Levodopa (co-beneldopa and co-careldopa)

Levodopa is a chemical building block that your body converts into dopamine in the brain.

Levodopa already occurs naturally in your body and taking it as a drug treatment boosts the supply, meaning the nerve cells can make more dopamine.

Levodopa drugs are sometimes one of the first types of medication that people with Parkinson’s are prescribed. However, this will not be the same for everyone.

Your levodopa treatment will usually start with a low dose. This will gradually be increased until your symptoms are under control.

Levodopa can help treat Parkinson’s symptoms because it helps to top up dopamine levels in the brain.

You may experience a big improvement in your symptoms when taking it, especially with stiffness and slowness of movement.

Levodopa becomes less effective over time. This is because it cannot stop the dopamine-producing cells from being lost so you will continue to get symptoms. This means that more frequent doses are needed.

Your brain can’t become resistant to levodopa. People with Parkinson’s will benefit from medications containing levodopa throughout their lifetime.

The patient information leaflet that comes with your drugs will tell you the full range of side effects that you may experience but some possible ones include:

Wearing off

When you take levodopa for a long time you may experience wearing off. This is when your drugs wear off before you take the next dose so you have times when you’re stiff and slow.

Involuntary movements (dyskinesia)

With long-term use of levodopa you may experience involuntary movements (dyskinesia). These are muscle movements that you can’t control. They can include twitches, jerks, twisting or writhing movements.

Find out more about wearing off and dyskinesia

Impulsive and compulsive behaviours

Behaviours may involve gambling, becoming a ‘shopaholic’, binge eating or focusing on sexual feelings and thoughts. This can have a huge impact on people’s lives including family and friends.

Not everyone who takes Parkinson’s medication will experience impulsive and compulsive behaviours, so these side effects should not put you off taking your medication to control your symptoms.

Find out more about impulsive and compulsive behaviours 

Withdrawal syndrome with levodopa

Research has shown that withdrawal symptoms can happen when someone stops taking levodopa medication very suddenly, perhaps because they are experiencing impulsive and compulsive behaviour.

It can lead to symptoms including depression, anxiety or pain, and in the most serious cases, effects can lead to hospitalisation. 

Any withdrawal from Parkinson’s drugs needs to be done gradually, under the supervision of a health professional, to avoid the risk of developing this syndrome.

Iron
When you take your levodopa medication it may help to avoid any medicines or vitamin supplements with iron in them. Iron can mean that less levodopa gets into the parts of the body where it is needed. Talk to your healthcare professional for more information about this. 

Other side effects

Other common side effects include:
 

• nausea and vomiting
• low blood pressure (hypotension)
• loss of appetite
• anxiety and depression
• hallucinations (seeing, hearing, feeling and smelling things that aren’t there)
• sleep problems 

Find out more about the side effects of Parkinson's drugs

For some people with Parkinson’s, protein (which is found mainly in meat, fish, eggs, cheese, beans and pulses) seems to interfere with how well levodopa medications are absorbed by the body. Because of this, you may benefit from taking your medication 30 - 60 minutes before you eat a meal.

However, levodopa drugs can sometimes make people feel sick. Eating a low protein snack (such as crackers) when you take your dose may help to reduce this side effect.

You may also benefit from a protein redistribution diet, where you take most of your daily protein in the evening. This can help the levodopa treatment to be more effective in the daytime, when you are likely to need it more.
 
Protein is essential for a healthy diet so you should not reduce your overall intake. Talk to your specialist or Parkinson’s nurse before you make any changes to what you eat.

Find out more about diet and Parkinson's

Co-beneldopa is a type of generic (unbranded) levodopa medication. Madopar is the brand name for co-beneldopa.

It contains two ingredients, levodopa and benserazide. The benserazide ingredient helps levodopa get in to the brain where it can be converted to dopamine.

The dose of co-beneldopa (Madopar) is expressed with the levodopa content first and then the benserazide content. For example, Madopar 50/12.5 contains 50 mg levodopa and 12.5 mg of benserazide.

Below we have included the different forms of co-beneldopa (Madopar) medication and some key points on taking them.
 
