Carbidopa and levodopa

Carbidopa and levodopa can be used by themselves or with other medications to help treat symptoms of Parkinson's disease, like stiffness or tremors in adults.

Carbidopa and levodopa is also used in adults to treat Parkinson's disease that is caused by infection, carbon monoxide poisoning, or manganese intoxication.

Carbidopa and levodopa may also be used for reasons not mentioned in this medication guide.

Follow all instructions on your prescription label and read all medication guides or instruction sheets. Your doctor may change your dose from time to time. Use the medicine exactly as directed.

Stop taking any other medications that contain carbidopa and levodopa when you begin the extended-release form.

Your dose may need to change if you switch to a different brand, strength, or form of this medicine. Avoid mistakes by using it exactly as directed on the label or as your doctor prescribed.

Take this medicine at regular intervals. Follow your doctor's instructions about whether to take your medication with food or on an empty stomach.

Swallow the capsule whole and do not crush, chew, break, or open it. The tablet can sometimes be split in half to provide the correct dose. Always swallow a whole or half tablet without chewing or crushing.

If you cannot swallow an extended-release capsule whole, open it and mix the medicine with applesauce. Swallow the mixture immediately without chewing.

Take an orally disintegrating tablet from the package with dry hands only when you are ready to use it. Let the orally disintegrating tablet dissolve in your mouth without chewing.

It may take up to several weeks for your symptoms to improve. Tell your doctor if your symptoms do not improve or if the effects of this medicine go away quickly between doses.

Carbidopa and levodopa will most likely darken the color of your saliva, urine, or sweat to an orange or red color. This is a normal effect and is not harmful. It may also cause permanent stains to your underwear.

You may need frequent medical tests, and your doctor will need to monitor your progress regularly.

This medicine can affect the results of certain medical tests. Inform any doctor treating you that you are using carbidopa and levodopa.

Do not stop using carbidopa and levodopa suddenly, as this could lead to unpleasant withdrawal symptoms (such as agitation, confusion, tingling). Ask your doctor before stopping the medicine.

You may need to follow a special diet. Learn about the foods you should eat or avoid.

Store tightly closed at room temperature, away from moisture, heat, and light.

Do not use this medicine if you have used a MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, or tranylcypromine.

Some people have thoughts about suicide while taking carbidopa and levodopa. Tell your doctor right away if you have any sudden changes in mood or behavior, or thoughts about suicide.

You should not use carbidopa and levodopa if you are allergic to it or any of its ingredients, or if you have narrow-angle glaucoma.

Do not use carbidopa and levodopa if you have taken a MAO inhibitor in the past 14 days. A dangerous drug interaction could happen. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, and tranylcypromine. Wait at least 14 days after stopping a MAO inhibitor before taking carbidopa and levodopa.

If you are already taking levodopa, you must stop taking it at least 12 hours before starting carbidopa and levodopa.

Tell your doctor if you have or have ever had:

• an endocrine disease, heart disease, high blood pressure, or heart attack;
• asthma, chronic obstructive pulmonary disease (COPD), or other breathing disorder;
• skin cancer (melanoma), a stomach or intestinal ulcer;
• glaucoma, depression, mental illness, or psychosis;
• if you received general anesthesia; or
• liver or kidney disease.

The orally disintegrating tablet may contain phenylalanine and could be harmful if you have phenylketonuria (PKU). Ask your doctor about your risk.

Some people may have thoughts about suicide while taking carbidopa and levodopa. Stay alert to changes in your mood or symptoms. Your family or caregivers should also monitor for sudden changes in your behavior.

People with Parkinson's disease may have a higher risk of skin cancer (melanoma). Ask your doctor about skin symptoms to watch for.

It is not known if carbidopa and levodopa will harm an unborn baby. The benefit of this treatment may outweigh any risks to the mother and baby. Tell your doctor if you are pregnant or plan to become pregnant.

Ask a doctor if it is safe to breastfeed while using carbidopa and levodopa.

Get emergency medical help if you notice signs of an allergic reaction: hives, trouble breathing, or swelling of your face, lips, tongue, or throat.

Contact your doctor right away if you experience new or sudden changes in mood or behavior, such as depression or anxiety, panic attacks, difficulty sleeping, or if you feel more impulsive, irritable, agitated, aggressive, more active or talkative, or have thoughts about suicide or self-harm.

Some individuals taking carbidopa and levodopa have fallen asleep during regular daytime activities, like working or driving, after starting carbidopa and levodopa and up to a year later. Inform your doctor if you have any issues with daytime sleepiness.

Carbidopa and levodopa can cause serious side effects. Call your doctor immediately if you have:

• signs of stomach bleeding, such as bloody or tarry stools, coughing up blood, or vomiting that looks like coffee grounds;
• uncontrolled muscle movements, blurred vision, eye pain or redness, or seeing halos around lights; or
• severe nervous system reactions, including very stiff muscles, high fever, sweating, confusion, fast or irregular heartbeats, tremors, or feeling faint.

You may experience increased sexual urges, unusual urges to gamble, or other intense urges while on this medication. Discuss this with your doctor if it happens.

Your dose may be lowered or stopped permanently if you experience certain side effects.

Common side effects of carbidopa and levodopa may include:

• uncontrolled muscle movements;
• dry mouth, anxiety, headache, dizziness;
• drops in blood pressure or feeling light-headed when standing up;
• sleep issues (insomnia), unusual dreams, muscle contractions; or
• nausea, vomiting, constipation.

This is not a complete list of side effects; others may occur. Contact your doctor for medical advice about side effects. You can report side effects to the FDA at 1-800-FDA-1088.

Take the medicine as soon as you can, but skip the missed dose if it is close to the time for your next dose. Do not take two doses at the same time.

Get your prescription refilled before you completely run out of medicine.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Avoid driving or doing anything that could be dangerous until you know how carbidopa and levodopa will affect you. Dizziness or drowsiness can lead to falls, accidents, or serious injuries. Also, avoid getting up too quickly from a sitting or lying position, as this may cause dizziness.

Drinking alcohol with this medicine can lead to side effects.

Avoid taking iron supplements or eating high-fat or high-calorie meals before or after taking carbidopa and levodopa. These can make it harder for your body to absorb carbidopa and levodopa.

Using carbidopa and levodopa with other drugs that make you drowsy can make you feel even more sleepy. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

When you start or stop taking carbidopa and levodopa, your doctor may need to change the doses of other medicines you take regularly.

Tell your doctor about all your other medicines, especially:

• phenytoin, metoclopramide;
• papaverine, isoniazid, selegiline, reserpine, tetrabenazine;
• vitamin or mineral supplements that contain iron; or
• medicine to treat blood pressure, nausea or vomiting, anxiety, mood disorders, or mental illness such as schizophrenia.

This list is not complete. Other drugs may affect carbidopa and levodopa, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.