Co-careldopa is a medicine which has been prescribed for many years for people with Parkinson's disease. Most people notice a good improvement in symptoms within a few weeks of starting it.
Side-effects can occur. Although these tend to be mild at first, they can become problematic after long periods of treatment. Your doctor will discuss these with you before you start treatment.
|Type of medicine||A dopaminergic medicine|
|Used for||Parkinson's disease|
|Also called||Caramet®; Duodopa®; Sinemet® and Half Sinemet®|
Also Stalevo® (a combination brand of co-careldopa with entacapone)
|Available as||Tablets, prolonged-release tablets, and gel for use with a feeding tube|
You will have been prescribed co-careldopa to relieve symptoms of Parkinson's disease. In Parkinson's disease, a number of cells in a small part of the brain called the substantia nigra become damaged and die. These brain cells pass messages down nerves in the spinal cord by producing a chemical called dopamine, and it is these messages which control the muscles of the body. As the cells in the substantia nigra are damaged, the amount of dopamine that is produced is reduced. A combination of the reduction of cells and a low level of dopamine in the cells in this part of the brain, causes nerve messages to the muscles to become slowed and abnormal. This produces the main symptoms of Parkinson's disease, which are stiffness, shaking (tremor), and slowness of movement.
Co-careldopa contains two ingredients, levodopa and carbidopa. Once in the body, levodopa is converted into dopamine which helps to restore the level of dopamine in the damaged area of the brain. The carbidopa ingredient helps to prevent the levodopa from being broken down into dopamine in parts of the body other than the brain. This means more levodopa gets into the brain to be converted into dopamine, and it also helps to reduce side-effects.
Before taking co-careldopa
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking co-careldopa it is important that your doctor knows:
- If you have lung disease or a problem with your breathing.
- If you have ever had a stomach ulcer.
- If you have heart or blood vessel problems.
- If you have a problem with raised pressure in your eye (glaucoma).
- If you have ever had a fit (convulsion).
- If you have any problems with the way your liver works, or with the way your kidneys work.
- If you have a mental health problem.
- If you have ever had skin cancer.
- If you know you have any of the following: an overactive thyroid gland, Cushing's syndrome, diabetes, weakened bones (osteomalacia), or a growth on your adrenal glands, called phaeochromocytoma.
- If you are pregnant or breast-feeding.
- If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
- If you have ever had an allergic reaction to a medicine.
How to take co-careldopa
- Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack and any additional information your doctor has given to you. These will give you more information about co-careldopa and will provide you with a full list of the side-effects which you may experience from taking it.
- Take co-careldopa exactly as your doctor tells you to. It is usual to take a dose several times each day. Your doctor will prescribe a dose that best suits you and will tell you how much to take and when to take it. You will be started on a low dose at first, but your dose over time will most likely need to be increased to control your symptoms.
- Try to take co-careldopa at the same times of day each day, as this will help you remember to take it regularly. If you do miss a dose then take your next dose when it is due but leave out the missed dose. Do not take two doses together to make up for a forgotten dose.
- You can take the tablets either before or after a meal, although it is best not to take doses straight after large meals.
- Prolonged-release brands of co-careldopa (such as Caramet® CR, Half Sinemet® CR, and Sinemet® CR) and the combination brand called Stalevo®, are all formulated in a special way. These tablets should be swallowed whole - do not break or chew them.
- If you are using Duodopa® gel, your nurse will tell you how to use the cassette with a portable pump so that you receive the correct amount of medicine.
Getting the most from your treatment
- Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress. During the first few weeks of treatment in particular, your dose may require adjusting.
- Make sure you know exactly when to take your medication. Dose schedules and timings are important. Your pharmacist will be able to advise and help if you have difficulty in getting tablets out of blister packs, or if you have difficulty in remembering when to take your doses.
- Co-careldopa tablets are available in several different strengths. Each time you collect a fresh supply, it's a good idea to check the strength on the pack to make sure they are what you are expecting. If you are unsure, ask your pharmacist for advice.
- Co-careldopa can make your urine look a dark reddish colour. This is harmless and is nothing to worry about. It is caused by your body getting rid of the medicine.
