Use Cautiously in:
CNS: involuntary movements , anxiety, dizziness, hallucinations , memory loss, psychiatric problems .
EENT: blurred vision, mydriasis.
GI: nausea, vomiting, anorexia , dry mouth, hepatotoxicity.
Hemat: hemolytic anemia, leukopenia.
Misc: darkening of urine or sweat.
Symptomatic postural hypotension may occur when adding carbidopa/levodopa; therefore, be prepared to adjust antihypertensive therapy as needed.
Dopamine D2 receptor antagonists (eg, butyrophenones, isoniazid, phenothiazines, risperidone), papaverine, phenytoin
May reduce the therapeutic effects of levodopa.
Drugs known to interfere with biliary excretion, glucuronidation, and intestinal beta-glucuronidase (eg, ampicillin, chloramphenicol, cholestyramine, erythromycin, probenecid, rifampin)
Because entacapone is excreted via the bile, use drugs known to interfere with biliary excretion, glucuronidation, and intestinal beta-glucuronidase with caution.
Drugs metabolized by COMT (eg, alpha-methyldopa, apomorphine, bitolterol, dobutamine, dopamine, epinephrine, isoproterenol, isotharine)
Increased heart rate, possible arrhythmia, and excessive BP changes may occur.
May reduce the bioavailability of levodopa; however, the clinical importance is unclear.
Concurrent therapy with nonselective MAOIs (eg, phenelzine) is contraindicated. Discontinue therapy with MAOIs 2 wk prior to starting carbidopa/levodopa/entacapone.
May increase levodopa bioavailability by increasing gastric emptying and because of its dopamine receptor antagonistic properties; metoclopramide may also adversely affect disease control.
Pyridoxine in doses of 10 to 25 mg may reverse the effects of levodopa; however, carbidopa inhibits this effect of levodopa. Therefore, supplemental pyridoxine can be given concurrently.
Tricyclic antidepressants (TCAs) (eg, amitriptyline)
Rare reports of adverse reactions, including hypertension and dyskinesia, have been noted with concomitant use of levodopa/carbidopa and TCAs.
Therapeutic Classification: antiparkinson agents
Pharmacologic Classification: dopamine agonists
Absorption: Well absorbed following oral administration.
Distribution: Widely distributed. enters the CNS in small concentrations.
Metabolism/Excretion: mostly metabolized by the GI tract and liver.
Half-life: 1 hr;
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