Carbidopa/Levodopa/Entacapone: Price, Dosage & Where to Buy

Carbidopa/Levodopa/Entacapone, also sold as Stalevo, is a combination medicine used for Parkinson's disease and requires a prescription in the United Kingdom. Its pharmacological class is not formally listed, although its ingredients support dopamine-based treatment; the detailed treatment and safety information described here relates to carbidopa/levodopa tablets called DHIVY, rather than the entacapone-containing combination.

These ingredients work together to support the action of dopamine, a chemical messenger involved in controlling movement. Levodopa is converted into dopamine in the brain. Carbidopa reduces the breakdown of levodopa outside the brain, allowing more to reach the brain.

Entacapone inhibits an enzyme involved in breaking down levodopa outside the brain, helping prolong its availability. This explains the general pharmacology of the combination, although a formal pharmacological class is not listed for this product.

Parkinson's disease is the main condition described in the treatment information for carbidopa/levodopa. The DHIVY label also lists post-encephalitic parkinsonism, meaning parkinsonism following inflammation of the brain, and symptomatic parkinsonism that may follow carbon monoxide or manganese poisoning.

These indications belong to DHIVY, which contains carbidopa and levodopa. They should not be assumed to establish every approved use of Carbidopa/Levodopa/Entacapone, because that product also contains entacapone.

The label lists oral film-coated Carbidopa/Levodopa/Entacapone tablets containing 12.5 mg/50 mg/200 mg, 18.75 mg/75 mg/200 mg, 25 mg/100 mg/200 mg, 31.25 mg/125 mg/200 mg, 37.5 mg/150 mg/200 mg and 50 mg/200 mg/200 mg, respectively. The detailed dosing information concerns DHIVY, a carbidopa/levodopa tablet that does not contain entacapone, so its schedule should not be treated as a dosing schedule for the combination. The label lists a starting dosage for DHIVY of one 25 mg/100 mg tablet orally three times a day.

The label lists increases of up to one whole DHIVY tablet every day or every other day, with a maximum of eight whole tablets a day. DHIVY treatment is individualised according to response and tolerability, with close monitoring during adjustment.

Its label also calls for assessment of vitamin B6 levels before treatment and periodically during treatment. Sudden discontinuation or rapid dose reduction is to be avoided.

The DHIVY label specifies storage at 20°C to 25°C, with excursions permitted between 15°C to 30°C, in a tightly closed container protected from light and moisture. For Carbidopa/Levodopa/Entacapone, follow the storage directions on its own packaging to maintain quality.

For a missed dose, follow the medicine's patient leaflet or ask a pharmacist for advice specific to the prescribed product. Do not double a dose to compensate. Avoid changing or stopping treatment abruptly: the carbidopa/levodopa label warns that sudden withdrawal or rapid dose reduction can cause high temperature and confusion.

The DHIVY label states that adequate pregnancy data are unavailable and that animal studies of carbidopa/levodopa suggest potential harm to the developing baby. Levodopa has been detected in human milk; there are no data on carbidopa in human milk or effects on the breastfed infant.

Levodopa may inhibit lactation by reducing prolactin secretion. Discuss pregnancy or breastfeeding with a doctor or pharmacist, as these statements concern carbidopa/levodopa rather than the complete entacapone-containing combination.