The most recent and complete information on your specific drug will be on your patient information leaflet that comes with your medication packet. Always read it carefully before you start your treatment.

For detailed information you should follow the advice of your specialist or Parkinson’s nurse about how to take co-beneldopa (Madopar) so that it works well for your Parkinson’s.

Immediate-release co-beneldopa capsules (Madopar capsules)

Taking this medication with a meal, or shortly after it, will mean you are less likely to experience any nausea. If you don’t experience nausea it may be beneficial to take your capsules 30 – 40 minutes before a meal to help your medication work.

Controlled release co-beneldopa capsules (Madopar CR capsules)

Controlled release co-beneldopa capsules (Madopar CR) let the levodopa enter your body slowly instead of all at once. They are particularly helpful if they are taken before going to bed to reduce stiffness during the night.

Controlled release co-beneldopa capsules (Madopar CR capsules) can also help to reduce one of the side effects of levodopa medication - involuntary movements (dyskinesia).

You should take the capsules with a good drink of water. Don’t break, crush or chew them.

Be aware that you should avoid taking drugs for heartburn, indigestion or an upset stomach in the two hours before and after you take controlled-release co-beneldopa (Madopar) medication. This is because they can make it more difficult for your body to absorb your controlled-release capsules.

Co-beneldopa dispersible tablets (Madopar tablets)

These dispersible tablets can be mixed with water to make a drink. It takes effect more quickly than capsules because it doesn’t need to be broken down in your stomach to release the active ingredient. It can also be used if you have trouble swallowing tablets or capsules.

You should take these tablets with water or fruit squash.

Taking this medication with a meal or after it will mean you are less likely to experience any nausea.

Co-beneldopa dispersible tablets (Madopar tablets) are useful if you experience slowness of movement or the ‘on/off’ effect.

Co-careldopa is a type of generic (unbranded) levodopa medication.

Sinemet, Caramet, Lecado and Apodespan are the branded versions of co-careldopa.

Co-careldopa contains two ingredients, levodopa and carbidopa. The carbidopa ingredient helps levodopa get in to the brain where it can become dopamine.

Carbidopa also helps to make sure you experience fewer side effects.

The dose of co-careldopa (Sinemet) is expressed with the carbidopa content first and then the levodopa content. For example, Sinemet 12.5/50 contains carbidopa 12.5 mg and levodopa 50 mg.

Taking co-careldopa (Sinemet, Caramet, Lecado, Apodespan)

Below we have included the different forms of co-careldopa medication and some key points on taking them.

The most recent and complete information on your specific drug will be on your patient information leaflet that comes with your medication packet. Always read it carefully before you start your treatment.

For detailed advice you should speak to your GP, specialist or Parkinson’s nurse about how to take co-careldopa so that it works well for your Parkinson’s.

Co-careldopa (Sinemet, Sinemet plus tablets)

You will usually take Sinemet or Sinemet plus three or four times a day. But this will vary and your healthcare professional will be best placed to advise you on what dose is best for your Parkinson’s.

Co-careldopa (Sinemet controlled release tablets)

Co-careldopa controlled release lets the levodopa enter your body slowly instead of all at once. This is particularly helpful if taken before going to bed to reduce stiffness during the night.

Co-careldopa controlled release tablets mean that your medication takes effect slowly during the day. Your dose can be adjusted by your specialist or Parkinson’s nurse so that your symptoms are well controlled.

You should take these tablets whole. Don’t break, crush or chew these tablets because they have been made to release your medication slowly.

Duodopa is a gel form of levodopa (co-careldopa) medication reserved for advanced and complex Parkinson’s. It is pumped through a tube that is surgically inserted into the intestine. This means your dose of medication acts more quickly.

Duodopa gel can help reduce:

• involuntary movements as a side effect of your medication
• motor fluctuations from your drugs wearing off
• problems with your symptoms at night

When is Duodopa used?

It is only suitable for a small number of people whose symptoms can’t be controlled with more common drug treatments, such as levodopa tablets.

It is most often used when Parkinson’s symptoms have progressed.

Speak to your GP, specialist or Parkinson's nurse for more information about Duodopa.