Levodopa is converted to a chemical called dopamine (DOE pa meen) in the brain. Symptoms of Parkinson’s disease may be caused by low levels dopamine in the brain. Levodopa is turned into dopamine in the body.

Carbidopa helps prevent the breakdown of levodopa before it can reach the brain and take effect.

The combination of carbidopa and levodopa is used to treat Parkinson symptoms such as muscle stiffness, tremors, spasms, and poor muscle control.

Carbidopa and levodopa is also used to treat Parkinson symptoms caused by carbon monoxide poisoning or manganese intoxication.

Carbidopa and levodopa may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Sinemet (carbidopa and levodopa)?

If you are already taking levodopa (Larodopa, Dopar), you must stop taking it at least 12 hours before you start taking carbidopa and levodopa. It may take up to several weeks of using carbidopa and levodopa before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after a few weeks of treatment. Also tell your doctor if the effects of this medication seem to wear off quickly in between doses. Do not crush, chew, or break an extended-release tablet (Sinemet CR). Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time. Carbidopa and levodopa can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What should I discuss with my healthcare provider before taking Sinemet (carbidopa and levodopa)?

Do not take carbidopa and levodopa if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take carbidopa and levodopa before the MAO inhibitor has cleared from your body.

Do not take this medication if you are allergic to carbidopa (Lodosyn) or levodopa (Larodopa), or if you have:

• narrow-angle glaucoma;
• unusual skin lesions that have not been checked by a doctor; or
• a history of malignant melanoma (skin cancer).

Before taking carbidopa and levodopa, tell your doctor if you are allergic to any drugs, or if you have:

• heart disease, high blood pressure, coronary artery disease, a heart rhythm disorder, or a prior heart attack;
• asthma, chronic obstructive pulmonary disease (COPD), or other breathing disorder;
• liver disease;
• kidney disease;
• an endocrine (hormonal) disease;
• a stomach or intestinal ulcer;
• wide-angle glaucoma; or
• depression or other mental illness.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take carbidopa and levodopa.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether this medicine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

The disintegrating tablet (such as Parcopa) may contain phenylalanine. Talk to your doctor before using this form of carbidopa and levodopa if you have phenylketonuria (PKU).

How should I take Sinemet (carbidopa and levodopa)?

If you are already taking levodopa (Larodopa, Dopar), you must stop taking it at least 12 hours before you start taking carbidopa and levodopa.

Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Carbidopa and levodopa can be taken with or without food.

Do not crush, chew, or break an extended-release tablet (Sinemet CR). Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

The regular tablet can be broken or crushed if needed to make it easier to swallow.

To take the orally disintegrating tablet (Parcopa):

• Keep the tablet in its blister pack until you are ready to take the medicine. Open the package and peel back the foil from the tablet blister. Do not push a tablet through the foil or you may damage the tablet.
• Using dry hands, remove the tablet and place it in your mouth. It will begin to dissolve right away.
• Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. Swallow several times as the tablet dissolves.

It may take up to several weeks of using carbidopa and levodopa before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after a few weeks of treatment. Also tell your doctor if the effects of this medication seem to wear off quickly in between doses.

To be sure this medication is helping your condition and not causing harmful side effects, your blood will need to be tested on a regular basis. Your kidney, heart, and liver function may also need to be tested. Do not miss any scheduled appointments.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using carbidopa and levodopa.

Parkinson’s disease is sometimes treated with a combination of different drugs. To best treat your condition, use all of your medications as directed by your doctor. Be sure to read the medication guide or patient instructions provided with each of your medications. Do not change your doses or medication schedule without advice from your doctor.

Store carbidopa and levodopa at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include uneven heart rate, muscle spasms, and severe nausea or vomiting.

