Levodopa/Carbidopa, Infusion

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KEY POINTS

• This medicine is given by infusion pump to treat the symptoms of Parkinson's disease.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may make you dizzy or drowsy or cause you to fall asleep suddenly without warning during daily activities. This medicine may cause other unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: anti-Parkinson's

Generic and brand names: carbidopa/levodopa, enteral infusion; Duopa

What is this medicine used for?

This medicine is a combination of 2 medicines given by infusion pump to treat the symptoms of Parkinson's disease.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• A blockage in the intestines, Crohn's disease, ulcerative colitis, severe constipation, bowel perforation, or diverticulitis
• Diabetes
• Glaucoma
• Heart disease, an irregular heartbeat, or a heart attack
• Liver or kidney disease
• Low or high blood pressure
• Melanoma (skin cancer) or skin problems such as moles or sores that don’t heal
• Mental health problems such as depression or psychosis
• Peripheral neuropathy (numbness, tingling, pain, or burning feelings in your feet or hands)
• Ulcers or stomach surgery

Do not take this medicine and an MAO inhibitor medicine within 14 days of each other. Taking an MAO inhibitor medicine within 14 days of taking this medicine may cause serious side effects. Tell your healthcare provider about ALL of the medicines you take.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I take it?

Read the Medication Guide that comes in the medicine package when you start taking this medicine and each time you get a refill.

You will need to have a procedure to make a small hole (called a “stoma”) in your stomach wall. This medicine is delivered directly to your small intestine through this tube. Your healthcare provider will teach you what you need to do to care for your stoma, and how to use the pump to deliver your medicine.

Check the label on the medicine for directions about your specific dose. Use this medicine exactly as your healthcare provider prescribes. Do not use more or less or stop taking this medicine without your healthcare provider's approval. You may have to reduce your dosage gradually.

Check with your healthcare provider before using this medicine in children under age 18.

What if I miss a dose?

If you miss a dose, contact your healthcare provider right away. Keep a supply of carbidopa-levodopa immediate release tablets with you in case you are not able to give the infusion.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: irregular or fast heartbeat, lightheadedness, dizziness, nausea, diarrhea, vomiting, weakness, fainting, confusion, hallucinations, twitching, restlessness.

What should I watch out for?

You will need to have regular checkups and blood tests to see how this medicine affects you. Keep all appointments.

If your condition does not improve within a few weeks, or if it gets worse, contact your healthcare provider. Also tell your healthcare provider if the effects of this medicine seem to wear off quickly in between doses.

This medicine may make you dizzy or drowsy or cause you to fall asleep suddenly without warning during daily activities, including driving a car, eating, or talking. Drinking alcohol may make it worse. Do not drink alcohol unless your healthcare provider approves. Do not drive or operate machinery unless you are fully alert. Contact your healthcare provider if the drowsiness continues or is severe, or if you fall asleep suddenly without warning.

You may become dizzy or feel faint when you get up from sitting or lying down. Getting up slowly may help.

Do not change your diet while taking this medicine without your healthcare provider's approval. Certain foods may change the way this medicine works.

Some people taking medicines for Parkinson's disease have developed skin cancer (melanoma). Talk to your healthcare provider about this and what to watch for. You may need to have regular skin exams.

You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medicine. Talk with your healthcare provider if you experience any intense or unusual urges while taking this medicine.

Adults over the age of 65 may be at greater risk for side effects. Talk with your healthcare provider about this

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (Report these to your healthcare provider right away.): Stomach pain; constipation, nausea, or vomiting; bloody or black tarry bowel movement; severe dizziness or drowsiness; fainting; trouble urinating; new or worsening depression; thoughts of suicide; high blood pressure; fast or irregular heartbeat; chest pain; severe nausea or vomiting; eye or body twitching or movements you cannot trouble; trouble speaking or swallowing; worsening of tremors; high fever; stiff muscles; sore throat or cough; increased sweating; unusual tiredness or weakness; black, tarry, or bloody bowel movement; sudden daytime sleepiness; confusion; hallucinations; unusual mood or behavior changes; unusual bruising or bleeding; unusual or intense urges; rash or skin changes; numbness or tingling in your hands or feet.

