Synamet 110 Tablet

Generic Names: Levodopa and Carbidopa

Strength: Levodopa 100 mg, Carbidopa 10 mg

Presentation: Tablets, available in strips.

Indications:

• Treatment of Parkinson's disease.

• Post-encephalitic Parkinsonism.

• Symptomatic Parkinsonism.

Dosage and Administration:

• The optimum daily dosage must be determined by careful titration for each patient.

• Usual Initial Dosage: If Synamet 110 is used, dosage may be initiated with one tablet three or four times a day.

• Dosage may be increased by one tablet every day or every other day until a total of eight tablets (two tablets four times a day) is reached.

• Maintenance dose: Therapy should be individualized and adjusted according to the desired therapeutic response.

• When more levodopa is required, Doparkin 275 (Levodopa 250mg/Carbidopa 25mg) should be substituted for Synamet 110.

• If necessary, the dosage of Doparkin 275 may be increased by one-half or one tablet every day or every other day to a maximum of eight tablets a day.

Side Effects:

• The most common adverse reactions include dyskinesias (choreiform, dystonic, and other involuntary movements) and nausea.

• Other common side effects:

  • Dryness of mouth

  • Dizziness

  • Headache

  • Abnormal dreams

  • Involuntary muscle movement

  • Gastrointestinal disturbance

  • Sweating

Precautions:

• Levodopa alone, as well as the combination, is associated with dyskinesias, which may require dosage reduction.

• Administer cautiously to patients with severe cardiovascular or pulmonary disease, bronchial asthma, or renal, hepatic, or endocrine disease.

• Monitor for depression and suicidal tendencies.

• May cause drowsiness; caution should be exercised while driving or operating machinery.

• Symptomatic postural hypotension can occur.

• Hallucinations, confusion, and psychosis can occur.

Contraindications:

• Nonselective monoamine oxidase (MAO) inhibitors are contraindicated and must be discontinued at least two weeks prior to initiating therapy with Levodopa and Carbidopa.

• Known hypersensitivity to any component of the drug.

• Narrow-angle glaucoma.

Use in Pregnancy & Lactation:

• Pregnancy Category C.

• Caution should be exercised when administered to a nursing woman.

Pediatric Use:

• Use in patients below the age of 18 is not recommended.

Drug Interactions:

• Antihypertensive Drugs: Dosage adjustment of the antihypertensive medicine may be required.

• Psychoactive Drugs: Dopamine D2 receptor antagonists, dopamine-depleting agents are not recommended.

• Tricyclic Antidepressants: There have been rare reports of adverse reactions, including hypertension and dyskinesia.

• Iron: Studies demonstrate a decrease in the bioavailability of carbidopa and/or levodopa when ingested with ferrous sulphate or ferrous gluconate.

• Dopamine-2 receptor antagonists (e.g., phenothiazines, butyrophenones, and risperidone) and isoniazid may reduce the therapeutic effects of levodopa.

• The beneficial effects of levodopa in Parkinson's disease have been reported to be reversed by phenytoin and papaverine.

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