|1st choices||Co-beneldopa (Madopar®) containing levodopa and benserazide||Dose:|
|Co-careldopa (Sinemet®) containing levodopa and carbidopa||Dose:|
- To reduce the risk of nausea, levodopa should be taken initially with food and the dose increased slowly. Protein may interfere with levodopa absorption. Levodopa should not be withdrawn abruptly. It may colour urine red.
- Levodopa is a useful first line drug for older/frailer patients to optimise control faster.
- Co-beneldopa (Madopar®) and co-careldopa (Sinemet®) are used equally and there is no evidence of benefit of one over the other.
- Sinemet–110® (co-careldopa) is not recommended for initiation of therapy as the dose of carbidopa may be inadequate for full inhibition of dopa-decarboxylase. Sinemet-110® may have a use in patients on more than 700mg levodopa.
- Dispersible Madopar® may be useful for patients, who are on co-beneldopa or co-careldopa at equivalent levodopa doses, with swallowing difficulties, or where rapid absorption is desired, for example first thing in the morning. Often an inactive sediment remains in the glass.
- Modified-release formulations of levodopa are not recommended for initiation of therapy. They may be useful for nocturnal immobility and rigidity.
- For driving advice, see general notes (cautions).