Levodopa + Carbidopa (Levodopum + Carbidopum)

Pharmacodynamics Pharmacokinetics Indications Carefully Contraindications Dosing and Administration Side effects
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Clinical and pharmacological group: & nbsp

Anti-Parkinsonics

Dopaminomimetics

Included in the formulation
  • Duodope®
    gel c / cavity 
    EbbVi Ltd.     Russia
  • Carbidopa / Levodopa
    pills inwards 
    Remedika Co., Ltd.     Cyprus
  • Madopar ® high-speed tablets (dispersible) "125"
    pillscapsules inwards 
    Hoffmann-La Roche Ltd.     Switzerland
  • Nacom ®
    pills inwards 
    Lek dd     Slovenia
  • Sindop
    pills inwards 
    San Pharmaceutical Industries Co., Ltd.     India
  • Tidomet forte
    pills inwards 
    Torrent Pharmaceuticals Co., Ltd.     India
  • Tremonorm
    pills inwards 
    Teva Pharmaceutical Enterprises Co., Ltd.     Israel
    • Included in the list (Order of the Government of the Russian Federation No. 2782-r of 30.12.2014):

    VED

    ONLS

    АТХ:

    N.04.B.A.02   Levodopa and a decarboxylase inhibitor

    Pharmacodynamics:

    Combined anti-Parkinsonics.

    Levodopa

    Replenishes the deficiency of dopamine. The precursor of the dopamine mediator penetrates the blood-brain barrier and is converted to dopamine in the central nervous system.

    Carbidopa

    Inhibits peripheral dopa-decarboxylase, reducing the formation of dopamine in peripheral tissues, which increases the concentration of levodopa in the central nervous system.

    Pharmacokinetics:

    Levodopa

    Absorbed in the gastrointestinal tract in an amount of 20-30% of the dose. The maximum concentration in the blood plasma is achieved in 2-3 hours.It binds to plasma proteins by 10-30%.

    Metabolized by the action of catechol-O-methyltransferase and dopa decarboxylase in all tissues to dopamine, norepinephrine, epinephrine and 3-O-methyldopa.

    The elimination half-life is 0.6-1.3 hours. Elimination by the kidneys, partly with feces.

    Carbidopa

    It binds to plasma proteins by 36%. Metabolised in the liver. Half-life is 2-3 hours. Elimination by the kidneys.

    Indications:

    It is used to treat Parkinson's disease, Parkinson's syndrome. It is used in children with Segawa syndrome and dopaminosensitive dystonias, including those associated with cerebral palsy, as well as in newborns with tetrahydrobiopterin synthesis defects and dihydrobiopterin reductase deficiency.

    ICD-10

    VI.G20-G26.G21   Secondary Parkinsonism

    VI.G20-G26.G20   Parkinson's disease

    Contraindications:
    • Liver failure.
    • Pheochromocytoma.
    • Closed-angle glaucoma.
    • Atraumatic acute rhabdomyolysis (including in the anamnesis).
    • Malignant neuroleptic syndrome.
    • Individual intolerance.
    Carefully:Cardiovascular and pulmonary insufficiency, bronchial asthma, endocrine diseases in the stage of decompensation,erosive and ulcerative lesions of the gastrointestinal tract, convulsions (including in the anamnesis), psychoses, open-angle glaucoma, depressive states with suicidal tendencies.
    Pregnancy and lactation:Recommendations for FDA - Category C. During pregnancy and lactation, the drug is contraindicated.
    Dosing and Administration:

    Use in children

    For the treatment of Segawa syndrome and dopaminosensitive dystonias, including those associated with cerebral palsy

    3 months to 18 years at 250 mcg / kg 2-3 times a day, bringing to the optimal dose at intervals of 2-3 days. The maximum dose: 1mkg / kg 3 times a day.

    With defects in the synthesis of tetrahydrobiopterin and a deficiency of dihydrobiopterin reductase

    Newborns: the initial dose of 250-500 mcg / kg (the ratio of levodopa to carbidopa 4: 1) 4 times a day. Increase the dose every 4-5 days at 2.5-3 μg / kg.

    Adults

    Inside regardless of the time of meal. The dose is selected individually. On the first day, ¼ tablets (250 mg and 25 mg) 2-3 times a day, with a dose increase of ¼ tablets 2-3 days before the optimal dose.

    The highest daily dose: 1.5 mg of levodopa, 150 mg of carbidopa (6 tablets of 250 mg + 25 mg).

    The highest single dose: 1 tablet (250 mg + 25 mg).

    Side effects:

    Central and peripheral nervous system: headache, insomnia, nightmares, hallucinations, euphoria, paranoid thinking, cognitive dysfunction, ataxia, trismus, blepharospasm, bruxism.

    The cardiovascular system: orthostatic hypotension, arrhythmia, arterial hypertension, phlebitis.

    Respiratory system: dyspnea, pain in the chest.

    The system of hematopoiesis: anemia, agranulocytosis, thrombocytopenia.

    Digestive system: dryness, bitter aftertaste, burning sensation in the mouth, nausea, salivation, vomiting, hiccough, dysphagia, diarrhea, constipation, flatulence, hepatitis, duodenal ulcer development.

    Sense organs: oculogic crises, diplopia, mydriasis, blurred vision.

    Urinary system: urinary retention, priapism, change in urine color, urinary incontinence.

    Dermatological reactions: hyperemia, hot flushes, hyperhidrosis, hair loss, hives.

    Allergic reactions.

    Overdose:

    Symptoms: increased side effects.

    Treatment: symptomatic.

    Interaction:

    Contraindicated simultaneous use with nonselective and selective MAO inhibitors types A and B.

    Compatible with other antiparkinsonian drugs, antidepressants: imizin, moclobemide.

    Antagonists of dopamine receptors, phenytoin, papaverine reduce the therapeutic effect of levodopa.

    It is recommended to take iron preparations with a 2-3 hour interval, since levodopa is combined with iron ions, forming chelate complexes.

    Compatible with vitamin B6, ibuprofen, diazepam.

    Special instructions:

    Not effective against extrapyramidal disorders caused by medication.

    Causes drowsiness and short-term sudden falling asleep. When taking the drug, patients are forbidden to drive a car and work with moving machinery.

    Instructions
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