Carbidopa / Levodopa Dosage

This dosage information may not include all the information needed to use Carbidopa / Levodopa safely and effectively. See additional information for Carbidopa / Levodopa.

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Parkinson's Disease

Initial: 1 tablet of carbidopa 25 mg/levodopa 100 mg orally 3 times a day, or 1 tablet of 10 mg carbidopa/100 mg levodopa orally 3 to 4 times a day. The dose may be increased by 1 tablet orally every 1 to 2 days to a dose of 8 tablets/day (2 tablets orally 4 times a day).

Switch from Immediate to Extended Release:
Levodopa must be discontinued at least 12 hours before starting carbidopa-levodopa. Dosage with extended release should be substituted at an amount that provides approximately 25% of the previous levodopa dosage. Patients who are taking less than 1500 mg of levodopa a day should be started on 1 tablet of carbidopa-levodopa 25-100 three or four times a day. The suggested starting dosage for most patients taking more than 1500 mg of levodopa is one tablet of carbidopa-levodopa 25-250 three or four times a day.

Maintenance: May be increased or decreased depending upon therapeutic response. At least 70 to 100 mg of carbidopa per day should be provided. When a greater proportion of carbidopa is required, 1 tablet of carbidopa-levodopa 25-100 may be substituted for each tablet of carbidopa-levodopa 10-100. When more levodopa is required, carbidopa-levodopa 25-250 should be substituted for carbidopa-levodopa 25-100 or carbidopa-levodopa 10-100. If necessary, the dosage of carbidopa/levodopa 25-250 may be increased by 1/2 to 1 tablet every day or every other day to a maximum of 8 tablets per day. Experience with total daily dosages of carbidopa greater than 200 mg is limited.

Because both therapeutic and adverse responses occur more rapidly with carbidopa-levodopa than with levodopa alone, patients should be monitored closely during the dose adjustment period. Specifically, involuntary movements will occur more rapidly with carbidopa-levodopa than with levodopa. The occurrence of involuntary movements may require dosage reduction. Blepharospasm may be a useful early sign of excess dosage in some patients. Most patients have been adequately treated with 400 to 1600 mg of levodopa/day, administered as divided doses at intervals ranging from 4 to 8 hours during the waking day. Higher doses (2400 mg or more of levodopa/day) and shorter intervals (less than 4 hours) have been used, but are not usually recommended. The maximum daily dosage of carbidopa should not exceed 200 mg.

Usual Adult Dose for Neuroleptic Malignant Syndrome

Case Report:
Carbidopa 25 mg/levodopa 250 mg three times daily via nasogastric tube for 2 days.

Usual Pediatric Dose for GTP-CH Deficiency

Case Reports:
Greater than 1 year:
Initial: 5 mg/kg/day of carbidopa/levodopa, then titrated slowly downward with the aim of maintaining control of extrapyramidal syndrome.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

When a greater proportion of carbidopa is required, a 25-100 tablet may be substituted for a 10-100 tablet. When more levodopa is required, a 25-250 tablet should be substituted for a 25-100 or 10-100 tablet.

Patients Currently Treated With Levodopa Without A Decarboxylase Inhibitor: Levodopa must be discontinued at least eight hours before therapy with carbidopa-levodopa extended-release is started. carbidopa-levodopa extended-release should be substituted at a dosage that will provide approximately 25% of the previous levodopa dosage. In patients with mild to moderate disease, the initial dose is usually 1 tablet of carbidopa-levodopa extended-release orally 2 times a day.

Patients Not Receiving Levodopa: In patients with mild to moderate disease, the initial recommended dose is 1 tablet of carbidopa-levodopa extended-release 50-200 twice daily. Initial dosage should not be given at intervals of less than 6 hours.

