Levodopa plus Benserazid AL indications
Treatment of Parkinson's disease.
Levodopa plus Benserazid AL dispersible is a formulation which is suitable for patients with dysphagia (difficulties in swallowing) or who require a formulation with a more rapid onset of action eg, patients suffering from early morning and afternoon akinesia, or who exhibit "delayed on" or "wearing off" phenomena.
Levodopa plus Benserazid AL HBS is indicated for patients presenting with all types of fluctuations (eg, "peak-dose dyskinesia" and "end of dose deterioration" eg, nocturnal immobility).
Levodopa plus Benserazid AL description
Levodopa plus Benserazid AL is a combination of Levodopa (Levodopa plus Benserazid AL) and the decarboxylase inhibitor besnerazide (as hydrochloride) in a ratio of 4:1 for the treatment of Parkinson's disease..
Levodopa plus Benserazid AL 62.5 is Levodopa (Levodopa plus Benserazid AL) 50 mg and Benserazide (Levodopa (Levodopa plus Benserazid AL) plus Benserazid AL) 12.5 mg; 125 is Levodopa (Levodopa plus Benserazid AL) 100 mg and Benserazide (Levodopa (Levodopa plus Benserazid AL) plus Benserazid AL) 25 mg; 250 is Levodopa (Levodopa plus Benserazid AL) 200 mg and besenrazide 50 mg.
Levodopa plus Benserazid AL 250: Each capsule contains Levodopa (Levodopa plus Benserazid AL) 200 mg and Benserazide (Levodopa (Levodopa plus Benserazid AL) plus Benserazid AL) HCl 50 mg.
Levodopa plus Benserazid AL HBS (Hydrodynamically Balanced System): Each capsule contains Levodopa (Levodopa plus Benserazid AL) 100 mg and Benserazide (Levodopa (Levodopa plus Benserazid AL) plus Benserazid AL) HCl 25 mg.
Levodopa plus Benserazid AL dosage
Standard
Dosage: Treatment with Levodopa plus Benserazid AL should be introduced gradually, dosage should be assessed individually and titrated for optimal effect. The following dosage instructions should therefore be regarded as guidelines.
Initial Therapy: In the early stages of Parkinson's disease it is advisable to start treatment with 1 capsule of Levodopa plus Benserazid AL '62.5' or half a tablet of Levodopa plus Benserazid AL '125' 3-4 times daily. As soon as tolerability of the initial dosing schedule is confirmed, the dosage should be increased slowly in accordance with the patient's response.
An optimal effect is generally achieved with a daily dosage of Levodopa plus Benserazid AL corresponding to Levodopa (Levodopa plus Benserazid AL) 300-800 mg + Benserazide (Levodopa (Levodopa plus Benserazid AL) plus Benserazid AL) 75-200 mg, to be divided into ≥3 doses. Between 4 and 6 weeks may be needed to achieve the optimal effect. If it proves necessary to further increase the daily dosage, this should be done on a monthly basis.
Maintenance Therapy: The average maintenance dosage is 1 capsule or tablet of Levodopa plus Benserazid AL '125' 3-6 times daily. The number of individual doses (not <3) and their distribution throughout the day must be titrated for optimal effect. Levodopa plus Benserazid AL HBS and Levodopa plus Benserazid AL dispersible may substitute standard Levodopa plus Benserazid AL to achieve an optimal effect.
Special Dosage Instructions: Dosage must be carefully titrated in all patients. Patients on other antiparkinsonian agents may receive Levodopa plus Benserazid AL. However, as treatment with Levodopa plus Benserazid AL proceeds and the therapeutic effect becomes apparent, the dosage of the other drugs may need to be reduced or these drugs gradually withdrawn.
Levodopa plus Benserazid AL dispersible tablets are particularly suitable for patients with dysphagia (difficulties in swallowing) or in situations where a more rapid onset of action is required eg, in patients suffering from early morning and afternoon akinesia or who exhibit "delayed on" or "wearing off" phenomena.
Patients who experience large fluctuations in the drug's effect in the course of the day (on-off phenomena) should receive smaller, more frequent single doses or be switched to Levodopa plus Benserazid AL HBS.
