Uses of Co-Dopa: - Parkinson's disease Parkinson's disease and 'end of dose' motor fluctuations Hypersensitivity. Narrow angle glaucoma. Should not be used in patients with suspicious, undiagnosed skin lesions or a history ot melanoma.

How to use Carbidopa + Entacapone + Levodopa: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Carbidopa + Entacapone + Levodopa may be taken with or without food, but it is better to take it at a fixed time. Avoid Carbidopa + Entacapone + Levodopa with high protein meals such as cottage cheese, Swiss cheese, protein powder, eggs and milk. Administration: May be taken with or without food. Keep a consistent diet. A change in diet to foods high in protein may delay levodopa absorption & reduce amount taken up in circulation. Excessive acidity also delays stomach emptying & thus delays levodopa absorption. Fe salts (eg in multivit prep) may also reduce amount of levodopa available to the body. Swallow whole. Adult Dose: Parkinson's disease Adult: PO: Each tab contains levodopa and carbidopa in a ratio of 4:1 and entacapone 200 mg: Initial: 1 tab/day. Titrate dose according to patient's response. Recommended to take only 1 tab per dose administration. Max: 8 tabs/day. Hepatic impairment: Severe: Contraindicated. Child Dose: Safety & efficacy not established

Increased risk of postural hypotension when used concurrently with hypotensive drugs. Severe orthostatic hypotension may result from concurrent usage with MAOIs. Dopamine D2 receptor antagonists, phenytoin or papaverine may reduce the efficacy of levodopa. Iron salts may reduce the bioavailability. Concurrent usage with drugs that interfere with biliary excretion may lead to increased plasma levels of entacapone. May depress prolactin secretion and increase growth hormone levels.

Hypersensitivity. Narrow angle glaucoma. Should not be used in patients with suspicious, undiagnosed skin lesions or a history ot melanoma.

Common - Nausea - Vomiting - Constipation - Urine discoloration - Headache - Dryness in mouth - Insomnia (difficulty in sleeping) - Orthostatic hypotension (sudden lowering of blood pressure on standing) - Anxiety - Dizziness - Abnormality of voluntary movements - Abnormal dreams >10% Entacapone Dyskinesia (25%),Nausea (14%),Diarrhea (10%),Hyperkinesia (10%),Urine discoloration (10%) 1-10% Entacapone Hypokinesia (9%), dizziness (8%), Fatigue (6%), hallucinations (1-4%), anxiety (2%), somnolence (2%), asthenia (2%), agitation (1%),Increased sweating (2%),Purpura (2%),Abdominal pain (8%), constipation (6%), vomiting (4%), dry mouth (3%), dyspepsia (2%), flatulence (2%), taste perversion (1%), gastritis (1%),Back pain (4%),Dyspnea (3%),Bacterial infection (1%) Frequency Not Defined Levodopa/Carbodopa Edema,Agitation, anxiety, ataxia, bruxism, confusion, daytime somnolence decreased attention span, dyskinesia, dystonia, euphoria, insomnia, fainting, fatigue, increased trembling of hands, insouciance, malaise, memory loss, nightmares, nervousness, restlessness, trismus, vivid dreams,Alopecia, hot flushes, increased &/or dark perspiration, skin eruptions,Abdominal pain & discomfort, burning feeling in tongue, constipation, diarrhea, dysgeusia, dry mouth, dysphagia, hiccups, meteorism, sialorrhea, nausea, weight loss,Muscular spasms, muscular cramp,Hematuria, dark urine, incontinence, priapism, urine retention,Blurred vision, diplopia, dilated pupil, oculogyric problems. Entacapone Postural hypotension,Insomnia,Confusion Potentially Fatal: Rhabdomyolysis.

Precaution: Periodic monitoring of hepatic, renal, haematopoietic and CV functions in patients on prolonged therapy. Monitor for changes in IOP in patients with chronic wide-angle glaucoma. Caution when used in patients with biliary obstruction. Caution when interpreting plasma and urine levels of catecholamines and their metabolites. Withdrawal should be gradual. Lactation: not known if excreted in breast milk; use caution

Levodopa is the metabolic precurosor of dopamine, it crosses the blood-brain barrier and is converted to dopamine in the brain. Carbidopa increases the amount of levodopa that is transported into the CNS by inhibiting the decarboxylation of peripheral levodopa. Entacapone is a selective inhibitor of catechol-o-methyltransferase. Given concurrently, entacapone results in greater and more substained plasma levels of levodopa, leading to greater control of parkinsonism symptoms.

Pregnancy Category: C Lactation: not known if excreted in breast milk; use caution