Patient Medication Information: uses, side effects, how to take - PMS-Levodopa-Carbidopa
What is pms-LEVODOPA-CARBIDOPA used for?
pms-LEVODOPA-CARBIDOPA is used to treat the symptoms of Parkinson’s disease in adults.
How does pms-LEVODOPA-CARBIDOPA work?
pms-LEVODOPA-CARBIDOPA contains two ingredients:
- Levodopa: this acts to replenish dopamine in the brain.
- Carbidopa: ensures that enough levodopa gets to the brain where it is needed.
It is believed that the symptoms of Parkinson’s disease are caused by a lack of dopamine. Dopamine is a naturally occurring chemical produced by certain brain cells. It has the role of relaying messages in certain regions of the brain that control muscle movement. Difficulty in movement results when too little dopamine is produced.
In many patients, pms-LEVODOPA-CARBIDOPA help to reduce the symptoms of Parkinson’s disease.
Serious Warnings and Precautions
You can suddenly fall asleep without any warning while taking pms-LEVODOPA-CARBIDOPA. You should not drive, use machines, or take part in activities that require you to be alert until you know how pms-LEVODOPA-CARBIDOPA affects you. You may put yourself and others at risk for serious injury or death.
- Falling asleep suddenly without warning has also been reported in patients taking similar medicines to treat Parkinson’s disease.
If you ever feel sleepy or fall asleep without warning:
- do not take part in any activities that require you to be alert (e.g., driving, using machines); and
- tell your healthcare professional right away.
What are the ingredients in pms-LEVODOPA-CARBIDOPA?
Medicinal ingredients: Levodopa and Carbidopa
Non-medicinal ingredients: crospovidone, D&C Yellow No: 10 aluminum lake (100 / 25), FD&C Blue No; 2 aluminum (100 / 10 and 250 / 25), hydroxypropyl cellulose, magnesium stearate, microcrystalline cellulose, pregelatinized starch.
pms-LEVODOPA-CARBIDOPA comes in the following dosage forms:
Tablets: 100 mg / 25 mg (yellow), 100 mg / 10 mg and 250 mg / 25 mg (blue).
pms-LEVODOPA-CARBIDOPA tablets are available in a levodopa : carbidopa 4:1 ratio (pms-LEVODOPA-CARBIDOPA 100 mg / 25 mg) and in a 10:1 ratio of levodopa to carbidopa (pms-LEVODOPA-CARBIDOPA 100 mg / 10 mg and 250 mg / 25 mg).
Do not use pms-LEVODOPA-CARBIDOPA if:
- you are allergic to levodopa, carbidopa, or to any other ingredients in pms-LEVODOPA-CARBIDOPA.
- you are taking certain monoamine oxidase inhibitor (MAOIs) (such as those used to treat depression). Most MAOIs should be stopped at least two weeks before starting therapy with pms-LEVODOPA-CARBIDOPA.
- you have an untreated heart, liver, kidney, lung, blood or hormonal disease.
- you have a serious eye condition called narrow-angle glaucoma.
you have been told that you should not take sympathomimetic medicines such as:
- isoproterenol (used to treat asthma and certain heart conditions)
- amphetamines (used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy (uncontrollable urge to sleep))
- epinephrine (used to treat life-threatening allergic reactions)
- you have any suspicious skin lesions (moles) which have not been examined by your healthcare professional or if you have ever had skin cancer.
To help avoid side effects and ensure proper use, talk to your healthcare professional before you take pms-LEVODOPA-CARBIDOPA. Talk about any health conditions or problems you may have, including if you:
- are taking or have taken levodopa in the past.
- have a history of heart problems (heart attack or irregular heartbeat). Your d healthcare professional should carefully monitor you in an appropriate facility when you first start taking pms-LEVODOPA-CARBIDOPA.
- have or have had ulcers in your gut (called "duodenal" or "peptic ulcers").
- have a history of convulsions/seizures.
- have dyskinesia, which are severe uncontrolled involuntary movements that can look like fidgeting, writhing or swaying.
- have any unusual conditions related to your eyes or eyesight (glaucoma).
- are going to have an operation that requires general anesthesia.
- suffer from a medical condition called psychosis.
- have or had skin cancer (melanoma).
are pregnant, think you might be pregnant or become pregnant while taking pms-LEVODOPA-CARBIDOPA. Your healthcare professional will advise whether you should take pms-LEVODOPA-CARBIDOPA while you are pregnant.
- are breastfeeding or wish to breastfeed. Your healthcare professional will decide whether you should take pms-LEVODOPA-CARBIDOPA while breastfeeding.