Titration with carbidopa-levodopa extended-release:

Following initiation of therapy, doses and dosing intervals may be increased or decreased depending upon therapeutic response. Most patients have been adequately treated with doses of carbidopa-levodopa extended-release that provide 400 to 1600 mg of levodopa per day, administered as divided doses at intervals ranging from 4 to 8 hours during the waking day. Higher doses of carbidopa-levodopa extended-release (2400 mg or more of levodopa per day) and shorter intervals (less than 4 hours) have been used, but are not usually recommended.

When doses of carbidopa-levodopa extended-release are given at intervals of less than 4 hours, and/or if the divided doses are not equal, it is recommended that the smaller doses be given at the end of the day.

An interval of at least 3 days between dosage adjustments is recommended.

Maintenance

A dose of carbidopa-levodopa 25-100 or 10-100 (1/2 to 1 tablet) can be added to the dosage regimen of carbidopa-levodopa extended-release in selected patients with advanced disease who need additional immediate release levodopa for a brief time during daytime hours.

In patients already on levodopa, allow 12 hours between the last dose of levodopa and the initiation of therapy with carbidopa-levodopa.

Precautions

Studies show that peripheral dopa decarboxylase is saturated by carbidopa at approximately 70 to 100 mg a day. Patients receiving less than this amount of carbidopa are more likely to experience nausea and vomiting.

When a greater proportion of carbidopa is required, a 25-100 tablet may be substituted for a 10-100 tablet. When more levodopa is required, a 25-250 tablet should be substituted for a 25-100 or 10-100 tablet.

Patients Currently Treated With Levodopa Without A Decarboxylase Inhibitor: Levodopa must be discontinued at least eight hours before therapy with carbidopa-levodopa extended-release is started. carbidopa-levodopa extended-release should be substituted at a dosage that will provide approximately 25% of the previous levodopa dosage. In patients with mild to moderate disease, the initial dose is usually 1 tablet of carbidopa-levodopa extended-release orally 2 times a day.

Patients Not Receiving Levodopa: In patients with mild to moderate disease, the initial recommended dose is 1 tablet of carbidopa-levodopa extended-release 50-200 twice daily. Initial dosage should not be given at intervals of less than 6 hours.

Titration with carbidopa-levodopa extended-release:

Following initiation of therapy, doses and dosing intervals may be increased or decreased depending upon therapeutic response. Most patients have been adequately treated with doses of carbidopa-levodopa extended-release that provide 400 to 1600 mg of levodopa per day, administered as divided doses at intervals ranging from 4 to 8 hours during the waking day. Higher doses of carbidopa-levodopa extended-release (2400 mg or more of levodopa per day) and shorter intervals (less than 4 hours) have been used, but are not usually recommended.

When doses of carbidopa-levodopa extended-release are given at intervals of less than 4 hours, and/or if the divided doses are not equal, it is recommended that the smaller doses be given at the end of the day.

An interval of at least 3 days between dosage adjustments is recommended.

Maintenance:

A dose of carbidopa-levodopa 25-100 or 10-100 (one half or a whole tablet) can be added to the dosage regimen of carbidopa-levodopa extended-release in selected patients with advanced disease who need additional immediate release levodopa for a brief time during daytime hours.

In patients already on levodopa, allow 12 hours between the last dose of levodopa and the initiation of therapy with carbidopa-levodopa.. Dosage adjustment of When a greater proportion of carbidopa is required, a 25-100 tablet may be substituted for a 10-100 tablet. When more levodopa is required, a 25-250 tablet should be substituted for a 25-100 or 10-100 tablet.

Patients Currently Treated With Levodopa Without A Decarboxylase Inhibitor: Levodopa must be discontinued at least eight hours before therapy with carbidopa-levodopa extended-release is started. carbidopa-levodopa extended-release should be substituted at a dosage that will provide approximately 25% of the previous levodopa dosage. In patients with mild to moderate disease, the initial dose is usually 1 tablet of carbidopa-levodopa extended-release orally 2 times a day.

Patients Not Receiving Levodopa: In patients with mild to moderate disease, the initial recommended dose is 1 tablet of carbidopa-levodopa extended-release 50-200 twice daily. Initial dosage should not be given at intervals of less than 6 hours.

