Table 3. Pharmacotherapeutic Options for Symptomatic Treatment of P
Levodopa carbidopa1
Parcopa /levodopa
10/100, 25/100, 25/250 mg orally disintegrating immediate release tablets
Initial: 25/100 mg tid; titrate up by 25/100 mg/d or ever day until 200/800 mg/d OR 10/100 mg tid-qid; titrate u 10/100 mg/d or every other day until 20/200 mg qid Maintenance: ≥ 70-100 mg/d carbidopa to max 200 mg/d
Sinemet, generics Sinemet CR, generics carbidopa1
entacapone2 Stalevo
/levodopa/
10/100, 25/100, 25/250 mg immediate release tablets
25/100, 50/200 mg sustained release tablets
12.5/50/200, 25/100/200, 37.5/150/200 mg tablets
Initial: 25/100 mg tid; titrate up by 25/100 mg/d or ever day until 200/800 mg/d Maintenance: ≥ 70-100 mg/d carbidopa to max 200 mg/d
Initial: 50/200 mg bid (≥6 h); titrate up (q ≥ 3 d) until 400-1600 mg/d levodopa in divided doses
Follow dosage for immediate release carbidopa/levidopa a (only one tablet per dose) to max 1600 mg/d entacapone
C OMT (catechol-O-methyl transferase) inhibitors 200 mg tablet
entacapone Comtan
tolcapone Tasmar
100, 200 mg tablets
200 mg concomitant with each carbidopa/levodopa dose 1600 mg/d
100 mg tid (1st dose concomitant with 1st dose carbidopa/levodopa, subsequent doses 6 an hr later)
200 mg tid if anticipated incremental clinical benefit justified
Table partially constructed from individual drug Prescribing Information labeling.
* 3/29/2007 FDA announces voluntary withdrawal of pergolide products 1.
2.
Carbidopa added to levodopa reduces peripheral effects (e.g., nausea, vomiting) of levodopa but does not decrease CNS effects (e.g., dyskinesia, akinesia) of levodopa.
Entacapone in conjunction with levodopa and carbidopa produces greater and more sustained plasma levels of levodopa than after administration of levodopa and carbidopa alone. These more sustained plasma levels of levodopa result in more constant dopaminergic stimulation in the brain, leading to greater effects on the signs and symptoms of Parkinson disease. Higher levodopa levels may also lead to increased levodopa adverse effects, sometimes requiring a decrease in the dose of levodopa.
NOTE: The transdermal patch was not available for delivering medication when the original guideline was written.
**Recommendations are based only on evidence available in the literature and are limited by the quality of the studies reviewed. Studies are limited in recommendations of one drug over another.