The switch from standard Levodopa plus Benserazid AL to Levodopa plus Benserazid AL HBS is preferably made from 1 day to the next, beginning with the morning dose. The daily dose and dosing interval should initially be the same as with standard Levodopa plus Benserazid AL.
After 2-3 days, the dosage should be gradually increased by about 50%. Patients should be informed that their condition may temporarily deteriorate.
Due to the pharmacokinetic properties of Levodopa plus Benserazid AL HBS, the onset of action is delayed. The clinical effect may be achieved more rapidly by administering Levodopa plus Benserazid AL HBS together with standard Levodopa plus Benserazid AL or Levodopa plus Benserazid AL dispersible. This may prove especially useful for the 1st morning dose, which should preferably be higher than the subsequent daily doses. The individual titration for Levodopa plus Benserazid AL HBS must be carried out slowly and carefully, allowing intervals of at least 2-3 days between dose changes.
In patients with nocturnal immobility, positive effects have been reported after gradually increasing the last evening dose to Levodopa plus Benserazid AL HBS 250 mg on retiring.
Excessive responses to Levodopa plus Benserazid AL HBS (dyskinesia) can be controlled by increasing the interval between doses rather than reducing the single doses.
Treatment with standard Levodopa plus Benserazid AL or Levodopa plus Benserazid AL dispersible should be resumed if the response to Levodopa plus Benserazid AL HBS is inadequate.
Patients should be carefully observed for possible undesirable psychiatric symptoms.
Administration: When taking standard Levodopa plus Benserazid AL capsules or Levodopa plus Benserazid AL HBS, patients must always ensure to swallow the whole capsule without chewing it.
Standard Levodopa plus Benserazid AL tablets are breakable to facilitate swallowing.
Levodopa plus Benserazid AL dispersible tablets are to be dispersed in a quarter of a glass of water (approximately 25-50 mL). The tablets disintegrate completely, producing a milky-white dispersion within a few minutes. Because of rapid sedimentation, it is advisable to stir the dispersion before drinking. Levodopa plus Benserazid AL dispersible tablets should be taken within ½ an hr of preparing the dispersion.
Levodopa plus Benserazid AL should be taken 30 min before or 1 hr after meals where possible. Undesirable gastrointestinal effects, which may occur mainly in the early stages of the treatment, can largely be controlled by taking Levodopa plus Benserazid AL with a small snack (eg, biscuits) or liquid or by increasing the dose slowly.
Levodopa plus Benserazid AL interactions
Pharmacokinetic Interactions: Co-administration of the anticholinergic drug trihexyphenidyl with standard Levodopa plus Benserazid AL reduces the rate, but not the extent of Levodopa (Levodopa plus Benserazid AL) absorption. Trihexyphenidyl given concomitantly with Levodopa plus Benserazid AL HBS does not affect the pharmacokinetics of Levodopa (Levodopa plus Benserazid AL).
Co-administration of antacids with Levodopa plus Benserazid AL HBS reduces the extent of Levodopa (Levodopa plus Benserazid AL) absorption by 32%.
Ferrous sulphate decreases the maximum plasma concentration and the AUC of Levodopa (Levodopa plus Benserazid AL) by 30-50%. The pharmacokinetic changes observed during co-treatment with ferrous sulphate appear to be clinically significant in some but not all patients.
Metoclopramide increases the rate of Levodopa (Levodopa plus Benserazid AL) absorption.
Domperidone may increase the bioavailability of Levodopa (Levodopa plus Benserazid AL) by stimulation of gastric emptying.
Pharmacodynamic Interactions: Neuroleptics, opioids and antihypertensive medications containing reserpine inhibit the action of Levodopa plus Benserazid AL.