Titration with carbidopa-levodopa extended-release:

Following initiation of therapy, doses and dosing intervals may be increased or decreased depending upon therapeutic response. Most patients have been adequately treated with doses of carbidopa-levodopa extended-release that provide 400 to 1600 mg of levodopa per day, administered as divided doses at intervals ranging from 4 to 8 hours during the waking day. Higher doses of carbidopa-levodopa extended-release (2400 mg or more of levodopa per day) and shorter intervals (less than 4 hours) have been used, but are not usually recommended.

When doses of carbidopa-levodopa extended-release are given at intervals of less than 4 hours, and/or if the divided doses are not equal, it is recommended that the smaller doses be given at the end of the day.

An interval of at least 3 days between dosage adjustments is recommended.

Maintenance

A dose of carbidopa-levodopa 25-100 or 10-100 (one half or a whole tablet) can be added to the dosage regimen of carbidopa-levodopa extended-release in selected patients with advanced disease who need additional immediate release levodopa for a brief time during daytime hours.

In patients already on levodopa, allow 12 hours between the last dose of levodopa and the initiation of therapy with carbidopa-levodopa. may be necessary when these agents are added.

Interruption Of Therapy: Patients should be observed carefully if abrupt reduction or discontinuation of When a greater proportion of carbidopa is required, a 25-100 tablet may be substituted for a 10-100 tablet. When more levodopa is required, a 25-250 tablet should be substituted for a 25-100 or 10-100 tablet.

Patients Currently Treated With Levodopa Without A Decarboxylase Inhibitor: Levodopa must be discontinued at least eight hours before therapy with carbidopa-levodopa extended-release is started. carbidopa-levodopa extended-release should be substituted at a dosage that will provide approximately 25% of the previous levodopa dosage. In patients with mild to moderate disease, the initial dose is usually 1 tablet of carbidopa-levodopa extended-release orally 2 times a day.

Patients Not Receiving Levodopa: In patients with mild to moderate disease, the initial recommended dose is 1 tablet of carbidopa-levodopa extended-release 50-200 twice daily. Initial dosage should not be given at intervals of less than 6 hours.

Titration with carbidopa-levodopa extended-release:

Following initiation of therapy, doses and dosing intervals may be increased or decreased depending upon therapeutic response. Most patients have been adequately treated with doses of carbidopa-levodopa extended-release that provide 400 to 1600 mg of levodopa per day, administered as divided doses at intervals ranging from 4 to 8 hours during the waking day. Higher doses of carbidopa-levodopa extended-release (2400 mg or more of levodopa per day) and shorter intervals (less than 4 hours) have been used, but are not usually recommended.

When doses of carbidopa-levodopa extended-release are given at intervals of less than 4 hours, and/or if the divided doses are not equal, it is recommended that the smaller doses be given at the end of the day.

An interval of at least 3 days between dosage adjustments is recommended.

Maintenance

A dose of carbidopa-levodopa 25-100 or 10-100 (one half or a whole tablet) can be added to the dosage regimen of carbidopa-levodopa extended-release in selected patients with advanced disease who need additional immediate release levodopa for a brief time during daytime hours.

In patients already on levodopa, allow 12 hours between the last dose of levodopa and the initiation of therapy with carbidopa-levodopa is required, especially if the patient is receiving neuroleptics.

Dialysis

Data not available

Other Comments

Levodopa must be discontinued at least 8 hours before starting carbidopa/levodopa. A daily dose of carbidopa/levodopa should be 25% of the previous levodopa dose. Patients taking less than 1500 mg of levodopa/day should be started on one 25-100 tablet orally 3 to 4 times a day.

If general anesthesia is required, carbidopa-levodopa may be continued as long as the patient is permitted to take oral medication. If therapy is interrupted temporarily, the usual dosage should be administered as soon as the patient is able to take oral medication.

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