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Drug Interactions between Etrafon Forte and Stalevo 50

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

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Interactions between your drugs

Major

levodopa perphenazine

Applies to: Stalevo 50 (carbidopa / entacapone / levodopa) and Etrafon Forte (amitriptyline / perphenazine)

Perphenazine may reduce the effectiveness of levodopa. In addition, using these medications together may increase the risk and/or severity of side effects like drowsiness, low blood pressure, dizziness, and lightheadedness. These effects may occur with either medication alone and are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid 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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Major

perphenazine entacapone

Applies to: Etrafon Forte (amitriptyline / perphenazine) and Stalevo 50 (carbidopa / entacapone / levodopa)

Perphenazine may reduce the effectiveness of entacapone. In addition, using these medications together may increase the risk and/or severity of side effects like drowsiness, low blood pressure, dizziness, and lightheadedness. These effects may occur with either medication alone and are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid 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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Moderate

amitriptyline levodopa

Applies to: Etrafon Forte (amitriptyline / perphenazine) and Stalevo 50 (carbidopa / entacapone / levodopa)

Consumer information for this interaction is not currently available.

MONITOR: Coadministration of levodopa with tricyclic antidepressants may increase the risk of hypertension and dyskinesia. The mechanism of this interaction is not understood. There have been rare case reports of this interaction; however, causality was not established.

MANAGEMENT: Until more information is available, it may be prudent to monitor patients for hypertension and dyskinesia if levodopa is coadministered with tricyclic antidepressants. Patients may be advised to report changes in blood pressure and new or worsened involuntary movement.

References

  1. Morgan JP, Rivera-Calimlim L, Messiha F, Sundaresan PR, Trabert N "Imipramine-mediated interference with levodopa absorption from the gastrointestinal tract in man." Neurology 25 (1975): 1029-34
  2. Rampton DS "Hypertensive crisis in a patient given Sinemet, metoclopramide, and amitriptyline." Br Med J 2 (1977): 607-8
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  4. "Product Information. Vyalev (foscarbidopa-foslevodopa)." AbbVie Corporation (2023):
  5. "Product Information. Dhivy (carbidopa-levodopa)." Avion Pharmaceuticals (2022):
View all 5 references
Moderate

amitriptyline perphenazine

Applies to: Etrafon Forte (amitriptyline / perphenazine) and Etrafon Forte (amitriptyline / perphenazine)

Before taking amitriptyline, tell your doctor if you also use perphenazine. You may need dose adjustments or special tests in order to safely take both medications together. This combination should be used with caution, particularly in the elderly. You should notify your doctor promptly if you have signs of bladder problems, dry mouth, stomach pain, fever, blurred vision, confusion, dizziness, or reduced heart rate. You should avoid driving until you know how these medications will affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using your medications without first talking to your doctor.

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Moderate

amitriptyline entacapone

Applies to: Etrafon Forte (amitriptyline / perphenazine) and Stalevo 50 (carbidopa / entacapone / levodopa)

Using amitriptyline together with entacapone may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. 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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Moderate

levodopa entacapone

Applies to: Stalevo 50 (carbidopa / entacapone / levodopa) and Stalevo 50 (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 50 (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 50 (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

amitriptyline food

Applies to: Etrafon Forte (amitriptyline / perphenazine)

Ask your doctor before using amitriptyline together with ethanol, this can alter the effects of amitriptyline and cause increased side effects. Call the doctor if you experience uneven heartbeats, extreme drowsiness, confusion, agitation, vomiting, blurred vision, sweating, muscle stiffness, feeling light-headed, and seizures. You should be warned not to exceed recommended dosages, to avoid alcohol, and to avoid activities requiring mental alertness. If your doctor prescribes these medications together, you may need a dose adjustment to safely take this combination. 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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Moderate

perphenazine food

Applies to: Etrafon Forte (amitriptyline / perphenazine)

Ask your doctor before using perphenazine together with ethanol. This can cause uncontrollable movements, agitation, seizures, severe dizziness or fainting, coma, very deep sleep, irregular heartbeats, and high or low body temperature. Use caution when driving, operating machinery, or performing other hazardous activities, these medicaions may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. 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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Moderate

levodopa food

Applies to: Stalevo 50 (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.


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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.