If Levodopa plus Benserazid AL is to be administered to patients receiving irreversible nonselective MAO inhibitors, an interval of at least 2 weeks should be allowed between cessation of the MAO inhibitor and the start of Levodopa plus Benserazid AL therapy. Otherwise unwanted effects eg, hypertensive crises are likely to occur. Selective MAO-B inhibitors eg, selegiline and rasagiline and selective MAO-A inhibitors eg, moclobemide, can be prescribed to patients on Levodopa plus Benserazid AL therapy; it is recommended to readjust the Levodopa (Levodopa plus Benserazid AL) dose to the individual patient's needs, in terms of both efficacy and tolerability. Combination of MAO-A and MAO-B inhibitors is equivalent to nonselective MAO inhibition and hence this combination should not be given concomitantly with Levodopa plus Benserazid AL.
Levodopa plus Benserazid AL should not be administered concomitantly with sympathomimetics (agents eg, epinephrine, norepinephrine, isoproterenol or amphetamine which stimulate the sympathetic nervous system) as Levodopa (Levodopa plus Benserazid AL) may potentiate their effects. Should concomitant administration prove necessary, close surveillance of the cardiovascular system is essential, and the dose of the sympathomimetic agents may need to be reduced.
Combination with other agents eg, anticholinergics, amantadine, selegiline,bromocriptine and dopamine agonists is permissible, though both the desired and the undesired effects of treatment may be intensified. It may be necessary to reduce the dosage of Levodopa plus Benserazid AL or the other substance. When initiating an adjuvant treatment with a COMT inhibitor, a reduction of the dosage of Levodopa plus Benserazid AL may be necessary. Anticholinergics should not be withdrawn abruptly when Levodopa plus Benserazid AL therapy is instituted, as Levodopa (Levodopa plus Benserazid AL) does not begin to take effect for some time.
Levodopa (Levodopa plus Benserazid AL) may affect the results of laboratory tests for catecholamines, creatinine, uric acid and glucose.
Coombs' tests may give a false-positive result in patients taking Levodopa plus Benserazid AL.
Concomitant administration of antipsychotics with dopamine-receptor blocking properties, particularly D2-receptor antagonists might antagonize the antiparkinsonian effects of Levodopa (Levodopa plus Benserazid AL)-Benserazide (Levodopa (Levodopa plus Benserazid AL) plus Benserazid AL). Levodopa (Levodopa plus Benserazid AL) may reduce antipsychotic effects of these drugs. These drugs should be co-administration with caution.
A diminution of effect is observed when the drug is taken with a protein-rich meal.
General Anesthesia with Halothane: Levodopa plus Benserazid AL should be discontinued 12-48 hrs before surgical intervention requiring general anesthesia with halothane as fluctuations in blood pressure and/or arrhythmias may occur.
For general anesthesia with other anesthetics see Precautions.
Levodopa plus Benserazid AL side effects
Post-Marketing: Blood and Lymphatic System Disorders: Hemolytic anemia, transient leukopenia and thrombocytopenia have been reported in rare cases. Therefore, as in any long-term Levodopa (Levodopa plus Benserazid AL)-containing treatment, blood count and liver and kidney function should be monitored periodically.
Metabolic and Nutritional Disorders: Anorexia has been reported.
Psychiatric Disorders: Depression can be part of the clinical picture in patients with Parkinson's disease and may also occur in patients treated with Levodopa plus Benserazid AL. Agitation, anxiety, insomnia, hallucinations, delusions and temporal disorientation may occur particularly in elderly patients and in patients with a history of such disorders.
Nervous System Disorder: Isolated cases of ageusia or dysgeusia have been reported. At later stages of the treatment, dyskinesia (eg, choreiform or athetotic) may occur. These can usually be eliminated or be made tolerable by a reduction of dosage. With prolonged treatment, fluctuations in therapeutic response may also be encountered.
They include freezing episodes, end-of-dose deterioration and the "on-off" effect. These can usually be eliminated or made tolerable by adjusting the dosage and by giving smaller single doses more frequently. An attempt at increasing the dosage again can subsequently be made in order to intensify the therapeutic effect. Levodopa plus Benserazid AL is associated with somnolence and has been associated very rarely with excessive daytime somnolence and sudden sleep onset episodes.
Cardiac Disorders: Cardiac arrhythmias may occur occasionally.
