Do you or someone in your family have Parkinson's disease? If so, your doctor may have given you a pill made by combining these three medications. Although the name of this medicine may seem a bit complicated, once you understand how it works, it is very simple. Today, let's talk about this medicine, what it does, and what you need to be careful of, in a friendly and simple way.

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What happens when these three drugs are combined?

Simply put, this is a combination of three medications: Carbidopa, Levodopa, and Entacapone . The main hero of this pill is Levodopa. Parkinson's disease is caused by a decrease in the chemical 'Dopamine' in our brain. The medicine called Levodopa works by going to the brain and helping to rebuild this decreased dopamine.

So what happens to the other two drugs? Imagine that Levodopa is a person carrying an important message.

Carbidopa is like a bodyguard that protects the person from problems along the way (from the drug breaking down in other parts of the body before reaching the brain).
Entacapone is like another helper that strengthens the bodyguard's work and allows Levodopa to work longer and more efficiently.

When these three come together, they can be a great help in controlling Parkinson's symptoms (such as tremors, shaking, and slow walking).

Things you need to tell your doctor before taking this medicine

It is very important that your doctor knows your complete medical history before prescribing this medicine to you. This is because we need to be very careful when using this medicine with certain medical conditions. If you have any of the conditions listed below, be sure to tell your doctor about it.

Illness or condition	Why should you inform?
Depression or other mental illnesses	This medication can sometimes affect mental states.
Diabetes	The medicine can affect blood sugar levels.
Glaucoma condition	Because it can affect eye pressure.
Heart disease, history of heart attack, irregular heartbeat	Heart rate and blood pressure may be affected.
Kidney or liver disease	Because it affects the process of eliminating the drug from the body.
Lung diseases such as asthma	Sometimes the respiratory system may be affected.
Sleep apnea or narcolepsy	Because this medicine can cause drowsiness.
Stomach ulcers or intestinal diseases	The risk of certain side effects may increase.
If you are pregnant, trying to get pregnant, or breastfeeding	You should talk to your doctor about the possible effects on your child.
Allergies to other medicines, foods or substances	Be aware of the possibility of an allergy to this medicine.

How do you use this medicine?

Swallow the pill with a glass of water. Take it exactly as prescribed by your doctor, at the right time.
Most importantly: Do not break, crush, or chew the tablet. Swallow it whole.
Be careful with food: This medicine can be taken with or without food. However, be careful when taking the medicine.Avoid eating foods that are high in fat, calories, and protein (such as meat, fish, eggs, and dairy products) , as these foods can reduce the absorption of Levodopa. Talk to your doctor about your diet.
Don't miss a dose: Take your medicine on time. Don't take more than the prescribed dose or stop taking it suddenly without your doctor's advice. Doing so can have serious consequences.
If you miss a dose: Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take the next pill at the scheduled time. Never take two doses at the same time.

Important: If you think you have taken too much of this medicine, immediately call the National Poisons Information Centre at the Colombo National Hospital , or go to the Emergency Treatment Unit (ETU) of the nearest hospital.

Other things that may interact with this medicine

It is very important to tell your doctor about all the medications you are taking (including vitamins, herbs, and supplements), as some medications may interact with this one.

In particular, MAOI (Monoamine Oxidase Inhibitors) medications for mental illness (e.g. Marplan, Nardil, Parnate) should never be taken with this medication.

In addition, this medicine may interact with the following:

Alcohol
Iron supplements - If you are taking iron supplements, take them 2 hours before or after taking this medicine.
Some medications for high blood pressure
Medications for mental illness, anxiety, and sleep
Some antibiotics (e.g. ampicillin, erythromycin, rifampin)
Narcotic medicines for pain
Warfarin (a medicine used to prevent blood clotting)

This list is not complete, so tell your doctor about everything you take.

Special points to be considered while taking the medicine

Drowsiness and sudden sleepiness

This medicine may make you feel drowsy or dizzy. Sometimes, without warning , you may fall asleep while driving or talking. Therefore, do not drive or operate machinery until you know how this medicine affects you. Especially if you are elderly, do not get up quickly from a sitting or standing position. This can reduce the risk of dizziness and falls.

Unusual impulses and behaviors

Very rarely, some people taking this medicine have been reported to have unusual urges. For example, they may have a strong desire to gamble, have sex, spend money unnecessarily, or overeat. If you or your family notice any of these changes, tell your doctor immediately.

'Wearing-off' and 'On-Off' effect

Sometimes, as the next dose of the medicine approaches, it may feel like the medicine is losing its effectiveness and your Parkinson's symptoms are coming back. This is called the 'wearing-off' effect. Other times, it may feel like the medicine is not working at all (an 'off' period), and then start working again after a while (an 'on' period). If this happens to you, tell your doctor. He or she may be able to adjust your dose.

Change in color of urine and sweat

This medicine may turn your urine, saliva, or sweat dark brown, red, or black. This is not something to worry about. However, be careful as it may stain clothes.

Take care of your skin.

While taking this medicine, check your skin regularly for changes in your existing moles or the appearance of new moles. Tell your doctor if you notice any changes.

What side effects might I experience?

Like any medicine, this one can have some side effects. Most of them are not serious. But there are some things we need to be aware of.

Side effects that should be reported to your doctor immediately
• Allergic reactions such as skin rash, itching, swelling of the face, lips or tongue	• Uncontrollable movements of the hands, face, mouth, neck, or upper body
• Sudden sleepiness	• Changes in mental status or behavior, hallucinations
• Fast, irregular heartbeat	• Stomach ache, fever, muscle pain
• Dizziness, fainting	• Difficulty urinating or a change in the amount of urine
Usually not serious (but tell your doctor if it persists)
• Constipation	• Headache
• Loss of appetite	• Stomach upset, nausea
• Difficulty falling asleep	• Dry mouth

💡 Take-Home Message

Take this medicine exactly as prescribed by the doctor, at the right time, and in the right dosage. Do not break or crush the pill.
Do not stop taking this medication suddenly for any reason without your doctor's advice.
Inform your doctor about all other medications, vitamins, and any other medical conditions you may have.
If you experience sudden sleepiness or unusual mental agitation while taking the medication, tell your doctor immediately.
Avoid eating foods high in protein and iron close to the time you take the medication. Talk to your doctor about this.
If you have any questions or concerns about your health, don't be afraid to talk to your doctor.