carbidopa monohydrate + entacapone + levodopa at a glance
Medicine class
Levodopa-based dopaminergic treatment with peripheral DDC and COMT inhibitors.
Licensed use
Advanced Parkinson’s disease with severe motor fluctuations and hyperkinesia or dyskinesia despite available oral combinations.
Administration
Intestinal gel delivered by a Crono LECIG pump through a temporary intestinal tube or long-term enteral access.
Pump or tube problems
A sudden or gradual return of slowness or movement fluctuations may indicate displacement, blockage or pump failure.
What is carbidopa monohydrate + entacapone + levodopa used for?
Licensed use:
Advanced Parkinson’s disease with severe motor fluctuations and hyperkinesia or dyskinesia when available oral combinations of Parkinson’s treatments have not produced satisfactory results.
How does carbidopa monohydrate + entacapone + levodopa work?
Levodopa enters the brain and is converted to dopamine. Carbidopa and entacapone reduce its breakdown outside the brain, increasing and prolonging levodopa availability. Intestinal delivery aims to maintain levodopa concentrations more consistently within the individual therapeutic window.
carbidopa monohydrate + entacapone + levodopa preparations and strengths
Gel
Route: Cutaneous
Strengths: 20 mg/mL + 5 mg/mL + 20 mg/mL
How to take carbidopa monohydrate + entacapone + levodopa
Use the gel only through the prescribed intestinal tube and Crono LECIG pump, following specialist training and the pump manual. Each cartridge is single-use. Protein-rich meals can reduce levodopa absorption, so discuss major dietary changes or persistent loss of effect with the Parkinson’s team.
Check that the cartridge, pump and tubing are connected as trained.
Do not change pump settings unless instructed by the specialist team.
Report abdominal symptoms, leakage, redness, discharge or difficulty operating the system.
Tell the team if movement control suddenly worsens, as the tube may be displaced or blocked.
carbidopa monohydrate + entacapone + levodopa side effects
Common or expected effects
- Involuntary movements or worsening movement fluctuations
- Nausea, constipation or diarrhoea
- Dizziness on standing and falls
- Weight loss or reduced appetite
- Anxiety, depression or difficulty sleeping
- Sleepiness, confusion or hallucinations
- Muscle or musculoskeletal pain
- Abdominal discomfort and pump-, tube- or stoma-related problems
- Harmless reddish-brown urine discolouration
Get urgent medical advice
- Swelling of the face, mouth or throat, breathing difficulty or collapse
- Fever, severe muscle stiffness, confusion or altered consciousness
- Unexplained severe muscle pain, cramps or weakness
- Severe or persistent abdominal pain, nausea or vomiting
- Gastrointestinal bleeding, obstruction, perforation, peritonitis or sepsis symptoms
- Suicidal thoughts or attempts
- Severe infection symptoms, particularly fever with sore throat or mouth ulcers
- New compulsive gambling, spending, eating or sexual behaviour, or craving excessive treatment
carbidopa monohydrate + entacapone + levodopa in pregnancy
Human information is limited, and animal studies identified reproductive toxicity. Treatment is not recommended during pregnancy, or for someone who could become pregnant and is not using contraception, unless a specialist concludes that maternal benefit outweighs fetal risk. Seek specialist advice before conception or promptly after discovering a pregnancy; do not stop abruptly.
carbidopa monohydrate + entacapone + levodopa while breastfeeding
Breastfeeding should be avoided during treatment. Levodopa passes into human milk and may suppress milk production. It is uncertain whether carbidopa or entacapone passes into human milk or how the combination affects an infant.
carbidopa monohydrate + entacapone + levodopa interactions
Give the specialist and pharmacist a complete list of prescribed, non-prescribed and complementary products. Important interactions include:
Non-selective MAO inhibitors and selective MAO-A inhibitors
Combinations such as phenelzine or moclobemide are contraindicated because serious cardiovascular reactions may occur.
Warfarin
Entacapone may increase anticoagulant effect, so INR should be checked when treatment is started, stopped or changed.
Antihypertensives
May increase postural hypotension, dizziness and fainting.
Common questions about carbidopa monohydrate + entacapone + levodopa
Answers are fully visible for fast scanning and source review.
What should I do if the pump stops?
Follow the pump troubleshooting instructions and contact the Parkinson’s team promptly if delivery cannot be restored. Do not compensate by increasing delivery or stop treatment without medical advice.
Can it make me suddenly fall asleep?
Yes. Sleepiness and sudden sleep episodes can occur. Do not drive or operate machinery if affected, and tell the clinical team promptly.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.