- have allergies.
- have problems with your lungs, kidneys, or liver.
- have hormonal problems.
Other warnings you should know about:
Laboratory tests and monitoring: When you take pms-LEVODOPA-CARBIDOPA for a prolonged time, your healthcare professional may:
- monitor your liver, kidney and heart function
- do blood tests
Physical activity: As you improve on pms-LEVODOPA-CARBIDOPA you may increase your physical activity slowly depending if you have any other medical conditions.
Uncontrollable movements: pms-LEVODOPA-CARBIDOPA may cause uncontrollable movements and “on and off” episodes. This may happen soon after you take pms-LEVODOPA-CARBIDOPA.
Mental health changes/disturbances: pms-LEVODOPA-CARBIDOPA may cause changes to your mental health.
- Tell your healthcare professional right away if you start to feel depressed or have thoughts of suicide.
- Hallucinations (seeing or hearing things that are not there) can occur when taking pms-LEVODOPA-CARBIDOPA.
Neuroleptic malignant syndrome: This is a disorder that causes you to have a high fever, confusion, altered states or consciousness and stiffness in your muscles. Neuroleptic malignant syndrome may happen if you suddenly:
- Reduce your dose
- Stop taking pms-LEVODOPA-CARBIDOPA
- Switch medicines
Your healthcare professional should monitor you when your dose is reduced or when you stop taking pms-LEVODOPA-CARBIDOPA, especially if you take antipsychotic medicines.
Compulsive behaviours: While taking pms-LEVODOPA-CARBIDOPA, you may have unusual urges and/or behaviours such as excessive:
- gambling
- sexual behaviour
- eating
- spending
You or your caregiver should tell your healthcare professional if either of you notice that you have new or changes to your behaviour.
Skin: People with Parkinson’s disease have a higher risk of developing skin cancer (melanoma). Your healthcare professional should monitor you for skin cancer while you are taking pms-LEVODOPA-CARBIDOPA. Tell your healthcare professional if you have:
- suspicious, undiagnosed changed patches of pigmented skin
- irritated or irregular moles
- moles in which you have noticed changes
Tell your healthcare professional about all the medicines you take, including any drugs, vitamins, minerals, natural supplements or alternative medicines.
The following may also interact with pms-LEVODOPA-CARBIDOPA:
- antihypertensive medicines (used to treat high blood pressure)
- some medications used to treat psychiatric conditions or mental depression (including phenothiazines, butyrophenones, risperidone, selegiline, and tricyclic antidepressants)
- phenytoin (used to treat and control seizures)
- papaverine (used to treat intestinal spasms)
- tetrabenazine (used to treat conditions related to involuntary movements such as Huntington’s Disease)
- isoniazid (used to treat tuberculosis)
- anesthetics (medicines used during surgery)
- iron salts (such as multivitamins tablets)
- metoclopramide (used to relieve nausea and vomiting)
foods that are high in protein. This includes meat, fish, dairy products, seeds and nuts
Serious Drug Interactions
Do not take pms-LEVODOPA-CARBIDOPA if you are taking, or have taken within the last 14 days:
- certain monoamine oxidase inhibitors (MAOIs) such as linezolid, methylene blue, moclobemide, phenelzine, procarbazine, and tranylcypromine.
Ask your healthcare professional if you are unsure.
How to take pms-LEVODOPA-CARBIDOPA:
- Swallow tablets whole with a glass of water. Do not chew, divide or crush tablets. pms-LEVODOPA-CARBIDOPA tablets have a score line on one side. Breaking the tablet in half may not give you half the dose.
DO NOT:
- stop taking pms-LEVODOPA-CARBIDOPA, reduce the amount of pms-LEVODOPA-CARBIDOPA you take or change your dose unless your healthcare professional tells you to. If you suddenly stop or reduce your dose, you may experience the following symptoms: stiff muscles, fever and mental changes.
- take any other medicines used to treat Parkinson’s disease without first consulting your healthcare professional. This includes other medicines containing levodopa and carbidopa.
- give pms-LEVODOPA-CARBIDOPA to other people.
- use pms-LEVODOPA-CARBIDOPA for any other condition.
Usual dose:
- Your healthcare professional will tell you how many tablets of pms-LEVODOPA-CARBIDOPA you will need take each day and when you should take them. Take pms-LEVODOPA-CARBIDOPA exactly as your healthcare professional has told you.
- Tell your healthcare professional right away if you notice any changes in your symptoms during your treatment, such as nausea or abnormal movements. Your healthcare professional may need to adjust your dose.