Vascular Disorders: Orthostatic hypotension may occur occasionally. Orthostatic disorders commonly improve following reduction of the Levodopa plus Benserazid AL dosage.
Gastrointestinal Disorders: Nausea, vomiting and diarrhea have been reported with Levodopa plus Benserazid AL. Undesirable gastrointestinal effects, which may occur mainly in the early stages of the treatment, can largely be controlled by taking Levodopa plus Benserazid AL with some food or liquid or by increasing the dose slowly.
Skin and Subcutaneous Tissue Disorders: Allergic skin reactions eg, pruritus and rash may occur in rare cases.
Investigations: Transient elevation of liver transaminase and alkaline phosphatase may occur. Increase of γ-glutamyltransferase has been reported.
Rises in blood urea nitrogen have been noted with Levodopa plus Benserazid AL.
Urine may be altered in color, usually acquiring a red tinge which turns dark on standing. Other body fluids or tissues may also be discoloured or stained including saliva, the tongue, teeth or oral mucosa.
Laboratory Abnoramlities: See Post-Marketing as previously mentioned.
Levodopa plus Benserazid AL contraindications
Hypersensitivity to Levodopa (Levodopa plus Benserazid AL) or Benserazide (Levodopa (Levodopa plus Benserazid AL) plus Benserazid AL).
In conjunction with nonselective monoamine oxidase (MAO) inhibitors. However, selective MAO-B inhibitors eg, selegiline and rasagiline or selective MAO-A inhibitors eg, moclobemide are not contraindicated. Combination of MAO-A and MAO-B inhibitors is equivalent to nonselective MAO inhibition and hence, this combination should not be given concomitantly with Levodopa plus Benserazid AL.
Patients with decompensated endocrine, renal (except patients on dialysis) or hepatic function, cardiac disorders, psychiatric diseases with a psychotic component or closed angle glaucoma.
Pregnant women or to women of childbearing potential in the absence of adequate contraception. If pregnancy occurs in a woman taking Levodopa plus Benserazid AL, the drug must be discontinued (as advised by the prescribing physician).
Patients <25 years (skeletal development must be complete).
Use in pregnancy: Levodopa plus Benserazid AL is contraindicated during pregnancy and in women of childbearing potential in the absence of adequate contraception.
Active ingredient matches for Levodopa plus Benserazid AL:
Benserazide/Levodopa in Germany.
List of Levodopa plus Benserazid AL substitutes (brand and generic names) | Sort by popularity |
| Unit description / dosage (Manufacturer) | Price, USD |
| Levodopa/Benserazide PCH (Netherlands) | |
| Levopar (Germany, Indonesia, Israel) | |
| Capsule; Oral; Benserazide 12.5 mg; Levodopa 50 mg (M & H Manufacturing) | |
| Capsule; Oral; Benserazide 25 mg; Levodopa 100 mg (M & H Manufacturing) | |
| Capsule; Oral; Benserazide 50 mg; Levodopa 200 mg (M & H Manufacturing) | |
| Levopar 5 x 10's (M & H Manufacturing) | $ 24.80 |
| Levopar tab 250 mg 10 x 10's (M & H Manufacturing) | |
| Levopar Plus (Israel) | |
| Capsule; Oral; Benserazide Hydrochloride 25 mg; Levodopa 100 mg (Teva) | |
| Levopar Plus 125 (Israel) | |
| Levopar Plus 250 (Israel) | |
| LEVOSTAL (Peru) | |
| LEVOSTAL 250MG TABLET 1 strip / 10 tablets each (Stallion Laboratories Pvt Ltd) | $ 0.45 |
