Levacin 200/50mg Uses

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• Levacin 200/50mg indications
• Uses of Levacin 200/50mg in details
• Levacin 200/50mg description
• Levacin 200/50mg dosage
• Levacin 200/50mg interactions
• Levacin 200/50mg side effects
• Levacin 200/50mg contraindications

What is Levacin 200/50mg?

Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) combination is used to treat Parkinson's disease, sometimes called shaking palsy or paralysis agitans. Parkinson's disease is a disorder of the central nervous system (brain and spinal cord).

Extended-release Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) (Levacin 200/50mg®) is also used to treat parkinsonism caused by encephalitis, or parkinsonism caused by carbon monoxide or manganese poisoning.

Dopamine is a naturally occurring substance in the brain that helps provide control of movement and activities such as walking and talking. In patients with Parkinson's disease, there is not enough dopamine in some parts of the brain. Levodopa (Levacin 200/50mg) enters the brain and helps replace the missing dopamine, which allows people to function better. By increasing the amount of dopamine in the brain, Levodopa (Levacin 200/50mg) helps control symptoms and helps you to perform daily activities such as dressing, walking, and handling utensils.

Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) is available only with your doctor's prescription.

Levacin 200/50mg indications

Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) orally disintegrating tablets are indicated in the treatment of the symptoms of idiopathic Parkinson’s disease (paralysis agitans), postencephalitic parkinsonism, and symptomatic parkinsonism which may follow injury to the nervous system by carbon monoxide intoxication and/or manganese intoxication. Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) orally disintegrating tablets are indicated in these conditions to permit the administration of lower doses of Levodopa (Levacin 200/50mg) with reduced nausea and vomiting, with more rapid dosage titration, with a somewhat smoother response, and with supplemental pyridoxine (vitamin B6).

In some patients, a somewhat smoother antiparkinsonian effect results from therapy with Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) than with Levodopa (Levacin 200/50mg). However, patients with markedly irregular (“on-off”) responses to Levodopa (Levacin 200/50mg) have not been shown to benefit from Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) therapy.

Although the administration of Carbidopa (Levacin 200/50mg) permits control of parkinsonism and Parkinson’s disease with much lower doses of Levodopa (Levacin 200/50mg), there is no conclusive evidence at present that this is beneficial other than in reducing nausea and vomiting, permitting more rapid titration, and providing a somewhat smoother response to Levodopa (Levacin 200/50mg).

Certain patients who responded poorly to Levodopa (Levacin 200/50mg) have improved when Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) was substituted. This is most likely due to decreased peripheral decarboxylation of Levodopa (Levacin 200/50mg) which results from administration of Carbidopa (Levacin 200/50mg) rather than to a primary effect of Carbidopa (Levacin 200/50mg) on the nervous system. Carbidopa (Levacin 200/50mg) has not been shown to enhance the intrinsic efficacy of Levodopa (Levacin 200/50mg) in parkinsonian syndromes.

In considering whether to give Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) orally disintegrating tablets to patients already on Levodopa (Levacin 200/50mg) who have nausea and/or vomiting, the practitioner should be aware that, while many patients may be expected to improve, some do not. Since one cannot predict which patients are likely to improve, this can only be determined by a trial of therapy. It should be further noted that in controlled trials comparing Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) with Levodopa (Levacin 200/50mg), about half of the patients with nausea and/or vomiting on Levodopa (Levacin 200/50mg) improved spontaneously despite being retained on the same dose of Levodopa (Levacin 200/50mg) during the controlled portion of the trial.

How should I use Levacin 200/50mg?

Use Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) by mouth with or without food.
• If you take an iron product or a multivitamin that contains iron, ask your doctor or pharmacist how to take it with Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg). Iron may decrease your body's ability to absorb Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg).
• Diets that are high in some contents (eg, protein, fat, calories) may decrease your body's ability to absorb Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg). Discuss any questions or concerns with your doctor. Tell your doctor if you have a diet that is high in protein, fat, or calories or if you will be changing your diet.
• Carefully follow the dosing schedule given to you by your health care provider.
• Take Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) on a regular schedule to get the most benefit from it. Taking Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) at the same times each day will help you to remember to take it.
• Continue to take Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) even if you feel well. Do not miss any doses.
• If you have been taking Levodopa (Levacin 200/50mg), do not start taking Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) until at least 12 hours after your final dose of Levodopa (Levacin 200/50mg).
• Do not suddenly stop taking Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) or lower your dose without checking with your doctor. Side effects may occur. Discuss any questions or concerns with your doctor.
• If you miss a dose of Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg), take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg).

