Generic name: carbidopa 25mg
Dosage form: tablet
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Whether given with carbidopa-levodopa or with levodopa, the optimal daily dose of
LODOSYN must be determined by careful titration. Most patients respond to a 1:10
proportion of carbidopa and levodopa, provided the daily dosage of carbidopa is 70 mg or
more a day. The maximum daily dosage of carbidopa should not exceed 200 mg, since
clinical experience with larger dosages is limited. If the patient is taking carbidopa-levodopa,
the amount of carbidopa in carbidopa-levodopa should be considered when calculating the
total amount of LODOSYN to be administered each day.
Patients Receiving Carbidopa-Levodopa Who Require Additional Carbidopa
Some patients taking carbidopa-levodopa may not have adequate reduction in nausea and
vomiting when the dosage of carbidopa is less than 70 mg a day, and the dosage of levodopa
is less than 700 mg a day. When these patients are taking carbidopa-levodopa, 25 mg of LODOSYN may be given with the first dose of carbidopa-levodopa each day. Additional doses of 12.5 mg or 25 mg may be given during the day with each dose of carbidopa-levodopa. LODOSYN may be given with any dose of carbidopa-levodopa as required for optimum therapeutic response. The maximum daily dosage of carbidopa, given as LODOSYN
and as carbidopa-levodopa, should not exceed 200 mg.
Patients Requiring Individual Titration of Carbidopa and Levodopa Dosage
Although carbidopa-levodopa is the most frequently used of carbidopa and levodopa
administration, there may be an occasional patient who requires individually titrated doses of
these two drugs. In these patients, LODOSYN (carbidopa) should be initiated at a dosage
of 25 mg three or four times a day. The two drugs should be given at the same time,
starting with no more than one-fifth (20%) to one-fourth (25%) of the previous or
recommended daily dosage of levodopa when given without LODOSYN (carbidopa). In
patients already receiving levodopa therapy, at least twelve hours should elapse between
the last dose of levodopa and initiation of therapy with LODOSYN (carbidopa) and
levodopa. A convenient way to initiate therapy in these patients is in the morning
following a night when the patient has not taken levodopa for at least twelve hours.
Health care providers who prescribe separate doses of LODOSYN and levodopa should be
thoroughly familiar with the directions for use of each drug.
Dosage of LODOSYN may be adjusted by adding or omitting one-half or one tablet a day. Because both therapeutic and adverse responses occur more rapidly with combined therapy than when only levodopa is given, patients should be monitored closely during the dose adjustment period. Specifically, involuntary movements will occur more rapidly when LODOSYN and levodopa are given concomitantly than when levodopa is given without LODOSYN. The occurrence of involuntary movements may require dosage reduction. Blepharospasm may be a useful early sign of excess dosage in some patients.
Current evidence indicates other standard antiparkinsonian drugs may be continued while carbidopa and levodopa are being administered. However, the dosage of such other standard antiparkinsonian drugs
may require adjustment.
Interruption of Therapy
Sporadic cases of hyperpyrexia and confusion have been associated with dose reductions and
withdrawal of carbidopa-levodopa) or carbidopa-levodopa extended release. Patients should
be observed carefully if abrupt reduction or discontinuation of carbidopa-levodopa or
carbidopa-levodopa extended release is required, especially if the patient is receiving
neuroleptics. (See WARNINGS.)
If general anesthesia is required, therapy may be continued as long as the patient is permitted to take fluids and medication by mouth. When therapy is interrupted temporarily, the patient should be observed for symptoms resembling NMS, and the usual daily dosage may be resumed as soon as the patient is able to take medication orally.
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- Drug class: dopaminergic antiparkinsonism agents