| LEVOSTAL 500MG TABLET 1 strip / 10 tablets each (Stallion Laboratories Pvt Ltd) | $ 0.91 |
| Levostal 500mg Tablet (Stallion Laboratories Pvt Ltd) | $ 0.09 |
| Levostal 750mg Tablet (Stallion Laboratories Pvt Ltd) | $ 0.14 |
| Madopar (Albania, Argentina, Armenia, Aruba, Australia, Austria, Azerbaijan, Bahrain, Belarus, Bolivia, Bosnia & Herzegowina, Brazil, Bulgaria, Cambodia, Chile, China, Colombia, Cote D'ivoire, Croatia (Hrvatska), Cuba, Czech Republic, Denmark, Dominican Republic, Estonia, Ethiopia, Finland, Georgia, Germany, Greece, Guinea, Hong Kong, Hungary, Iceland, Indonesia, Iran, Ireland, Italy, Jamaica, Japan, Kazakhstan, Laos, Latvia, Lebanon, Libya, Lithuania, Luxembourg, Malaysia, Malta, Mauritania, Mauritius, Mexico, Moldova, Morocco, Netherlands, New Zealand, Norway, Oman, Paraguay, Peru, Philippines, Poland, Portugal, Romania, Russian Federation, Saudi Arabia, Senegal, Serbia, Singapore, Slovakia, Slovenia, South Africa, South Korea, Spain, Sri Lanka, Switzerland, Syria, Taiwan, Thailand, Trinidad & Tobago, Turkey, Turkmenistan, United Kingdom, Uruguay, Uzbekistan, Venezuela, Vietnam) | |
| Capsule; Oral; Levodopa 50 mg; Benserazide Hydrochloride 12.5 mg (Abbott) | |
| Capsule; Oral; Levodopa 100 mg; Benserazide Hydrochloride 25 mg (Abbott) | |
| Capsule; Oral; Levodopa 200 mg; Benserazide Hydrochloride 50 mg (Abbott) | |
| Tablet, Dispersible; Oral; Levodopa 100 mg; Benserazide Hydrochloride 25 mg (Abbott) | |
| Tablet; Oral; Levodopa 100 mg; Benserazide Hydrochloride 25 mg (Abbott) | |
| Tablet; Oral; Levodopa 200 mg; Benserazide Hydrochloride 50 mg (Abbott) | |
| Madopar Dispersible 100's (Abbott) | |
| Madopar HBS 100's (Abbott) | |
| Madopar 100's (Abbott) | |
| Madopar 125 125 mg x 100's (Abbott) | |
| Madopar 125 125 mg x 1000's (Abbott) | |
| Madopar 250 250 mg x 100's (Abbott) | |
| Madopar 250 250 mg x 1000's (Abbott) | |
| Madopar HBS 125 mg x 100's (Abbott) | $ 51.87 |
| Madopar HBS 125 mg x 1000's (Abbott) | |
| Madopar 250 100's (Abbott) | $ 68.11 |
| Madopar Dispersible 125 100's (Abbott) | |
| Madopar 125 1000's (Abbott) | |
| Madopar 250 100 Tablet (Abbott) | |
| Madopar HBS 100 Tablet (Abbott) | |
| Madopar 125 125 mg x 1's (Abbott) | |
| Madopar 250 250 mg x 1's (Abbott) | |
| Madopar Dispersible 125 125 mg x 100's (Abbott) | |
| Madopar 62.5 mg x 30 Tablet (Abbott) | |
| Madopar 62.5 mg x 100 Tablet (Abbott) | |
| Madopar 125 mg x 30 Tablet (Abbott) | |
| Madopar 125 mg x 100 Tablet (Abbott) | |
| Madopar 250 mg x 30 Tablet (Abbott) | |
| Madopar 250 mg x 100 Tablet (Abbott) | |
| Madopar 30 Tablet (Abbott) | |
| Madopar 100 Tablet (Abbott) | |
| MADOPAR TABLET 1 strip / 10 tablets each (Abbott) | $ 1.78 |
| MADOPAR tab 10's (Abbott) | $ 1.29 |
| Madopar HBS cap 100's (Abbott) | |
| Madopar 250 tab 100's (Abbott) | |
| Madopar Tablet (Abbott) | $ 0.21 |
| Madopar 100 mg/25 mg (Hungary) | |
| Madopar 100 mg/25 mg retard (Hungary) | |
| Madopar 125 (Australia, Denmark) | |
See 175 substitutes for Levodopa plus Benserazid AL | |
References
- 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).
- PubChem. "levodopa". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
- PubChem. "benserazide". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