Sinemet (carbidopa and levodopa) side effects

You may notice that your sweat, urine, or saliva appears dark in color, such as red, brown, or black. This is not a harmful side effect, but it may cause staining of your clothes or bed sheets.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

• restless muscle movements in your eyes, tongue, jaw, or neck;
• worsening of tremors (uncontrolled shaking);
• fever, stiff muscles, confusion, sweating, fast heart rate, rapid breathing;
• seizure (convulsions);
• severe nausea, vomiting, or diarrhea;
• uneven heart rate or fluttering in your chest;
• confusion, agitation, unusual thoughts or behavior; or
• depressed mood, thoughts of suicide or hurting yourself.

Less serious side effects may include:

• nausea, loss of appetite;
• diarrhea, constipation, upset stomach;
• headache, dizziness, drowsiness;
• nightmares, increased dreaming;
• numbness or tingly feeling;
• muscle pain; or
• skin rash or itching.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect Sinemet (carbidopa and levodopa)?

Before taking carbidopa and levodopa, tell your doctor if you are taking any of the following medicines:

• metoclopramide (Reglan);
• isoniazid (Nydrazid);
• phenytoin (Dilantin);
• papaverine (Pavabid, Papacon, Pavagen, Pavacot);
• blood pressure medication;
• antidepressants such as amitriptyline (Elavil, Etrafon), amoxapine (Ascendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil); or
• phenothiazines such as chlorpromazine (Thorazine), fluphenazine (Prolixin), mesoridazine (Serentil), perphenazine (Trilafon), prochlorperazine (Compazine), thioridazine (Mellaril), or trifluperazine (Stelazine).

This list is not complete and there may be other drugs that can interact with carbidopa and levodopa. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

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Sustiva is an antiviral medication that prevents human immunodeficiency virus (HIV) cells from multiplying in your body.

Sustiva is used to treat HIV, which causes the acquired immunodeficiency syndrome (AIDS). It is not a cure for HIV or AIDS.

Sustiva may also be used for purposes other than those listed in this medication guide.

Important information about Sustiva

Sustiva may cause serious psychiatric symptoms including severe depression, suicidal thoughts, aggression, extreme fear, or unusual behavior. Contact your doctor at once if you have any of these side effects.

Do not use Sustiva without telling your doctor if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment. Do not take Sustiva with astemizole (Hismanal), bepridil (Vascor), cisapride (Propulsid), pimozide (Orap), midazolam (Versed), triazolam (Halcion), voriconazole (Vfend), or ergot medicines such as dihydroergotamine (D.H.E. 45), ergonovine (Ergotrate), ergotamine (Ergomar, Cafergot, Wigraine), or methylergonovine (Methergine). These drugs can cause life-threatening side effects if you use them while you are taking Sustiva.

There are many other medicines that can interact with Sustiva, or make it less effective. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

HIV/AIDS is usually treated with a combination of different drugs. To best treat your condition, use all of your medications as directed by your doctor. Do not change your doses or medication schedule without advice from your doctor. Every person with HIV or AIDS should remain under the care of a doctor.

Taking Sustiva will not prevent you from passing HIV to other people through unprotected sex or sharing of needles. Talk with your doctor about safe methods of preventing HIV transmission during sex, such as using a condom and spermicide. Sharing drug or medicine needles is never safe, even for a healthy person.

Before taking Sustiva

Do not use this medication if you are allergic to Sustiva, or if you are using any of the following drugs:

• astemizole (Hismanal);
• bepridil (Vascor);
• cisapride (Propulsid);
• midazolam (Versed) or triazolam (Halcion);
• pimozide (Orap);
• voriconazole (Vfend); or
• ergot medicine such as ergotamine (Ergomar, Ergostat, Cafergot, Ercaf, Wigraine), dihydroergotamine (D.H.E. 45, Migranal Nasal Spray), ergonovine (Ergotrate), or methylergonovine (Methergine).

Using any of these medicines while you are taking Sustiva can cause serious medical problems or death.

Before taking Sustiva, tell your doctor if you are allergic to any drugs, or if you have

• liver disease (including hepatitis B or C);
• high cholesterol or triglycerides; or
• if you have ever taken delavirdine (Rescriptor) or nevirapine (Viramune) and they were not effective in treating your condition.

