Stalevo (Levodopa/Carbidopa/Entacapone) for Parkinson's disease

Overview
Stalevo is a prescription drug approved by the Food and Drug Administration (FDA) in 2003 to treat motor symptoms of Parkinson’s Disease. Stalevo is often prescribed in cases of advanced Parkinson’s Disease when other types of dopaminergic treatment begin to lose effectiveness. Stalevo may provide some benefit for those with Progressive Supranuclear Palsy, Vascular Parkinsonism, Multiple System Atrophy, and Corticobasal Degeneration.

Stalevo is not appropriate for people with undiagnosed skin lesions, narrow-angle glaucoma, or a history of melanoma. Stalevo is not suitable for use in people who have previously shown hypersensitivity to Levodopa, Carbidopa, or Entacapone. Stalevo must be used with caution in people with hypotension, biliary obstruction, wide-angle glaucoma, diabetes, asthma, emphysema, mental illness, or problems with the heart, kidneys, liver, lungs, or blood vessels. Stalevo may not be appropriate for women who are pregnant or breastfeeding.

Stalevo is a combination drug containing Levodopa, Carbidopa, and Entacapone. Levodopa is the precursor molecule to the neurotransmitter Dopamine. Levodopa is believed to treat Parkinsonian motor symptoms by increasing the concentration of Dopamine in the brain. Carbidopa is a molecule that inhibits the breakdown of Levodopa into Dopamine before it reaches the brain. Carbidopa is believed to work by increasing the amount of Levodopa that reaches the brain, making Levodopa effective at significantly lower doses. Entacapone inhibits the action of a molecule called catechol-O-methyl transferase (COMT), which converts Levodopa into an ineffective form. Entacapone is also believed to work by increasing the amount of Levodopa that reaches the brain, making Levodopa effective at significantly lower doses.

Some medications are available both as generic and branded products. Although generic and branded formulations of a drug contain the same active ingredients at the same concentrations, your body may react differently to different formulations. Check with your doctor before switching between drug brands or between generic and branded drugs.

How do I take it?
Do not begin taking Stalevo within two weeks of taking a monoamine oxidase (MAO) inhibitor. If you are switching from Levodopa to Stalevo, wait 12 hours after your final dose of Levodopa before taking your first dose of Stalevo.

While you are on Stalevo, your doctor will order regular blood tests to monitor your liver, kidney, and heart function. Examine your skin regularly for changes and visit your dermatologist regularly to check for signs of melanoma. If you have wide-angle glaucoma, make sure your ophthalmologist regularly monitors your intraocular pressure.

Stalevo is taken orally as a tablet up to eight times a day. Take one whole tablet with each dose; do not split, crush, or chew Stalevo. Stalevo should be taken at the same times each day. Take Stalevo 30 minutes to one hour before eating a meal to encourage efficient absorption. If you experience nausea after taking Stalevo, you may take it with a small amount of carbohydrate food, such as a plain cracker. Ginger tea may help calm your stomach when taking Stalevo. Avoid taking iron supplements or eating a diet high in protein or fat while taking Stalevo. Consuming large amounts of these nutrients can interfere with the body’s absorption of Stalevo.

Avoid driving or operating machinery until you are certain you understand how Stalevo affects you.

You may experience withdrawal symptoms if you stop taking Stalevo suddenly. If you decide to stop taking Stalevo, ask your doctor for a plan to decrease your dosage gradually.

Always follow your doctor’s instructions exactly when taking Stalevo.

Results
Levodopa/Carbidopa (Sinemet) is considered to be the most effective treatment for the motor symptoms of Parkinson’s Disease and some types of Parkinsonism. Levodopa/Carbidopa/Entacapone (Stalevo) has produced even greater improvements in some Parkinson’s symptoms during clinical trials.

Side effects
Stalevo may increase the risk of strokes, heart attacks, and other potentially fatal cardiovascular problems more than Sinemet does. The FDA is currently evaluating clinical data on this topic.

Common side effects of Stalevo include nausea, vomiting, diarrhea, constipation, dizziness, drowsiness, nervousness, headaches, confusion, memory problems, nightmares, problems sleeping, sweating, loss of appetite, or changes in the sense of taste. Tell your doctor if these side effects become worse. Stalevo may cause your urine, sweat, or saliva to turn dark colors, which can stain clothes.

Inform your doctor immediately if you experience a fast, pounding heartbeat, fainting, fever, rigid, stiff, or painful muscles, trouble breathing, hallucinations, suicidal thoughts, depression, increased urge to have sex or gamble, stools containing blood or a tarry substance, vomit containing blood or a substance resembling coffee grounds, dark-colored or red urine, hoarseness, or abnormal body movements while taking Stalevo.

Many drugs can cause allergic reactions that in the most serious cases, can result in death. Seek immediate medical help if you experience signs of a severe allergic reaction such as hives, difficulty breathing, or swelling in the face, throat, eyes, lips or tongue.