Parkinson disease
- Antihypertensive
- Avoid taking iron supplements within 2 hours of levodopa/carbidopa as they can interfere with absorption.
Avoid taking any OTC/ herbal medications without informing to the doctor.
Is this medicine safe in pregnant and feeding women?
Levodopa and carbidopa crosses placental barrier and can reach fetus, its effect on the fetus is not well studied, hence avoided unless absolutely required.
These medicines can pass into breast milk, so check with your doctor before using them while breastfeeding.
SUMMARY:
Levodopa and Carbidopa are medicines used together to treat Parkinson’s disease, restless leg syndrome, and sometimes dopa-responsive dystonia in children. Levodopa turns into dopamine in the brain to improve movement, while Carbidopa helps it work better and reduces nausea. They are taken orally, with or without food, at the same time each day. Common side effects include dizziness, drowsiness, headache, and nausea, while rare ones include irregular heartbeat or allergic reactions. Avoid alcohol, high-protein meals near dosing, and certain interacting medicines. Do not stop suddenly without medical advice. Use in pregnancy or breastfeeding only if prescribed by a doctor. Store in a cool, dry place, tightly sealed and away from children.
Let us know if this helped!
REFERENCE:
Author:
- Dr. Likitha B S, Pharm. D, Clinical Pharmacologist, Aster Hospitals, Bengaluru
- Dr Praveen Kumar, B. Pharm, Pharm D(PB), Lead Clinical Pharmacologist, REGIONAL HEAD KIMS Hospitals, Bengaluru
- Dr. C. P. Ravi Kumar Lead & Senior Consultant – Paediatric Neurology KIMS HOSPITALS BENGALURU
