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|Stalevo

Stalevo

Generic name:
Brand names: Stalevo

Why is Stalevo prescribed?

Stalevo is used to help relieve symptoms of Parkinson"s disease, including tremors, muscle stiffness and rigidity, slowness of movement, and poor balance or coordination.

Stalevo contains a combination of three drugs, carbidopa and levodopa (the active ingredients in Sinemet), and entacapone (the active ingredient in Comtan). The drug that actually relieves the symptoms of Parkinson"s is levodopa. Carbidopa and entacapone both keep the body from breaking down levodopa too quickly, thus allowing the drug"s effects to last longer. Stalevo can be used instead of Sinemet and Comtan by people who are taking those medicines separately or when the benefits of levodopa aren"t lasting as long as they used to.

Keep in mind that Stalevo is not a cure for Parkinson"s disease; it merely helps keep the symptoms under control.

Most important fact about Stalevo

You should never take Stalevo with certain antidepressants known as monoamine oxidase (MAO) inhibitors, such as phenelzine (Nardil) and tranylcypromine (Parnate). Combining Stalevo with these drugs could cause serious--and possibly life-threatening--side effects. This type of antidepressant should be discontinued at least 2 weeks before beginning therapy with Stalevo.

However, Stalevo may be combined with the drug selegiline (Eldepryl), which is a different type of MAO inhibitor that is often prescribed for Parkinson"s disease. Always check with your doctor before taking any type of MAO inhibitor.

How should you take Stalevo?

Stalevo may be taken with or without food. Never chew, crush, or break the tablets. Do not change the prescribed dosing regimen or add any Parkinson"s medications without first consulting your doctor.

--If you miss a dose...

If you forget to take a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take two doses at once.

--Storage instructions...

Store at room temperature.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe to continue using Stalevo.

• More common side effects may include:
  Abdominal pain, back pain, confusion, constipation, diarrhea, dizziness, fatigue, hallucinations, involuntary movements or tremor, nausea (especially at the start of therapy), slow movements or difficulty making voluntary movements, uncontrollable twitching or jerking, vomiting, urine discoloration

Why should Stalevo not be prescribed?

You should not use Stalevo if you have ever had an allergic reaction to any of its components: carbidopa, levodopa, entacapone (Comtan), or the carbidopa/levodopa combination found in Sinemet.

Do not take Stalevo if you have glaucoma. You must also avoid the drug if you have any suspicious, undiagnosed skin lesion or mole, or a history of melanoma.

Special warnings about Stalevo

Stalevo may cause or exacerbate depression, hallucinations, psychosis, or suicidal thoughts. If you develop any of these symptoms, tell your doctor right away. Also make sure the doctor knows if you have a history of mental or emotional problems.

Stalevo can make some medical conditions worse. Be sure your doctor knows if you have any of the following:

Asthma
Endocrine (glandular) disorder
Glaucoma (high pressure in the eye)
Heart or lung disease (severe)
History of heart attack or irregular heartbeat
History of peptic ulcer
Kidney disorder
Liver disorder
Undiagnosed skin lesions

Muscle rigidity, high temperature, rapid heartbeat or breathing, sweating, blood pressure changes, involuntary twitching or jerking movements, and mental changes may occur when Stalevo is reduced suddenly or discontinued. If you stop taking this medicine abruptly, your doctor should monitor your condition carefully.

Stalevo may lower blood pressure, causing symptoms such as dizziness, nausea, fainting, and sweating. Be careful about standing up too quickly, especially after lying down or sitting for a long time. Give yourself ample time to understand how the medication affects you before you attempt to drive a car or operate machinery.

Possible food and drug interactions when taking Stalevo

Stalevo should never be combined with certain MAO inhibitors such as the antidepressants Nardil and Parnate (see "Most important fact about Stalevo").

If Stalevo is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to consult your doctor before combining Stalevo with the following:

Apomorphine (Uprima)
Asthma medications
Ampicillin (Principen)
Blood pressure medication
Chloramphenicol (Chloromycetin)
Cholestyramine (Questran)
Dobutamine
Dopamine
Epinephrine or norepinephrine (such as Epi-Pen)
Erythromycin (E-Mycin, Erythrocin, and others)
Isoniazid (Laniazid, Nydrazid, Rifater)
Major tranquilizers such as chlorpromazine, Haldol, Mellaril, and Risperdal
Methyldopa (Aldomet)
Metoclopramide (Reglan)
Papaverine (Cerespan, Pavabid, and others)
Phenytoin (Dilantin)
Probenecid (Benemid)
Pyridoxine (vitamin B6)
Rifampin or rifampicin (Rifadin, Rifater, Rimactane)
Tricyclic antidepressants such as Elavil and Tofranil

Iron supplements or a high-protein diet may reduce the effectiveness of Stalevo.

Special information if you are pregnant or breastfeeding

The effects of Stalevo during pregnancy have not been studied. Notify your doctor if you are pregnant or plan to become pregnant. Stalevo should only be used if the potential benefits outweigh the potential risks.

It is not known whether Stalevo appears in breast milk. Your doctor may recommend that you discontinue breastfeeding while you are taking Stalevo.

Recommended dosage

ADULTS

Your doctor will tailor your individual dosage carefully, depending on your response to previous therapy and symptoms. If you are already taking carbidopa/levodopa and entacapone as two separate medications, you will start a Stalevo regimen that matches what you were previously taking.

Stalevo may be taken up to eight times a day. It is available in three different strengths:

• 12.5 milligrams carbidopa/50 milligrams levodopa/200 milligrams entacapone
• 25 milligrams carbidopa/100 milligrams levodopa/ 200 milligrams entacapone
• 37.5 milligrams carbidopa/150 milligrams levodopa/200 milligrams entacapone

Overdosage

An overdose of Stalevo can have potentially serious effects and may require hospitalization. If you suspect an overdose, seek medical treatment immediately.

• Symptoms of overdose may include:
  Abdominal pain, loose stools, low blood pressure, mental disturbances (depression, psychosis, hallucinations, suicidal thoughts), rapid heartbeat