Adult Dosing

• Determine optimal dose by titration during concomitant use with carbidopa-levodopa or with levodopa
• Max dose: PO 200mg/day
• Consider amount of carbidopa in carbidopa-levodopa during calculation of amount of carbidopa for administration

Parkinsonism

Patients receiving carbidopa-levodopa product who require additional carbidopa

• If on a regimen of carbidopa-levodopa 10-100 mg combination, give 25 mg PO given with the first dose; then 12.5 - 25 mg with each dose of carbidopa-levodopa combination if required. [Total maximum dose of carbidopa : 200 mg/day]
• If on a regimen of carbidopa-levodopa 25-250 mg give: 25 mg PO given with the doses of sinemet to a max of 200 mg/day. [Total maximum dose of carbidopa: 200 mg/day]

Patients requiring individual titration of carbidopa and levodopa

• Start carbidopa 25 mg PO tid-qid. Both drugs should be given at the same time, by lowering levodopa dose to 20% to 25% of previous daily dose. If patient is already receiving levodopa, do not give carbidopa and levodopa together until at least 12 hrs after last dose of levodopa was taken alone

Pediatric Dosing

• Safety and efficacy in pediatric patients have not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• Idiopathic Parkinson’s disease (paralysis agitans)
• Postencephalitic parkinsonism
• Symptomatic parkinsonism

• Hypersensitivity to any of the ingredients of the product
• Nonselective MAO inhibitors are contraindicated for use with levodopa, carbidopa or carbidopa-levodopa combination products
• In patients with narrow-angle glaucoma
• For treatment in patients with suspicious, undiagnosed skin lesions
• History of melanoma

• Initiate therapy with carbidopa and levodopa at same time in carbidopa naive patients being treated with levodopa
• Start with dose not exceeding 20 to 25% of the previous daily dosage of levodopa when given without carbidopa
• Initiate therapy with carbidopa and levodopa after minimum 12 hrs of last dose of levodopa

Renal Dose Adjustment

• Renal impairment: Decrease dose; dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Use with caution; dose adjustments not defined

• Does not produce antiparkinsonian effect when given alone, use in combination with carbidopa-levodopa or levodopa
• Central adverse reactions of levodopa are not reduced by carbidopa
• Initiate therapy with carbidopa and levodopa at same time in carbidopa naive patients being treated with levodopa, start with dose not exceeding 20 to 25% of the previous daily dosage of levodopa when given without carbidopa, initiate therapy with carbidopa and levodopa after minimum 12 hrs of last dose of levodopa (US Black box warning)
• Involuntary movements and mental disturbances have occurred on concomitant administration of carbidopa and levodopa
• Carefully monitor patients for development of depression with concomitant suicidal tendencies
• Dyskinesias have occurred at low levodopa doses and with concurrent use of carbidopa and levodopa or carbidopa-levodopa combination products than with levodopa alone
• Carefully monitor cardiac function during initial dose adjustments in intensive cardiac care unit
• Fatal neuroleptic malignant syndrome have occurred in patients on dosage reduction or discontinuance of therapy
• Carefully monitor and avoid abrupt removal of therapy in patients on neuroleptics therapy
• Abnormal neurological findings have been reported on diagnosis, carefully monitor and provide intensive symptomatic treatment for such patients
• Safety and efficacy for use of dopamine agonists, such as bromocriptine, and muscle relaxants, such as dantrolene for therapy of neuroleptic malignant syndrome is not established
• Periodically evaluate hepatic, hematopoietic, cardiovascular, and renal function in patients on extended therapy
• Monitor for CNS side-effects such as dyskinesias and hallucinations when initiating therapy, and reduce the dose of levodopa as necessary
• Carefully monitor patients for changes in intraocular pressure
• Abnormal LFTs, BUN and positive Coombs test have occurred
• Low levels of blood urea nitrogen, creatinine, and uric acid have occurred on concomitant therapy
• False-positive reaction for urinary ketone bodies have occurred on diagnosis during therapy
• False-negative tests have occurred on use of glucose-oxidase methods of testing for glucosuria
• Sudden onset of sleep has been reported

