Carbidopa; Levodopa Extended-Release Capsules

What is this medication?

CARBIDOPA; LEVODOPA (kar bi DOE pa; lee voe DOE pa) treats the symptoms of Parkinson disease. It works by increasing the amount of dopamine in your brain, a substance which helps manage body movements and coordination. This reduces the symptoms of Parkinson, such as body stiffness and tremors.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Rytary

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

• Depression or other mental illness
• Diabetes
• Glaucoma
• Heart disease, including history of a heart attack
• History of irregular heartbeat
• Kidney disease
• Liver disease
• Lung or breathing disease, like asthma
• Narcolepsy
• Sleep apnea
• Stomach or intestine problems
• An unusual or allergic reaction to levodopa, carbidopa, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breast-feeding

How should I use this medication?

Take this medication by mouth with a glass of water. Follow the directions on the prescription label. Swallow whole. Do not crush, chew, or divide the capsules. If you have trouble swallowing, you may open the capsule by carefully twisting apart both halves of the capsule and sprinkle the entire contents on 1 to 2 tablespoons of applesauce. Take the medication/food mixture immediately, and do not store for future use. Take your doses at regular intervals. Do not take your medication more often than directed. Do not stop taking except on the advice of your care team.

A high fat, high calorie meal may slow the absorption of the medication into your system and delay the onset of action by 2 to 3 hours. Consider taking the first dose of the day 1 to 2 hours before eating. If you develop nausea, the medication may be taken with food.

Talk to your care team about the use of this medication in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medication?

Do not take this medication with any of the following:

• MAOIs like Marplan, Nardil, and Parnate
• Reserpine
• Tetrabenazine

This medication may also interact with the following:

• Alcohol
• Droperidol
• Entacapone
• Iron supplements or multivitamins with iron
• Isoniazid, INH
• Linezolid
• Medications for depression, anxiety, or psychotic disturbances
• Medications for high blood pressure
• Medications for sleep
• Metoclopramide
• Papaverine
• Procarbazine
• Tedizolid
• Rasagiline
• Selegiline
• Tolcapone

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Visit your care team for regular checks on your progress. Tell your care team if your symptoms do not start to get better or if they get worse. Do not stop taking except on your care team's advice. You may develop a severe reaction. Your care team will tell you how much medication to take.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medication affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may interfere with the effect of this medication. Avoid alcoholic drinks.

When taking this medication, you may fall asleep without notice. You may be doing activities like driving a car, talking, or eating. You may not feel drowsy before it happens. Contact your care team right away if this happens to you.

There have been reports of increased sexual urges or other strong urges such as gambling while taking this medication. If you experience any of these while taking this medication, you should report this to your care team as soon as possible.

You may experience a 'wearing off' effect prior to the time for your next dose of this medication. You may also experience an 'on-off' effect where the medication apparently stops working for any time from a minute to several hours, then suddenly starts working again. Tell your care team if any of these symptoms happen to you. Your dose may need adjustment.

A high protein meal can slow or prevent absorption of this medication. Avoid high protein foods near the time of taking this medication to help prevent these problems. Take this medication at least 30 minutes before eating or one hour after meals. You may want to eat higher protein foods later in the day or in small amounts.

If you have diabetes, you may get a false-positive result for sugar in your urine. Check with your care team.

This medication may discolor the urine or sweat, making it look darker or red in color. This is of no cause for concern. However, this may stain clothing or fabrics.

This medication may cause a decrease in vitamin B6. You should make sure that you get enough vitamin B6 while you are taking this medication. Discuss the foods you eat and the vitamins you take with your care team.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Falling asleep during daily activities
• Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
• Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
• Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
• New or worsening uncontrolled and repetitive movements of the face, mouth, or upper body
• Stomach bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds
• Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
• Urges to engage in impulsive behaviors such as gambling, binge eating, sexual activity, or shopping in ways that are unusual for you

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

• Dark red or black saliva, sweat, or urine
• Dizziness
• Drowsiness
• Headache
• Nausea

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medication?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Protect from light and moisture. Throw away any unused medication after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.