Stalevo (carbidopa/entacapone/levodopa) and Alcohol / Food Interactions

There are 2 alcohol/food/lifestyle interactions with Stalevo (carbidopa/entacapone/levodopa) which include:

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

When COMT inhibitors are administered together with levodopa/carbidopa, they may increase the relative bioavailability (AUC) of levodopa. This is due to a decrease in levodopa clearance resulting in a prolongation of the terminal elimination half-life of levodopa (from approximately 2 hours to 3.5 hours).

In the presence of the decarboxylase inhibitor carbidopa, catechol-O-methyltransferase (COMT) is the major metabolizing enzyme for levodopa. In clinical trials of COMT inhibitors (administered concomitantly with levodopa), patients required a decrease in their daily levodopa dose if their daily dose of levodopa was greater than 600 mg for tolcapone or 800 mg for entacapone or if the patients had moderate or severe dyskinesias before beginning treatment. Although COMT inhibitors are intended for use with along with levodopa/carbidopa, the clinician should be aware that the dose of levodopa may need to be decreased when they are added to the patients drug regimen. This is especially true if the patient is experiencing dyskinesias induced by levodopa. Use with caution with severe dyskinesias or dystonia.

ADJUST DOSING INTERVAL: The oral bioavailability and pharmacologic effects of levodopa and carbidopa may be decreased during concurrent administration with iron-containing products. The proposed mechanism is chelation of levodopa and carbidopa by the iron cation, forming an insoluble complex that is poorly absorbed from the gastrointestinal tract. In nine patients with Parkinson's disease, administration of levodopa-carbidopa 100 mg-25 mg with ferrous sulfate 325 mg resulted in a 47% reduction in the peak plasma concentration (Cmax) and a 30% reduction in the area under the concentration-time curve (AUC) of levodopa compared to administration with placebo. Carbidopa Cmax and AUC decreased by 77% and 82%, respectively, compared to administration with placebo. There was also evidence of reduced efficacy of levodopa in some patients. In another study consisting of eight normal subjects, coadministration of levodopa 250 mg with ferrous sulfate 325 mg resulted in a greater than 50% decrease in the Cmax and AUC of levodopa compared to administration of levodopa alone. The magnitude of the interaction was the greatest in patients whose plasma levels of levodopa were the highest following administration of levodopa alone.

MANAGEMENT: Until more information is available, patients receiving levodopa and/or carbidopa in combination with iron-containing products should be advised to separate the times of administration by as much as possible. Patients should be monitored for reduced efficacy of levodopa, and the dosage adjusted as necessary.

ADJUST DOSING INTERVAL: The oral bioavailability of entacapone and iron salts may be decreased during concurrent administration. The proposed mechanism is chelation of iron by entacapone, forming an insoluble complex that is poorly absorbed from the gastrointestinal tract. Entacapone has been shown to be a chelator of iron. The impact of entacapone on the body's iron stores is unknown, but a tendency towards decreasing serum iron concentrations was noted in clinical trials.


MANAGEMENT: Until more information is available, patients receiving entacapone in combination with iron-containing products should be advised to separate the times of administration by 2 to 3 hours.

When COMT inhibitors are administered together with levodopa/carbidopa, they may increase the relative bioavailability (AUC) of levodopa. This is due to a decrease in levodopa clearance resulting in a prolongation of the terminal elimination half-life of levodopa (from approximately 2 hours to 3.5 hours).

In the presence of the decarboxylase inhibitor carbidopa, catechol-O-methyltransferase (COMT) is the major metabolizing enzyme for levodopa. In clinical trials of COMT inhibitors (administered concomitantly with levodopa), patients required a decrease in their daily levodopa dose if their daily dose of levodopa was greater than 600 mg for tolcapone or 800 mg for entacapone or if the patients had moderate or severe dyskinesias before beginning treatment. Although COMT inhibitors are intended for use with along with levodopa/carbidopa, the clinician should be aware that the dose of levodopa may need to be decreased when they are added to the patients drug regimen. This is especially true if the patient is experiencing dyskinesias induced by levodopa. Use with caution with severe dyskinesias or dystonia.

You should also know about...

Stalevo (carbidopa/entacapone/levodopa) drug Interactions

There are 810 drug interactions with Stalevo (carbidopa/entacapone/levodopa)

See also...

• Stalevo (carbidopa/entacapone/levodopa) Side Effects
• Stalevo (carbidopa/entacapone/levodopa) Consumer Information

• Drug Interactions Checker

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date, and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. Multum's drug information does not endorse drugs, diagnose patients, or recommend therapy. Multum's drug information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug of drug combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2012 Multum Information Services, Inc. The information in contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.