Cautions: use cautiously in

• Renal impairment
• Hepatic impairment
• Cardiac disease
• Wide angle glaucoma
• Hx of MI with arrhythmias
• Pulmonary disease
• Bronchial asthma
• Endocrine disease
• Peptic ulcer disease
• Hx of GI bleed
• Hx of depression
• Psychotic disorder
• Phenylketonuria
• concomitant use of linezolid

Pregnancy Category:C

Breastfeeding: Safety unknown; manufacturer recommends discontinuing of nursing or therapy taking into account the importance of the drug to the mother

• CV: Cardiac irregularities, hypertension, myocardial infarction, hypotension, orthostatic hypotension, palpitation, phlebitis, syncope
• GI: Anorexia, bruxism, dry mouth, dyspepsia, dysphagia, burning sensation of the tongue, constipation, dark saliva, development of duodenal ulcer, diarrhea, flatulence, gastrointestinal bleeding, gastrointestinal pain, heartburn, hiccups, sialorrhea, taste alterations, vomiting
• HEMA: Hemolytic and non-hemolytic anemia, leukopenia, thrombocytopenia, agranulocytosis
• Hypersensitivity: Henoch-Schonlein purpura, angioedema, urticaria, pruritus, bullous lesions (including pemphigus-like reactions)
• METABOLIC: Edema, weight gain, weight loss
• MUSC: Back pain, leg pain, muscle cramps, shoulder pain
• CNS: Agitation, anxiety, ataxia, blepharospasm, confusion, decreased mental activity, dream abnormalities, nightmares, bradykinetic episodes , disorientation, euphoria, dizziness, falling extrapyramidal disorder, gait abnormalities, headache, increased tremor, insomnia, memory impairment, muscle twitching, nervousness, numbness, peripheral neuropathy, somnolence, trismus, activation of latent Horner’s syndrome, increased libido
• NEURO: Paresthesia
• RESP: Upper respiratory infection, dyspnea, pharyngeal pain, cough
• DERM: Alopecia, dark sweat, flushing, increased sweating, malignant melanoma, rash
• EENT: Oculogyric crises, diplopia, blurred vision, dilated pupils
• GU: Dark urine, priapism, urinary frequency, urinary incontinence, urinary retention, urinary tract infection
• LAB TESTS: Abnormal LFTs, lactic dehydrogenase, blood urea nitrogen (BUN), Coombs test; elevated serum glucose; decreased hemoglobin and hematocrit, decreased white blood cell count and serum potassium, increased serum creatinine and uric acid, white blood cells, bacteria, blood, protein and glucose in the urine
• MISC: Bizarre breathing patterns, faintness, hoarseness, hot flashes, malaise, neuroleptic malignant syndrome, sense of stimulation

• Antiparkinson agent; prevents peripheral decarboxylation of levodopa, making more levodopa available for transport to brain and serves as dopamine precursor
• Metabolized by liver
• Renally excreted: (30% unchanged)
• Half-life: 1-2 hrs

US Trade Name(s)

• Lodosyn

US Availability

carbidopa (generic)

• TABS: 25 mg

Lodosyn

• TABS: 25 mg

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

[Outline]

Neurologic

Antiparkinson Agents

Dopaminergic Agents

Pricing data from www.DrugStore.com in U.S.A.

• Lodosyn 25 MG TABS [Bottle] (VALEANT)
  30 mg = $97.63
  90 mg = $271.92

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.

Drug Name: Lodosin 25 MG Oral Tablet

Ingredient(s): Carbidopa

Imprint: 511;LODOSYN

Color(s): Orange

Shape: Round

Size (mm): 8.00

Score: 2

Inactive Ingredient(s): cellulose / fd&c yellow 6 / magnesium stearate / starch

Drug Label Author:
Bristol-Myers Squibb Company

DEA Schedule:
Non-Scheduled