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Drug Interactions between papaverine and Stalevo 100

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

levodopa papaverine

Applies to: Stalevo 100 (carbidopa / entacapone / levodopa) and papaverine

Consumer information for this interaction is not currently available.

MONITOR: Concomitant use of levodopa and papaverine may result in reduced efficacy of levodopa. The exact mechanism is unknown, though some animal studies have suggested that papaverine may be able to block dopamine receptors in the brain. Clinical data are conflicting. Five case reports were documented in the 1970s where patients with Parkinson's disease began therapy with papaverine in the dose range recommended at that time for treatment of cerebral arteriosclerosis (e.g., 100 mg daily). Reports indicated a gradual loss of therapeutic effect of levodopa over a period of several weeks with recovery of the lost response to levodopa occurring about 7 to 10 days after papaverine was stopped. However, a small study (n=9) did not demonstrate any difference in the neurological symptoms of Parkinson's disease (global, tremor, rigidity, or akinesia scores) when oral papaverine (150 mg) was added to a regimen of antiparkinsonian drugs (range of 100 to 750 mg levodopa plus decarboxylase inhibitor in 9 patients, which was combined with bromocriptine 40 mg in 2 patients or trihexyphenidyl 15 mg in 2 other patients) every day for 3 weeks either preceding or following placebo for 3 weeks. Data examining other formulations of papaverine (intracoronary or intracavernosal for example) are not available.

MANAGEMENT: Some authorities recommend close monitoring for the loss of therapeutic response of levodopa if it is used concomitantly with papaverine. The amount of papaverine absorbed systemically may affect the severity of this interaction.

References

  1. Duvoisin RC "Antagonism of levodopa by papaverine." JAMA 231 (1975): 845-6
  2. Montastruc JL, Rascol O, belin j, ane m, rascol a "Does papaverine interact with levodopa in Parkinson's disease?" Ann Neurol 22 (1987): 558-9
  3. "Product Information. Carbidopa-Levodopa (carbidopa-levodopa)." Teva Pharmaceuticals USA (2020):
  4. "Product Information. Stalevo 50 (carbidopa/entacapone/levodopa)." Almatica Pharma Inc (2020):
  5. "Product Information. AA-Levocarb CR (carbidopa-levodopa)." AA Pharma Inc (2023):
  6. "Product Information. Lecado (co-careldopa)." Sandoz Ltd (2023):
  7. "Product Information. Lecigon (carbidopa/entacapone/levodopa)." Stada Pharmaceuticals Australia Pty Ltd (2023):
View all 7 references
Moderate

levodopa entacapone

Applies to: Stalevo 100 (carbidopa / entacapone / levodopa) and Stalevo 100 (carbidopa / entacapone / levodopa)

The side effects of levodopa may be increased when it is used in combination with entacapone. You may need a dose adjustment if you have been taking levodopa and are starting or stopping treatment with entacapone. Contact your doctor if your condition changes or if you experience movement difficulties, increased drowsiness, dizziness, lightheadedness, flushing, and/or fainting. Avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Drug and food interactions

Moderate

levodopa food

Applies to: Stalevo 100 (carbidopa / entacapone / levodopa)

Alcohol can increase the nervous system side effects of levodopa such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with levodopa. You may experience reduced effectiveness of levodopa in the presence of foods or enteral (tube) feedings with a high protein content. This may make the symptoms of Parkinson's disease worse. Talk with your doctor or nutrition counselor about the best foods to eat while you are taking this medication. Contact your doctor if your condition changes.

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Moderate

entacapone food

Applies to: Stalevo 100 (carbidopa / entacapone / levodopa)

Alcohol can increase the nervous system side effects of entacapone such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with entacapone. Do not use more than the recommended dose of entacapone, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

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Moderate

papaverine food

Applies to: papaverine

Consumer information for this interaction is not currently available.

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 references
Moderate

levodopa food

Applies to: Stalevo 100 (carbidopa / entacapone / levodopa)

Levodopa and multivitamin with minerals should not be taken orally at the same time. Products that contain iron may interfere with the absorption of levodopa and reduce its effectiveness. You should separate the dosing of these medications by as much as possible. Contact your doctor if your Parkinson symptoms worsen. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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