Uses of Levacin 200/50mg in details

This medication is used to treat symptoms of Parkinson's disease (such as shakiness, stiffness, difficulty moving).

Parkinson's disease is thought to be caused by too little of a naturally occurring substance (dopamine) in the brain. Levodopa (Levacin 200/50mg) changes into dopamine in the brain, helping to control movement. Carbidopa (Levacin 200/50mg) prevents the breakdown of Levodopa (Levacin 200/50mg) in the bloodstream so more Levodopa (Levacin 200/50mg) can enter the brain. Carbidopa (Levacin 200/50mg) can also reduce some of Levodopa (Levacin 200/50mg)'s side effects such as nausea and vomiting.

By giving this medication as a continuous infusion, it can help reduce the amount of "off" time (periods of slow movement or stiffness).

How to use Carbidopa (Levacin 200/50mg)-Levodopa (Levacin 200/50mg) via j-tube

Read the Medication Guide and the Instructions for Use provided by your health care professional before you start using this medication and each time you get a refill. If you have any questions, ask your health care professional.

Give this medication as directed as a continuous infusion into the small intestine using an infusion pump. It is usually given over 16 hours a day and stopped at bedtime. At bedtime, take your dose of immediate-release Levacin 200/50mg tablets by mouth as directed.

When you first start using this medication, it is given through a tube through the nose into the small intestine. After a few days, if the doctor decides that this product is right for you, then the medication will be given through a tube through the abdomen into the small intestine. Getting the tube through the abdomen will require surgery.

Follow all instructions from your health care professional about how to properly use this medication and the infusion pump. Take a cassette containing the medication from the refrigerator and leave it at room temperature for 20 minutes before using. Do not use a cassette for longer than 16 hours or re-use it, even if there is medication left in it. Learn how to store and discard medical supplies safely. Also learn how to properly care for the small hole in your abdomen and the skin area around the tube, and how to avoid infection.

The dosage is based on your medical condition and response to treatment. Your daily dose is made up of a morning dose, a continuous dose, and extra doses. An extra dose is a small dose of this medication that can be given as needed during the day to treat sudden "off" symptoms. Extra doses should not be given more often than one every 2 hours to avoid causing or worsening movements you cannot control.

Do not suddenly decrease the dose or suddenly stop using this medication because doing either may lead to a serious condition. If you must stop this medication, slowly reduce the dose as directed by your doctor. Contact your doctor right away if your infusion is interrupted. You may need to take the tablet form of Levacin 200/50mg by mouth.

If you plan to be disconnected from the pump for a short period of time (less than 2 hours, for example, to shower), ask your doctor ahead of time if you should use an extra dose of this medication before you disconnect. If you plan to be disconnected from the pump for longer than 2 hours, ask your doctor what you should do and discuss how you should take Levacin 200/50mg tablets by mouth during this time.

Avoid high-protein diets because they may reduce how much of the medication you can absorb.

Tell your doctor if your condition does not improve or if it worsens.

Levacin 200/50mg description

The naturally occurring form of dihydroxyphenylalanine and the immediate precursor of dopamine. Unlike dopamine itself, it can be taken orally and crosses the blood-brain barrier. It is rapidly taken up by dopaminergic neurons and converted to dopamine. It is used for the treatment of parkinsonian disorders and is usually given with agents that inhibit its conversion to dopamine outside of the central nervous system.

Levacin 200/50mg dosage

Dosage in Patients Naïve to Levodopa (Levacin 200/50mg) Therapy

The recommended starting dosage of Levacin 200/50mg in Levodopa (Levacin 200/50mg)-naïve patients is 23.75 mg / 95 mg taken orally three times a day for the first 3 days. On the fourth day of treatment, the dosage of Levacin 200/50mg may be increased to 36.25 mg / 145 mg taken three times a day.