Overdose:
Missed Dose:
If you have missed a dose, take it as soon as you remember. If it is almost time to take your next dose, do not take the dose you have missed, and take your next dose as scheduled.
What are possible side effects from using pms-LEVODOPA-CARBIDOPA?
These are not all the possible side effects you may have when taking pms-LEVODOPA-CARBIDOPA. If you experience any side effects not listed here, tell your healthcare professional.
If you think you, or a person you are caring for, have taken too much pms-LEVODOPA-CARBIDOPA, contact a healthcare professional, hospital emergency department, regional poison control centre or Health Canada’s toll-free number, 1-844 POISON-X (1-844-764-7669) immediately, even if there are no signs or symptoms.
Side effects may include:
- Nausea or vomiting
- Slow movements
- Sleepiness, abnormal dreams, difficulty to fall asleep or stay asleep
- Headache
- Dizziness
- Mental changes, confusion, feeling agitated
- Hair loss
- Dark-coloured saliva, urine and sweat
- Chest pain
- Feeling weak and tired
- Changes in blood pressure
- Dry mouth, changes in tastes, drooling, burning sensation of the tongue, grinding or clenching of the teeth
- Diarrhea, constipation, stomach pain, heartburn, gas
- Back,shoulder or leg pain
- Muscle cramps
- Bladder infection
- Hiccups
- Changes in weight, eating disorder (anorexia)
- Blurred or double vision
- Spasms that move the eye(s) into a fixed position (oculogyric crisis)
Serious side effects and what to do about them
| Symptom / effect | Talk to your healthcare professional | Stop taking drug and get immediate medical help | |
|---|---|---|---|
Only if severe | In all cases | ||
| VERY COMMON | |||
| Dyskinesia: severe uncontrolled movements | √ | ||
| COMMON | |||
| Hallucinations: seeing or hearing things that are not there | √ | ||
| RARE | |||
| Allergic reactions: hives, itching, rash, swelling of the face, lips, mouth, tongue or throat, trouble breathing and/or swallowing | √ | ||
| Compulsive Behaviour: Inability to resist the impulse to perform an action that could be harmful such as gambling too much, increased sexual urges, uncontrollable urge to eat or spend money, or repeating meaningless actions | √ | ||
| Convulsion: seizure, spasms, shaking or fits | √ | ||
Depression: (sad mood that won’t go away): difficulty sleeping or sleeping too much, changes in appetite or weight, feelings of worthlessness, guilt, regret, helplessness or hopelessness, withdrawal from social situations, family, gatherings and activities with friends, reduced libido (sex drive) and thoughts of death or suicide. If you have a history of depression, your depression may become worse | √ | ||
| Excessive sleepiness or falling asleep without warning while doing normal activities | √ | ||
| Feeling of lightheadedness as when standing quickly | √ | ||
| Melanoma (skin cancer): Changed patches of pigmented skin, including irritated or irregular moles, or moles in which you have noticed changes | √ | ||
Serious side effects and what to do about them
| Symptom / effect | Talk to your healthcare professional | Stop taking drug and get immediate medical help | |
|---|---|---|---|
| Only if severe | In all cases | ||
Neuroleptic Malignant Syndrome: pronounced muscle stiffness or inflexibility with high fever, rapid or irregular heartbeat, sweating, state of confusion or reduced consciousness | √ | ||
| Priapism: Long-lasting (greater than 4 hours in duration) and painful erection of the penis | √ | ||
Uneven (irregular) heartbeat, palpitations, chest pain and/or discomfort, pain in jaw, shoulders, arm and/or back, shortness of breath, sweating, nausea or light-headedness | √ | ||
If you have a troublesome symptom or side effect that is not listed here or becomes bad enough to interfere with your daily activities, tell your healthcare professional.
Storage:
Store at (15°C - 30°C) in a tightly closed container. Protect from light and moisture.
Keep out of reach and sight of children.
Do not use outdated medicine.
Reporting Side Effects
You can report any suspected side effects associated with the use of health products to Health Canada by:
- Visiting the Web page on Adverse Reaction Reporting (canada.ca/drug-device-reporting) for information on how to report online, by mail or by fax; or
- Calling toll-free at 1-866-234-2345.
NOTE: Contact your healthcare professional if you need information about how to manage your side effects. The Canada Vigilance Program does not provide medical advice.
If you want more information about pms-LEVODOPA-CARBIDOPA:
- Talk to your healthcare professional
- Find the full product monograph that is prepared for healthcare professionals and includes this Patient Medication Information by visiting the Health Canada Drug Product Database website(https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/drug-product-database.html); the manufacturer’s website (www.pharmascience.com), or by calling at 1-888-550-6060.