If you have any of these conditions, you may not be able to use Sustiva, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D. This medication can cause harm to an unborn baby. Do not use Sustiva without your doctor’s consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while taking Sustiva. HIV can be passed to the baby if the mother is not properly treated during pregnancy. Take all of your HIV medicines as directed to control your infection while you are pregnant.

Your name may need to be listed on an antiviral pregnancy registry when you start using Sustiva. The purpose of this registry is to track the outcome of the pregnancy and delivery to evaluate whether Sustiva had any effect on the baby.

You should not breast-feed while you are using Sustiva. Women with HIV or AIDS should not breast-feed at all. Even if your baby is born without HIV, you may still pass the virus to the baby in your breast milk.

How should I take Sustiva?

Take Sustiva exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Take this medicine with a full glass of water.

Sustiva can be taken with or without food. Avoid taking with a high-fat meal, which can make it harder for your body to absorb the medication.

Sustiva can cause side effects such as mood or behavior changes. These symptoms may improve the longer you take the medication. Taking Sustiva at bedtime may also lessen these effects. Contact your doctor if you have more serious symptoms such as severe depression or thoughts of hurting yourself.

It is important to take Sustiva regularly to get the most benefit. Get your prescriptions refilled before you run out of medicine completely.

Do not take Sustiva as your only HIV medication. HIV/AIDS is usually treated with a combination of different drugs. Your disease may become resistant to Sustiva if you do not take it in combination with other HIV medicines your doctor has prescribed.

To best treat your condition, use all of your medications as directed by your doctor. Do not change your doses or medication schedule without advice from your doctor. Every person with HIV or AIDS should remain under the care of a doctor.

To be sure this medication is helping your condition, your blood will need to be tested on a regular basis. Your liver function may also need to be tested. It is important that you not miss any scheduled visits to your doctor.

This medication can cause you to have a false positive drug-screening test. If you provide a urine sample for drug-screening, tell the laboratory staff that you are taking Sustiva.

Store Sustiva at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of an Sustiva overdose may include confusion, lack of balance or coordination, severe mood or behavior changes, or thoughts of suicide.

Sustiva side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Sustiva may cause serious psychiatric symptoms including confusion, severe depression, suicidal thoughts, aggression, extreme fear, hallucinations, or unusual behavior. Contact your doctor at once if you have any of these side effects, even if you have had them before.

Call your doctor at once if you have any of these serious side effects:

• fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;
• nausea, stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
• fever, chills, body aches, flu symptoms; or
• any other signs of new infection.

Less serious side effects may be more likely to occur, such as:

• mild nausea, vomiting, or stomach pain;
• diarrhea or constipation;
• cough;
• blurred vision;
• headache, dizziness, tired feeling;
• trouble concentrating;
• muscle or joint pain;
• sleep problems (insomnia), unusual dreams; or
• changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Sustiva?

There are many other medicines that can interact with Sustiva, or make it less effective. Before taking Sustiva, tell your doctor if you are using any of the following drugs:

• sildenafil (Viagra);
• St. John’s wort;
• a blood thinner such as warfarin (Coumadin);
• a cholesterol medication such as Lipitor or Zocor;
• an antibiotic such as clarithromycin (Biaxin), itraconazole (Sporanox), rifabutin (Mycobutin), or rifampin (Rifadin, Rifater, Rifamate, Rimactane);
• heart or blood pressure medications such as amlodipine (Norvasc), diltiazem (Tiazac, Cartia, Cardizem), felodipine (Plendil), nicardipine (Cardene), nifedipine (Procardia, Adalat), nimodipine (Nimotop), nisoldipine (Sular), or verapamil (Calan, Covera, Isoptin, Verelan);
• other HIV medicines such as amprenavir (Agenerase), indinavir (Crixivan), lopinovir/ritonavir (Kaletra), nevirapine (Viramune), ritonavir (Norvir), or saquinavir (Invirase); or
• seizure medications such as phenytoin (Dilantin) or carbamazepine (Tegretol).

If you are using any of these drugs, you may not be able to use Sustiva, or you may need dosage adjustments or special tests during treatment.

Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

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