Based upon individual patient clinical response and tolerability, the Levacin 200/50mg dose may be increased up to a maximum recommended dose of 97.5 mg / 390 mg taken three times a day. The dosing frequency may be changed from three times a day to a maximum of five times a day if more frequent dosing is needed and if tolerated. The maximum recommended daily dose of Levacin 200/50mg is 612.5 mg / 2450 mg.

Maintain patients on the lowest dosage required to achieve symptomatic control and to minimize adverse reactions such as dyskinesia and nausea.

Converting from Immediate-Release Carbidopa (Levacin 200/50mg)-Levodopa (Levacin 200/50mg) to Levacin 200/50mg

To convert patients from immediate-release Carbidopa (Levacin 200/50mg)-Levodopa (Levacin 200/50mg) to Levacin 200/50mg, determine the recommended starting dosage of Levacin 200/50mg using Table 1.

The dosages of other Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) products are not interchangeable with the dosages of Levacin 200/50mg.

Adjust the dose to maintain patient tolerance and sufficient symptomatic control. The dosing frequency may be changed from three times a day to a maximum of five times a day if more frequent dosing is needed and if tolerated. The maximum recommended daily dose of Levacin 200/50mg is 612.5 mg / 2450 mg.

For patients currently treated with Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) plus catechol-O-methyl transferase (COMT) inhibitors (such as entacapone), the initial total daily dose of Levodopa (Levacin 200/50mg) in Levacin 200/50mg described in Table 1 may need to be increased.

Use of Levacin 200/50mg in combination with other Levodopa (Levacin 200/50mg) products has not been studied.

Discontinuation of Levacin 200/50mg

Avoid sudden discontinuation or rapid dose reduction of Levacin 200/50mg. The daily dose of Levacin 200/50mg should be tapered at the time of treatment discontinuation.

Administration Information

Swallow Levacin 200/50mg whole with or without food. A high-fat, high-calorie meal may delay the absorption of Levodopa (Levacin 200/50mg) by about 2 hours.

Do not chew, divide or crush Levacin 200/50mg capsules. For patients who have difficulty swallowing intact capsules, administer Levacin 200/50mg by carefully opening the capsule, sprinkling the entire contents on a small amount of applesauce (1 to 2 tablespoons), and consuming immediately. Do not store the drug/food mixture for future use.

Levacin 200/50mg interactions

See also:
What other drugs will affect Levacin 200/50mg?

Monoamine Oxidase (MAO) Inhibitors

The use of nonselective MAO inhibitors with Levacin 200/50mg is contraindicated. Discontinue use of any nonselective MAO inhibitors at least two weeks prior to initiating Levacin 200/50mg.

The use of selective MAO-B inhibitors (e.g., rasagiline and selegiline) with Levacin 200/50mg may be associated with orthostatic hypotension. Monitor patients who are taking these drugs.

Antihypertensive Drugs

The concurrent use of Levacin 200/50mg with antihypertensive medications can cause symptomatic postural hypotension. A dose reduction of the antihypertensive medication may be needed after starting or increasing the dose of Levacin 200/50mg.

Dopamine D2 Receptor Antagonists And Isoniazid

Dopamine D2 receptor antagonists (e.g., phenothiazines, butyrophenones, risperidone, metoclopramide, papaverine) and isoniazid may reduce the effectiveness of Levodopa (Levacin 200/50mg). Monitor patients for worsening Parkinson's symptoms.

Iron Salts

Iron salts or multi-vitamins containing iron salts can form chelates with Levodopa (Levacin 200/50mg), Carbidopa (Levacin 200/50mg), and can cause a reduction in the bioavailability of Levacin 200/50mg. If iron salts or multi-vitamins containing iron salts are co-administered with Levacin 200/50mg, monitor patients for worsening Parkinson's symptoms.

High-Protein Diet

Because Levodopa (Levacin 200/50mg) competes with certain amino acids for transport across the gut wall, the absorption of Levodopa (Levacin 200/50mg) may be decreased in patients on a high-protein diet. Advise patients that a high-protein diet may reduce the effectiveness of Levacin 200/50mg.

