In idiopathic Parkinson's disease: to substitute for equivalent doses of previously-administered carbidopa/ levodopa and entacapone; and to replace immediate-release carbidopa and levodopa in patients with end-of-dose "wearing-off" symptoms who are taking levodopa up to 600mg/day without having dyskinesias.
Swallow whole; max one tablet per dosing interval. Previously on carbidopa/levodopa and entacapone: substitute on a mg/mg basis. Stalevo 50, 75, 100, 125, 150: max 8 tabs/day; Stalevo 200: max 6 tabs/day. Others: individualize; see literature. Avoid abrupt cessation.
Dopa-decarboxylase inhibitor + dopamine precursor + COMT inhibitor.
During or within 2 weeks of nonselective MAOIs (eg, phenelzine). Narrow-angle glaucoma. Undiagnosed skin lesions. History of melanoma.
Severe cardiovascular or pulmonary disease. Asthma. Dyskinesias. Renal, hepatic, or endocrine disorders. Biliary obstruction. Orthostatic hypotension. History of peptic ulcer or MI with residual arrhythmias. Suicidal tendencies. Psychosis. Chronic wide-angle glaucoma. Monitor cardiovascular, hematopoietic, renal and hepatic function, IOP. May stain body fluids. Elderly (>75yrs). Pregnancy (Cat.C). Nursing mothers.
See Contraindications. Orthostatic hypotension with selegiline, antihypertensives. Antagonized by isoniazid, dopamine D2 receptor antagonists (eg, phenothiazines, butyrophenones, risperidone), phenytoin, papaverine; possibly iron, high protein diets, excessive gastric acidity. Hypertension, dyskinesias with tricyclics. Metoclopramide. May cause false (+) urinary ketone test or false (–) urinary glucose (glucose oxidase) test. Potentiates CNS depression with alcohol, other CNS depressants. Chelates iron. Cardiac effects with drugs metabolized by COMT (eg, epinephrine, isoproterenol, dopamine, dobutamine, methyldopa, apomorphine, bitolterol). Caution with drugs that interfere with biliary excretion, glucuronidation, or intestinal beta-glucuronidase (eg, probenecid, cholestyramine, erythromycin, rifampicin, ampicillin, chloramphenicol).
Dyskinesias, GI upset (esp. diarrhea), CNS disturbances (eg, hallucinations, confusion, depression, psychosis, dizziness, headache, abnormal dreams, insomnia, somnolence), hypo- or hypertension, syncope, dyspnea, on-off phenomena, blepharospasm (may indicate excess dose), urine discoloration, lab abnormalities, rhabdomyolysis, neuroleptic malignant syndrome, hyperpyrexia and confusion upon withdrawal.
Tabs 50, 100, 150—100, 250; 75, 125, 200—100