A new treatment for Parkinson's disease: Let's learn about Carbidopa; Levodopa Suspension!

Parkinson's disease can sometimes make it difficult to carry out daily activities , right? Living with symptoms like stiffness and tremors is not easy. However, with the advancement of medical science, new treatments are being added to control these symptoms. Today we are going to talk about one such specific treatment. That is `Carbidopa; Levodopa Suspension` . This is not like regular pills, but a medicine that is administered to the body in a slightly different way.

What is this medicine? How does it work?

Simply put, `Carbidopa; Levodopa` is a medicine that is given to relieve the symptoms of Parkinson's disease. Did you know, there is a chemical called ` Dopamine` that helps control our brain's movements. In Parkinson's disease, the level of `Dopamine` in the brain decreases. So, this medicine increases the amount of `Dopamine` in the brain and reduces symptoms such as stiffness and tremors in the body.

Doctors may sometimes prescribe this medicine for other conditions. If you have any questions about it, ask your doctor or pharmacist. One brand name for this medicine is `Duopa`.

What should I tell the doctor before taking this medicine?

Before you start this treatment, it is very important to tell your care team about certain things. If you have any of the following conditions, you should definitely tell them:

• Diabetes​
• If you are an alcoholic
• Glaucoma condition
• Heart disease
• High blood pressure
• If you have previously had irregular heartbeats
• Kidney disease
• Liver disease
• Low blood pressure
• Lung or breathing diseases (e.g. asthma)
• Mood or behavior changes
• Narcolepsy
• Sleep apnea
• Stomach or intestine problems
• Suicidal thoughts, plans, or attempts; if you or a family member has ever done so
• If you have had an unusual or allergic reaction to levodopa, carbidopa, other medicines, foods, dyes or preservatives
• If you are pregnant or trying to get pregnant
• If you are a breastfeeding mother

When the doctor is aware of these things, he will be able to treat you in the most appropriate way.

How should I use this medicine?

Since this is a somewhat specialized medication, it is important to understand it well.

Your prescribed dose of medication will be prepared by your healthcare team and put into a small `pump`. You will first be shown how to use this `cassette` with the pump. You should also read the `Instructions for Use` carefully. Only your healthcare team will change your dose of medication, and only when they are present. Do not stop taking this medication or change the dose without your doctor's advice.

This medicine should be used at room temperature. Take the medicine cassette out of the refrigerator and out of the box 20 minutes before using it. Use it after it has reached room temperature, otherwise you may not get the correct dose of medicine.

This medicine will continue to be given to your body for 16 hours. This is done using a small pump, such as the CADD-Legacy 1400. This pump will deliver the medicine from the cassette to your PEG-J tube (a special tube that is inserted through your stomach into your small intestine). Each cassette can only be used once. Do not reuse an opened cassette. Also, it is not recommended to use the cassette for more than 16 hours.

After the 16-hour period of medication is over, remove the pump from the PEG-J tube. Then, flush your PEG-J tube with a syringe filled with room temperature water. After this daily infusion, you should take your usual nightly oral carbidopa-levodopa tablets as prescribed. If you are unable to take this infusion for any reason, keep some regular carbidopa-levodopa tablets on hand.

This medicine is not given to young children.

Important: This medicine is for you only. Do not share it with others.

What to do if you take too much medicine?

If you think you have taken too much medicine, call a poison control center or emergency room immediately.

What if I miss a dose of medication?

If for any reason your infusion is stopped for more than 2 hours during a 16-hour period, call your healthcare team and take your carbidopa-levodopa tablets as prescribed until the infusion starts again. If the infusion is stopped for less than 2 hours, you do not need to take the tablets, but your healthcare team may tell you to take an extra dose of the infusion.

Always keep some immediate-release carbidopa-levodopa tablets handy if you cannot get an infusion.

What other medications may interact with this medicine?

Some medications can interact with Carbidopa; Levodopa. This means that problems can occur when they are taken together. Therefore, it is essential to tell your doctor about all the medications you are taking, including vitamins, herbal remedies, and supplements.

Do not take this medicine with the following medications:

• `MAOI` type drugs (e.g. `Marplan`, `Nardil`, `Parnate`)
• `Reserpine`
• `Tetrabenazine`

These medications may also interact:

• Alcohol
• `Droperidol`
• `Entacapone`
• Iron supplements or multivitamins with iron
• `Isoniazid (INH)`
• `Linezolid`
• Medications for depression, anxiety, or psychotic disturbances
• Medication for high blood pressure
• Sleeping pills
• `Metoclopramide`
• `Papaverine`
• `Procarbazine`
• `Tedizolid`
• `Rasagiline`
• `Selegiline`
• `Tolcapone`

This list may not be complete, so tell your doctor if you smoke, drink alcohol, or use illegal drugs.

Things to be careful about when using this medicine

Your medical team will check your health regularly while you are taking this medicine. Be sure to keep your appointments. Tell your doctor if your symptoms do not improve or if they seem to get worse. Do not stop taking the medicine without your doctor's advice. Doing so may cause a severe reaction.

How to care for a PEG-J tube

Your medical team will tell you how to care for your PEG-J tube site. Watch the site regularly for signs of infection. The procedure for inserting a PEG-J tube can cause stomach or intestinal complications. If you have stomach pain, constipation for several days, nausea, vomiting, fever, or black stools, tell your medical team right away.