Other: Diarrhea; constipation; heartburn; mild nausea; mild dizziness or drowsiness; headache; dry mouth; sore throat; runny or stuffy nose; loss of appetite; trouble sleeping; nightmares; muscle cramps; dark urine, saliva, or sweat; back pain; change in sense of taste.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• ACE inhibitors such as benazepril (Lotensin), captopril, enalapril (Vasotec), fosinopril, lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), and ramipril (Altace)
• Alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress) and terazosin
• Angiotensin receptor blockers (ARBs) such as azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan)
• Antianxiety medicines such as alprazolam (Xanax), clonazepam (Klonopin), clorazepate (Gen-Xene, Tranxene), diazepam (Valium), lorazepam (Ativan), and oxazepam
• Antibiotics such as isoniazid, linezolid (Zyvox), and tedizolid (Sivextro)
• Antidepressants such as amitriptyline, citalopram (Celexa), clomipramine, desipramine (Norpramin), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), imipramine (Tofranil), nefazodone and nortriptyline (Pamelor), sertraline (Zoloft), trazodone, and venlafaxine (Effexor)
• Antihistamines such as chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), hydroxyzine (Vistaril), and meclizine (Dramamine)
• Antipsychotic medicines such as aripiprazole (Abilify), asenapine (Saphris), chlorpromazine, clozapine (Clozaril, FazaClo), fluphenazine, haloperidol (Haldol), iloperidone (Fanapt), lurasidone (Latuda), olanzapine (Zyprexa), paliperidone (Invega), perphenazine, pimozide (Orap), quetiapine (Seroquel), risperidone (Risperdal), thioridazine, trifluoperazine and ziprasidone (Geodon)
• Beta blockers such as acebutolol (Sectral), atenolol (Tenormin), betaxolol, bisoprolol (Zebeta), carvedilol (Coreg), labetalol (Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), nebivolol (Bystolic), pindolol, and sotalol (Betapace, Sorine)
• Blood pressure medicines such as hydralazine, methyldopa, minoxidil, and reserpine
• Calcium channel blockers such as amlodipine (Norvasc), amlodipine/atorvastatin (Caduet), diltiazem (Cardizem, Cartia, Tiazac), felodipine, isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat CC, Procardia), nisoldipine (Sular) and verapamil (Calan, Covera, Verelan)
• Clonidine (Catapres, Kapvay)
• Diuretics (water pills) such as amiloride, bumetanide, furosemide (Lasix), hydrochlorothiazide (Microzide), spironolactone (Aldactone), torsemide (Demadex), and triamterene (Dyrenium)
• Doxepin (Silenor)
• Iron supplements or multivitamins that contain iron, and iron medicines such as ferric carboxymaltose (Injectafer), ferric gluconate (Ferrlecit), ferumoxytol (Feraheme), and iron sucrose (Venofer)
• MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• Metoclopramide (Metozolv, Reglan)
• Muscle relaxants such as baclofen (Gablofen, Lioresal), carisoprodol (Soma), cyclobenzaprine (Amrix), dantrolene (Dantrium), methocarbamol (Robaxin), and tizanidine (Zanaflex)
• Natural remedies such as gotu kola, kava, St. John's wort, and valerian
• Nausea medicines such as prochlorperazine (Compro) and promethazine
• Other Parkinson’s disease medicines such as bromocriptine (Cycloset, Parlodel), entacapone (Comtan), levodopa/carbidopa (Duopa, Rytary, Sinemet), pramipexole (Mirapex), rasagiline (Azilect), and ropinirole (Requip)
• Pain medicines such as codeine, fentanyl (Abstral, Actiq, Duragesic, Fentora, Sublimaze), hydrocodone (Hysingla, Zohydro), hydrocodone/acetaminophen (Norco, Vicodin), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin), oxycodone (OxyContin, Roxicodone), oxycodone/acetaminophen (Percocet, Roxicet), pentazocine (Talwin), tapentadol (Nucynta), and tramadol (ConZip, Ultram)
• Phenytoin (Dilantin, Phenytek)
• Procarbazine (Matulane)
• Products that contain methylene blue (Hyophen, Prosed DS, Urophen, Uta)
• Propranolol (Hemangeol, Inderal, InnoPran)
• Sleeping pills such as eszopiclone (Lunesta), flurazepam, temazepam (Restoril), triazolam (Halcion), zaleplon (Sonata), and zolpidem (Ambien, Edluar, Intermezzo)
• Tetrabenazine (Xenazine)

Do not drink alcohol while taking this medicine without your healthcare provider's approval.

Diets high in protein may interfere with the body's response to this medicine. Talk with your healthcare provider about this.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.