- If you take any medicines that you have bought without a prescription, check with a pharmacist that they are suitable to take with co-careldopa. This is because some medicines, such as iron and some vitamins, may interfere with it.
- Sometimes people taking co-careldopa can fall asleep suddenly with little or no warning of being tired beforehand. Until you know how you react, take extra care if you drive or operate machinery. If you do find yourself falling asleep suddenly, you should see your doctor as soon as possible for advice, and avoid driving or using tools and machines in the meantime.
- Stay as active as possible and exercise regularly as much as you are able. You may walk more slowly than before, but a daily walk is good exercise and may help to loosen up stiff muscles.
- If you are a driver you should tell the DVLA and your insurance company that you have Parkinson's disease. Depending on the severity of symptoms and the medicines that you are taking, you may still be allowed to drive following a medical assessment.
- Treatment with medicines containing levodopa can sometimes cause problems with impulsive types of behaviour. If you notice any changes in your behaviour, such as an increased desire to gamble, binge eat, or spend excessively, or an increased sex drive, you must let your doctor know as soon as possible.
- If you are due to have an operation or dental treatment, tell the person carrying out the treatment that you are taking co-careldopa because there could be an increased risk of problems with some anaesthetics. Also, if you need to have any blood or urine tests, you must say that you are taking co-careldopa, because it can affect the result of some tests.
- There is a small increased risk of skin problems developing in people with Parkinson's disease, although the cause of this is unclear. It is a good idea to check your skin from time to time for any unusual patches, and to speak with your doctor if you are concerned.
- Continue to take co-careldopa regularly. Stopping treatment suddenly can cause serious problems. Your doctor will probably want you to reduce your dose gradually if this becomes necessary.
Can co-careldopa cause problems?
The table below contains some of the common side-effects associated with co-careldopa. You will find a full list in the manufacturer's information leaflet supplied with your medicine. Side-effects can sometimes occur when you first start taking medicines which contain levodopa, although most people have no problems with low doses. Unfortunately, most people taking levodopa over time (typically after several years) develop problems. These include muscle problems which can cause uncontrollable jerky movements, and 'on-off' effects (see below).
|Co-careldopa side-effects||What can I do if I experience this?|
|Loss of appetite, feeling or being sick, diarrhoea, changes in how things taste||These may occur when you first start co-careldopa. Taking your doses after a light meal may help. If it continues, let your doctor know so that your dose can be adjusted more slowly|
|Feeling dizzy when you stand up||Getting up more slowly should help. If this continues, let your doctor know, as your dose may need adjusting|
|Feeling sleepy or tired||If this happens, do not drive or use tools or machines. If you find yourself falling asleep suddenly without any warning of tiredness, let your doctor know|
|Changes in the way you feel, such as being anxious, excited, depressed or agitated; or thinking or believing things that are not true||Let your doctor know about any of these|
|Difficulties sleeping, dry mouth, being aware of your heartbeat||If any of these become troublesome, discuss them with your doctor|
|Uncontrollable jerky movements, 'on-off' effects (this is where you switch suddenly from being able to move to being immobile)||These can happen after taking co-careldopa long-term. You should let your doctor know about these as soon as possible|
If you experience any other symptoms which you think may be due to co-careldopa, speak with your doctor or pharmacist for further advice.
How to store co-careldopa
- Keep all medicines out of the reach and sight of children.
- Store in a cool, dry place, away from direct heat and light.
- If you are using Duodopa® gel, store the cassettes containing the gel in a refrigerator until they are required.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
Further reading & references
- Manufacturer's PIL, Sinemet® 10 mg/100 mg, 25 mg/100 mg and 25 mg/250 mg Tablets; Merck Sharp & Dohme Limited, The electronic Medicines Compendium. Dated November 2012.
- Manufacturer's PIL, Sinemet® CR and Half Sinemet® CR; Merck Sharp & Dohme Limited, The electronic Medicines Compendium. Dated November 2012.
- British National Formulary; 68th Edition (Sep 2014) British Medical Association and Royal Pharmaceutical Society of Great Britain, London
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Adrian Bonsall