If the PEG-J tube becomes kinked, tangled, or stuck, Parkinson's symptoms may worsen or motor fluctuations may return. If this happens, talk to your doctor.

Diet

Eating a high protein diet may affect the way this medicine works. If you are changing your diet, talk to your doctor about it.

Drowsiness and dizziness

You may feel sleepy or dizzy. Do not drive, operate machinery, or do anything that requires concentration until you know how this medicine affects you. Do not get up or sit down too quickly, especially if you are elderly. This can reduce the risk of dizziness and falls. Alcohol can interfere with the way this medicine works. So avoid drinking alcohol.

Sudden sleepiness

When you take this medicine, you may suddenly fall asleep without any warning. You may fall asleep while driving, talking, or eating. You may not feel sleepy before you fall asleep. If this happens to you, tell your doctor immediately.

Impulsive behavior

Some people have reported having increased sexual urges or other strong urges, such as gambling or binge eating, while taking this medicine. If you experience any of these, tell your doctor as soon as possible.

Mental health

Patients and their families should be alert for new or worsening depression and thoughts of suicide. If you feel depressed or have suicidal thoughts, call your healthcare team right away.

'Wearing off' and 'On-Off' effects

Before it is time to take your next dose, you may feel the medicine wearing off (a 'wearing off' effect). Also, sometimes the medicine may stop working for a few minutes to a few hours and then suddenly start working again (an 'on-off' effect). If you have these symptoms, tell your doctor. Your dose may need to be adjusted.

For diabetics

If you have diabetes, you may get a false-positive result when you test for sugar in your urine. Talk to your doctor about this.

Change in color of urine or sweat

This medicine may cause your urine or sweat to become darker or red in color. This is not a cause for concern. However, it may stain clothes.

Vitamin B6

This medicine may decrease your vitamin B6 levels. Therefore, you should make sure you are getting enough vitamin B6 while taking this medicine. Talk to your doctor about the foods and vitamins you are taking.

What are the possible side effects of this medicine?

Like all medications, this one can have side effects. Some are serious, some are not so serious.

Side effects that require immediate medical attention:

• Allergic reactions - skin rash, itching, hives, swelling of the face, lips, tongue or throat
• Bowel blockage - severe stomach cramping, inability to defecate or pass air, loss of appetite, vomiting
• Falling asleep during daily work
• Heart rhythm changes - fast or irregular heartbeat, dizziness, fainting, chest pain, difficulty breathing
• Low blood pressure - dizziness, fainting, blurred vision
• Mood and behavior changes - anxiety, restlessness, confusion, hallucinations, irritability, hostility, suicidal thoughts, depression
• New or severe uncontrolled movements of the face, mouth, or upper body
• Pain, tingling, or numbness in the limbs
• Site infection - redness, swelling, warmth, or pain at the site of the tube insertion
• Stomach bleeding - bloody or tarry black stools, vomiting brown material that looks like coffee grounds
• Sudden eye pain or vision changes (e.g., blurred vision, seeing rings around lights, loss of vision)
• You have an unusual urge to engage in impulsive behaviors, such as gambling, overeating, engaging in sexual activity, or shopping.

Side effects that usually do not require medical advice (but should be reported to the doctor if they persist or are bothersome):

• Dark red or black discoloration of saliva, sweat, or urine
• Dizziness
• Drowsiness
• Headache (This appears to be from another language, the correct Sinhala word is: Headache )
• Nausea

This list may not be complete. Talk to your doctor for medical advice about side effects.

How should I store this medicine?

• Keep out of reach of children.
• Store unopened cassettes in the refrigerator at 2 to 8 degrees Celsius (36 to 46 degrees Fahrenheit). Do not freeze. Protect the cassette from light and keep it in the carton until use. Use before the expiration date. Throw away expired medicine.
• Throw away a box after 16 hours of taking it out of the refrigerator, after opening it, or during use, even if it still contains medicine. Use before the expiration date.

It should be noted:This article is a summary only. It may not contain all the information. If you have any questions about this medicine, talk to your doctor, pharmacist, or other healthcare provider.

Take-Home Message

Okay, so let's recap the most important things we talked about:

• This ``Carbidopa; Levodopa Suspension'' is a specific treatment that helps control the symptoms of Parkinson's.
• This is given to the body through a `pump` and a `PEG-J tube`.
• You should definitely tell your doctor about any other medical conditions you have and any other medications you are taking.
• Follow your doctor's instructions exactly on how to use the medicine and how to care for the PEG-J tube.
• Be aware of things like drowsiness, sudden sleep onset, mood changes, and impulsive behavior. If you notice anything unusual , tell your doctor immediately.
• Do not stop taking the medicine suddenly.
• If side effects occur, especially if they are severe, seek medical advice immediately.

Although living with Parkinson's disease can be challenging, with the right treatment and medical advice, you can control your symptoms and live a better life. Talk openly with your doctor about any questions, fears, or concerns you may have. That way, you can get the help you need.

` Carbidopa, Levodopa, Parkinson's disease, Dopamine, PEG-J tube, Medication side effects, Parkinson's treatment