Levacin 200/50mg side effects

See also:
What are the possible side effects of Levacin 200/50mg?

The following serious adverse reactions are discussed below and elsewhere in the labeling:

• Falling asleep during activities of daily living and somnolence
• Withdrawal-emergent hyperpyrexia and confusion
• Cardiovascular ischemic events
• Hallucinations/psychosis
• Impulse control/compulsive behaviors
• Dyskinesia
• Peptic Ulcer Disease
• Glaucoma
• Melanoma

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

The safety population consisted of a total of 978 Parkinson's disease patients who received at least one dose of Levacin 200/50mg, and had an average duration of exposure of 40 weeks.

Adverse Reactions In Early Parkinson's Disease

In a placebo-controlled clinical study in patients with early Parkinson's disease (Study 1), the most common adverse reactions with Levacin 200/50mg (in at least 5% of patients and more frequently than in placebo) were nausea, dizziness, headache, insomnia, abnormal dreams, dry mouth, dyskinesia, anxiety, constipation, vomiting, and orthostatic hypotension.

Table 2 lists adverse reactions occurring in at least 5% of Levacin 200/50mg-treated patients and at a higher rate than placebo in Study 1.

Table 2: Adverse Reactions in Study 1 in Patients with Early Stage Parkinson's Disease

Adverse Reactions Leading to Discontinuation in Study 1

In Study 1, 12% of patients discontinued Levacin 200/50mg early due to adverse reactions; a higher proportion of patients in the 61.25 mg / 245 mg Levacin 200/50mg-treated group (14%) and in the 97.5 mg / 390 mg Levacin 200/50mg-treated group (15%) experienced adverse reactions leading to early discontinuation compared to (4%) in the placebo group. The most common adverse reactions resulting in early discontinuation were nausea, dizziness, and vomiting.

Adverse Reactions In Advanced Parkinson's Disease

In an active-controlled clinical study in patients with advanced Parkinson's disease (Study 2), the most common adverse reactions with Levacin 200/50mg that occurred during dose conversion or maintenance (in at least 5% of patients and more frequently than on oral immediate-release Carbidopa (Levacin 200/50mg)-Levodopa (Levacin 200/50mg)) were nausea and headache.

Table 3 lists adverse reactions occurring in at least 5% of Levacin 200/50mg-treated patients and at a higher rate than oral immediate-release Carbidopa (Levacin 200/50mg)-Levodopa (Levacin 200/50mg) in Study 2.

Table 3: Adverse Reactions in Study 2 in Patients with Advanced Parkinson's Disease

Adverse Reactions Leading to Discontinuation in Study 2

In Study 2, 5% of patients discontinued treatment due to adverse reactions during conversion to Levacin 200/50mg. The common adverse reactions leading to discontinuation during dose conversion were dyskinesia, anxiety, dizziness, and on and off phenomenon.

Levacin 200/50mg contraindications

See also:
What is the most important information I should know about Levacin 200/50mg?

Nonselective monoamine oxidase (MAO) inhibitors are contraindicated for use with Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) orally disintegrating tablets. These inhibitors must be discontinued at least two weeks prior to initiating therapy with Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) orally disintegrating tablets. Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) orally disintegrating tablets may be administered concomitantly with the manufacturer’s recommended dose of an MAO inhibitor with selectivity for MAO type B (e.g., selegiline HCI).

Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) orally disintegrating tablets are contraindicated in patients with known hypersensitivity to any component of this drug, and in patients with narrow-angle glaucoma.

Because Levodopa (Levacin 200/50mg) may activate a malignant melanoma, Carbidopa (Levacin 200/50mg) and Levodopa (Levacin 200/50mg) orally disintegrating tablets should not be used in patients with suspicious, undiagnosed skin lesions or a history of melanoma.

Active ingredient matches for Levacin 200/50mg:

Carbidopa/Levodopa in Switzerland.

References

1. DailyMed. "CARBIDOPA; ENTACAPONE; LEVODOPA: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
2. PubChem. "levodopa". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
3. PubChem. "carbidopa". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology