Levodopa (co-beneldopa and co-careldopa)
This information explains the Parkinson's drug levodopa, the benefits and side effects and its different types.
Levodopa is the name used to describe one of the main types (classes) of Parkinson’s drugs. It is one of the main drugs used to treat Parkinson's symptoms. It can be used at all stages of the condition.
How do levodopa drugs work?
Levodopa is a chemical building block that your body converts into dopamine in the brain. Levodopa already occurs naturally in your body and taking a levodopa drug treatment boosts the supply, meaning the nerve cells can make more dopamine.
When are levodopa drugs used?
Levodopa drugs are usually prescribed for someone newly diagnosed with Parkinson’s, or when mobility problems affect someone’s daily life. However, this will not be the same for everyone.
Your levodopa treatment will usually start with a low dose. This will gradually be increased until your symptoms are under control.
Benefits of levodopa
Levodopa can help treat Parkinson’s symptoms because it helps to top up dopamine levels in the brain.
You may see a big improvement in your symptoms when taking it, especially with stiffness and slowness of movement.
Risks and side effects of levodopa
Levodopa works less well over time. This means that you might need to take more of it over time. People with Parkinson’s will benefit from medications containing levodopa throughout their lifetime.
The patient information leaflet that comes with your drugs will tell you about all of the side effects that you may experience.
'Wearing off'
When you take levodopa for a long time you may experience ‘wearing off’. ‘Wearing off’ happens when the Parkinson’s medication you’ve been taking is no longer working as effectively as it used to. Because of this, your Parkinson’s symptoms may return towards the end of a medication dose, or near the beginning of the next dose. If these symptoms are affecting your day-to-day life, then your specialist or Parkinson’s nurse should review your medication.
In the early stages of Parkinson’s, you may not notice when a dose of levodopa begins to wear off. But as your Parkinson’s symptoms get worse, some people find that a dose doesn’t last as long as it used to, so any changes in symptoms can become more unpredictable.
As well as having an effect on your movement, you may also experience feelings of anxiety, sleepiness, low mood or pain as your medication wears off.
'On/off' changes
If your symptoms are well controlled, this is known as the ‘on’ period, which means that your medication is working well. When symptoms return, this is known as the 'off' period.
This might mean that a person who is out for a walk would suddenly be unable to continue walking, or when seated would feel unable to get up to answer the door.
‘Off' periods usually come on gradually, but occasionally can be more sudden. When they come on suddenly, some people have compared this ‘on/off' effect to that of a light switch being turned on and off.
Your specialist or Parkinson’s nurse may suggest trying apomorphine if you are having ‘wearing off’ and ‘on/off’ changes that aren’t controlled by other Parkinson’s medication. It can be used alone but is often prescribed with levodopa or other medication.
Involuntary movements (dyskinesia)
When you’ve taken levodopa for a long time, you may get involuntary movements (dyskinesia). These are muscle movements that you can’t control. They can include twitches, jerks, twisting or writhing movements.
Impulsive and compulsive behaviours
Impulsive and compulsive behaviours can happen with any Parkinson’s drugs.
Read our information on impulsive and compulsive behaviours.
Withdrawal symptoms with levodopa
Research has shown that withdrawal symptoms can happen when someone stops taking levodopa medication very suddenly.
It can lead to symptoms including depression, anxiety or pain. In the most serious cases, effects can lead to hospitalisation.
Withdrawal from any Parkinson’s drug needs to be done gradually, with the support of a healthcare professional. This is to avoid the risk of developing withdrawal symptoms.
Iron tablets
When you take your levodopa medication it may help not to take any medicines or vitamin supplements with iron in them at the same time of day. Iron can mean that less levodopa gets into the parts of the body where it is needed.
Talk to your specialist, Parkinson’s nurse or pharmacist for more information about this and when is best to take any iron supplements after taking your levodopa medication.
Other side effects
Other common side effects include:
- nausea and vomiting
- low blood pressure (postural hypotension)
- loss of appetite
- anxiety and depression
- sleep problems
- hallucinations (seeing, hearing, feeling and smelling things that aren’t there).
Levodopa and protein
For some people with Parkinson’s, protein (which is found mainly in meat, fish, eggs, cheese, beans and pulses) can cause problems with how well levodopa medications are absorbed by the body.
Because of this, you may benefit from having most of your daily protein in the evening (what’s known as a protein redistribution diet). This can help the levodopa treatment work better in the daytime, when you are likely to need it more.
Protein is necessary for a healthy diet so you should not reduce the amount you eat. Talk to your specialist or Parkinson’s nurse before you make any changes to what you eat.
It’s also best to take levodopa medication on an empty stomach if possible. If this medication makes you feel sick, take it when eating a low protein snack, like a cracker or a piece of fresh fruit. This can help you stop feeling sick, but will still mean that your medication is absorbed properly by your body.
Types of levodopa
Below are the types of levodopa drugs. Each drug has a generic (unbranded) name and a branded name.
Co-beneldopa
Co-beneldopa is a type of generic levodopa medication. Madopar is the brand name for co-beneldopa.
It contains 2 ingredients, levodopa and benserazide. The ingredient benserazide helps levodopa get into the brain.
Taking co-beneldopa
Below we have included the different forms of co-beneldopa (Madopar) medication and some key points on taking them.
The most up-to-date information on the drug you are taking will be on your patient information leaflet. You will find it with your medication packet. Always read it carefully before you start your treatment.
Follow the advice of your specialist or Parkinson’s nurse about how to take co-beneldopa (Madopar) so that it works well for your Parkinson’s.
Take Madopar capsules on an empty stomach so that it's absorbed properly. Take your capsules at least 30 minutes before or 60 minutes after you have eaten. A longer gap before or after you have eaten is even better.
These tablets are dispersible. This means they should be mixed with water to make a drink. It takes effect more quickly than capsules. This is because it doesn’t need to be broken down in your stomach to release the active ingredient. It can also be used if you have trouble swallowing tablets or capsules.
You should take these tablets with water or fruit squash. It’s best to take Madopar tablets on an empty stomach if possible and if you don’t feel sick.
Co-beneldopa dispersible tablets (Madopar tablets) are useful if you have slowness of movement or the ‘on/off’ effect.
Modified release co-beneldopa capsules (Madopar CR) let the levodopa enter your body slowly, not all at once. Taking them before you go to bed can help you feel less stiff during the night.
These capsules can also help to reduce involuntary movements (dyskinesia), which can be a side effect of levodopa medication.
Take the capsules with water. Don’t break, crush or chew them.
Drugs for indigestion, heartburn, or an upset stomach can make it more difficult for your body to absorb your controlled-release capsules. So don’t take this type of medication in the 2 hours before and after you take co-beneldopa (Madopar CR) capsules.
Sickness and Madopar
As with any levodopa medication, it’s best to take Madopar capsules, Madopar dispersible tablets and Madopar CR modified release capsules on an empty stomach if possible. But this medication can sometimes make you feel sick.
If this is the case, take your medication when eating a low protein snack like a cracker or piece of fresh fruit. This will still mean that your medication is absorbed properly by your body, but can help stop you feeling sick.
Co-careldopa
Co-careldopa is a type of generic levodopa medication. Sinemet, Caramet and Lecado are the branded versions of co-careldopa.
Co-careldopa contains 2 ingredients, levodopa and carbidopa. The carbidopa ingredient helps levodopa get into the brain. Carbidopa also helps to make sure you have fewer side effects.
Taking co-careldopa
Below are the different forms of co-careldopa medication and some key points on taking them
The most up-to-date information on the drug you are taking will be on your patient information leaflet. You will find it with your medication packet. Always read it carefully before you start your treatment.
For detailed advice, you should speak to your GP, specialist, Parkinson’s nurse or pharmacist about how to take co-careldopa so that it works well for your Parkinson’s.
You will usually take Sinemet or Sinemet Plus 3 or 4 times a day. But this will vary, and your healthcare professional will tell you what dose is best for your Parkinson’s.
Co-careldopa modified release tablets let the levodopa enter your body slowly instead of all at once.
Taking it before you go to bed can help you feel less stiff during the night.
Your specialist or Parkinson’s nurse can adjust your dose so your symptoms are well controlled.
Take these tablets whole. Don’t break, crush or chew them, because they have been made to release your medication slowly.
Co-careldopa (Duodopa)
Duodopa is a gel form of levodopa (co-careldopa) medication used for advanced and complex Parkinson’s.
It is pumped through a tube that is put into the small intestine. You will need to have an operation to have this tube put in. This means your dose of medication acts more quickly.
Duodopa gel can help reduce:
- involuntary movements as a side effect of your medication
- motor fluctuations from your drugs ‘wearing off’ - when you go from having good control of your movement symptoms to having less control, which can happen at the end of your dose before your next one is due
- problems with your symptoms at night.
When is Duodopa used?
Duodopa isn’t suitable for everyone. But it can be a good option for when levodopa has stopped managing your symptoms.
It is most often used when Parkinson’s symptoms have progressed.
Co-careldopa and entacapone
There are some branded versions of co-careldopa and entacapone medication. This means they combine the levodopa medication co-careldopa with entacapone, a COMT inhibitor drug.
The entacapone helps to make the levodopa part of the drug stronger, which helps to control your symptoms. Using this combination drug also means that it’s easier for people to take.
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